Heeeeeeere's Obamacare!

[eeyore1954]

Here is a notice I recieved today at work. I will not get to keep my insurance. I doubt if I will be alone.
I have a good comprehensive plan and somehow to meet the law it will become worse. Maybe at my company they will try to ease the "pain" because it is not easy to fill positions in our industry. But that will not neccesarily apply to other people

Yesterday my daughter found out she will not be able to keep her doctor either. She had a preemie born at a local University Hospital. My granddaughter did very well but she still has appointments through the hospital which yesterday said

they are not taking any of the eight plans offered in the county on New York's health insurance exchange, citing reimbursement rates that are too low to be acceptable.

Mine are only anectdotal stories but I would expect I am not alone in these types of issues.

 

[plague311]

Yesterday my daughter found out she will not be able to keep her doctor either. She had a preemie born at a local University Hospital. My granddaughter did very well but she still has appointments through the hospital which yesterday said

Mine are only anectdotal stories but I would expect I am not alone in these types of issues.

Well at least the hospital is helpful enough to allow the patients to acquire one of THEIR plans off of the exchange for a mere $225 more. I also find this a little ironic:

Stony Brook accepts other commercial plans -- which comprise about 50 percent of its business -- as well as Medicare and Medicaid, Gary Bie, the hospital's chief financial officer, said.

Yet:

"We certainly support universal coverage and are hoping the exchange would be vehicle for that," Pasternak said. But, he said, the rates being offered are too low -- "below Medicare and approaching Medicaid," the latter generally considered a very low rate of reimbursement.

So they'll take Medicaid, but they WILL NOT take reimbursement that is "approaching Medicaid". Sounds a little bit like political ******** to me to be honest.

 

[eeyore1954]

Well at least the hospital is helpful enough to allow the patients to acquire one of THEIR plans off of the exchange for a mere $225 more. I also find this a little ironic:



Yet:


So they'll take Medicaid, but they WILL NOT take reimbursement that is "approaching Medicaid". Sounds a little bit like political ******** to me to be honest.

I guess below Medicaid was the straw that broke the camel's back.

Out of the hospitals that are in Suffolk County Stony Brook is the one I would want to go to if I had any major health issue.

The idea that a State University Hospital will not take the plans offered on the state exchange does seem odd to me.

 

[Newtons Bit]

I guess below Medicaid was the straw that broke the camel's back.

Out of the hospitals that are in Suffolk County Stony Brook is the one I would want to go to if I had any major health issue.

The idea that a State University Hospital will not take the plans offered on the state exchange does seem odd to me.

New York State is controlled by Republicans, obviously.

 

[plague311]

I guess below Medicaid was the straw that broke the camel's back.

Out of the hospitals that are in Suffolk County Stony Brook is the one I would want to go to if I had any major health issue.

The idea that a State University Hospital will not take the plans offered on the state exchange does seem odd to me.

But...it's not below medicaid. It says it right in the article you posted.

"below Medicare and approaching Medicaid,"

They take both of those, they said this is in between those two. So...something doesn't stir the kool-aid

 

[Emily's Cat]

But...it's not below medicaid. It says it right in the article you posted.

They take both of those, they said this is in between those two. So...something doesn't stir the kool-aid

Historically, part of how hospitals claim to be able to get by on Medicare and Medicaid rates is by shifting cost to insurers - they charge insurers higher than break-even rates to make up for Medicare & Medicaid paying lower than break-even rates. It has been part of why commercial premiums have been so high.

Now that we have ACA, and for at least some portion of the commercial market insurers want rates that are in the ballpark of Medicare & Medicaid, they're not so happy about it... because there's nobody to shift the costs to.

For county hospitals, this can be a legitimate concern. Many of them operate on pretty slim (often zero or negative) margins as it is. For private hospitals... not so much. I don't have as much sympathy for their injured 15% profit margin, when insurers have been operating, on average, at below 5% for years. And that 5% is only because of the huge national publicly traded insurers. Most of the regional and/or non-profit insurers run closer to about 3% most of the time.

 

[eeyore1954]

But...it's not below medicaid. It says it right in the article you posted.



They take both of those, they said this is in between those two. So...something doesn't stir the kool-aid

Sorry I read it wrong.

I guess their argument would be now if they take the exchange plans a higher percentage of income would be coming from the lower reimbursement sources.

 

[plague311]

Sorry I read it wrong.

I guess their argument would be now if they take the exchange plans a higher percentage of income would be coming from the lower reimbursement sources.

Oh, so basically it's a greed thing. Just checking.

 

[DGM]

Oh, so basically it's a greed thing. Just checking.

Go with that. If you ever need heart surgery, will you go with the lowest bidder?

Even in countries with socialized healthcare, they do have pay hospitals.

 

[Emily's Cat]

Go with that. If you ever need heart surgery, will you go with the lowest bidder?

There's no justifiable reason for an aspirin to cost $7 at a hospital. It's the exact same aspirin that I get over the counter for $0.003. The cost inflation in the medical industry is ridiculous, and blithely assuming that higher cost is equivalent to higher quality is both naive and irresponsible.

 

[Trakar]

There's no justifiable reason for an aspirin to cost $7 at a hospital. It's the exact same aspirin that I get over the counter for $0.003. The cost inflation in the medical industry is ridiculous, and blithely assuming that higher cost is equivalent to higher quality is both naive and irresponsible.

At the gift shop in the Indian casino, I had to buy a package that contained 2 packs containing 2 Bayer aspirins for ~$5.00.

Not that this makes it right, or excuses what seem like excessive charges.

