I keep hearing from numerous sources that tiered in-network insurance products have lots of potential to create countervailing power against hospitals that currently command high prices because of their market power and not their care quality.
Well, Blue Cross Blue Shield of MA has announced it will offer a product along those lines, but not based on an exclusive network, called Hospital Choice Cost Sharing. The description is here, with the following plain English introduction:
With Hospital Choice Cost Sharing, your choice of hospital and other related facilities determines what you pay for hospital care.
- Lower Cost Share ($) applies to hospitals and related facilities that have met our quality benchmarks and are lower cost. You pay less when you get care at these hospitals.
- Higher Cost Share ($$) applies to hospitals and related facilities that have met our quality benchmarks and are higher cost. You pay more when you get care at these hospitals.
These costs apply to services such as:
- Inpatient Care
- Outpatient Day Surgery
- Outpatient Diagnostic High-tech radiology
- Outpatient Diagnostic Lab Tests
- Outpatient Diagnostic X-rays, and other imaging tests
- Outpatient Short Term Rehabilitation therapy
These cost levels don't apply to emergency care. If you get care at a hospital during an emergency you will pay the lower cost share, no matter where you go. This also applies if you're admitted to the hospital from the emergency room.
How much of a higher cost? Here are some examples:
And then a list of the hospitals is provided, indicating whether they are in the higher costs or lower cost category. Here is part of the list:
Customers are offered a simple worksheet to help them make choices, and a toll-free number to call with questions:
It will be revealing to see the degree of acceptance of this new plan over the coming months. According to the article cited above, "Businesses who join the Hospital Choice plan would see an average premium increase of 4.5 percent on Jan. 1, compared with nearly 10 percent if they continued without any change."
In the past, such plans might not have received favor, but times have changed. Congratulations to BCBS for testing the market and for offering consumer information that is clearly presented and understandable.