tag:blogger.com,1999:blog-32053362.post4859768076902760677..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Legislative battlesPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-32053362.post-69565916127221920932011-12-21T09:24:47.346-05:002011-12-21T09:24:47.346-05:00This is just shifting costs by insurers to anyone ...This is just shifting costs by insurers to anyone else. The tragedy is that local taxpayers will have to make up the difference, or response times will get longer.The ABH Bloggerhttps://www.blogger.com/profile/01909068527724504942noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-55180642931695839282011-12-20T09:01:41.793-05:002011-12-20T09:01:41.793-05:00I think it’s reasonable for insurers to send their...I think it’s reasonable for insurers to send their checks for out-of-network reimbursement directly to the ambulance companies for the reasons you stated. However, patients and families should not be liable for the full difference between the reimbursement rate and the list price if the ambulance companies accept less as full payment from insurers with whom they have contracts. As I’ve said many times, all insurer contract rates should be ascertainable by both patients and referring doctors.<br /><br />Regarding the tiering, high cost providers who claim to have unique or differentiated offerings should be able to prove it as you suggested. In theory, it should be possible to include those providers in the preferred tier for those services only but not all of their routine services for which they charge much more for comparable or sometimes even inferior quality. If I were a legislator on the receiving end of the providers’ argument as you stated it, I would tell them to pound salt.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-23147483435814705852011-12-19T22:08:32.936-05:002011-12-19T22:08:32.936-05:00...and all of this is opaque to the consumer.... ......and all of this is opaque to the consumer.... the real cost of anything!<br />We are retired, using pensioner benefits of large Co. for health insurance - trying to be responsible consumers along with "watching our pennies". Our present plan choice has a lifetime limit (cheaper premiums than other choices) but it is impossible to guess how that limit would be reached. <br />There is no public listing of what Medicare routinely pays (per hospital day, semi-private, for instance) or what the plan would then pay (which accumulates toward that limit). And the provider "charge" of course is entirely different than either.<br />You champion transparency, and I couldn't agree more. How can a consumer be an educated and responsible partner in trying to hold down health care costs without it?nanahttps://www.blogger.com/profile/16220595303403647789noreply@blogger.com