While I'm sure some steps could be taken to make these types of charges more reasonable, you have to understand that this cost isn't strictly a means of recovering the cost of an aspirin, this price is also a means of accounting for nursing and pharmacy labor. Just like waxpaper serving cups at fast food restaurants don't really cost $1.50 each, they are a convenient way to account for fountain soda sales.

 

[boooeee]

Ann Coulter claims her friend's sister 'died from Obamacare'

The woman "had been thrown off her insurance plan, you know Blue Shield completely just pulled out of California."

The woman tried to "get on Obamacare, (but) couldn’t get through the website." Then she got a fever, but she didn’t want to go to the emergency room without insurance. On Thursday, the woman went into septic shock, Coulter said, and went to the hospital.

Coulter recounted the story in a Saturday speech. "I got up to my hotel room after the speech and my friend sent me an email saying, ‘My sister died from Obamacare,’ " she said.

I don't know, this sounds pretty fishy. Ann Coulter has friends?

Also this:

Some insurance companies stopped writing health insurance policies in the individual market in California, but not Blue Shield of California.

The not-for-profit insurer competes with for-profit insurer Anthem Blue Cross and Kaiser Permanente. It continues to be a big player in the individual marketplace, which is what we assume Coulter is talking about, as well as the state’s health exchange, Covered California.

And this:

Blue Shield did not pull out of California, and the company did not leave people without insurance. In fact, customers were allowed to keep their existing insurance plans through March. If the basic facts of Coulter’s story are accurate, the woman in question elected to drop insurance coverage.

 

[Emily's Cat]

At the gift shop in the Indian casino, I had to buy a package that contained 2 packs containing 2 Bayer aspirins for ~$5.00.

Not that this makes it right, or excuses what seem like excessive charges.

While I'm sure some steps could be taken to make these types of charges more reasonable, you have to understand that this cost isn't strictly a means of recovering the cost of an aspirin, this price is also a means of accounting for nursing and pharmacy labor. Just like waxpaper serving cups at fast food restaurants don't really cost $1.50 each, they are a convenient way to account for fountain soda sales.

This is false. The hospital also charges a general facility charge that encompasses general staff and operating costs. They also itemize every supply used, and charge for every specific service, including services performed by nursing staff. Venipuncture and IV services, for example will be billed specifically, as will observation. ICU stays have a charge on top of the general facility charge.

They're not making up other labor costs in the aspirin, they're simply profiteering and burying costs anywhere they can... although in some cases they're passing on ridiculously high prices that they're being charged because they're required to get their supplies and pharmaceuticals directly from the manufacturer and they can't go out and buy them from the corner drug store. And because the hospital can't very well refuse to purchase ibuprofen or acetaminophen altogether, they end up over a barrel and paying whatever exorbitant price the manufacturer insists on.

Which of course makes my example of aspirin not a very good example... but the principle still stands.

 

[Trakar]

This is false. The hospital also charges a general facility charge that encompasses general staff and operating costs. They also itemize every supply used, and charge for every specific service, including services performed by nursing staff. Venipuncture and IV services, for example will be billed specifically, as will observation. ICU stays have a charge on top of the general facility charge.

They're not making up other labor costs in the aspirin, they're simply profiteering and burying costs anywhere they can... although in some cases they're passing on ridiculously high prices that they're being charged because they're required to get their supplies and pharmaceuticals directly from the manufacturer and they can't go out and buy them from the corner drug store. And because the hospital can't very well refuse to purchase ibuprofen or acetaminophen altogether, they end up over a barrel and paying whatever exorbitant price the manufacturer insists on.

Which of course makes my example of aspirin not a very good example... but the principle still stands.

Which principle is that?

 

[Dog Town]

Well here's an update on my ACA info.
New policy cost me 45.00 with a subsidy of 290.00. No deductible!
It'll go up next year, because I worked little this year.
BUT... HOOORAY OBAMA care!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Yep!

 

[Emily's Cat]

Which principle is that?

Most hospitals charge ridiculous amounts for their supplies and services.

 

[Trakar]

Most hospitals charge ridiculous amounts for their supplies and services.

Following state and federal rules and regulations while accounting for outrageous pharmaceutical (and other medical supply) industry pricing is "ridiculous" why?

 

[plague311]

Go with that. If you ever need heart surgery, will you go with the lowest bidder?

Even in countries with socialized healthcare, they do have pay hospitals.

I didn't know there was a bidding process when it came to heart surgery, then again I've never needed it. My whole point being is the story that was cited contradicted itself and is basically just another example of how the big bad Obamacare is messing up our entire country, we're all going to die, CHICKEN LITTLE!!!!

The hospital is playing favorite, and it has every right to do so. However, the fact that the hospital are being ******** doesn't reflect on the law, it reflects on the hospital.

 

[Emily's Cat]

Following state and federal rules and regulations while accounting for outrageous pharmaceutical (and other medical supply) industry pricing is "ridiculous" why?

There are no state or federal rules or regulations governing what private hospitals charge to commercial insurers or to private payers. I assume that you are referencing medicare and medicaid pricing? If so, then yes, those have pricing rules (more like pricing hammers), but that is not the context of the pricing discussion at the moment

 

[eeyore1954]

There are no state or federal rules or regulations governing what private hospitals charge to commercial insurers or to private payers. I assume that you are referencing medicare and medicaid pricing? If so, then yes, those have pricing rules (more like pricing hammers), but that is not the context of the pricing discussion at the moment

I have never done any work in the insurance industry but can't the insurance company negotiate a price or specify a price they will pay. For example $.50 for an aspirin instead of $6.
I don't think they are blindly at the mercy of the hospital and whatever they want to charge for aspirin.