How Much Health Insurers Pay For Care Is About To Go Public

[discocrisco01]

How much health insurers pay for care is about to go public : Shots - Health News New government rules are forcing insurers to post on websites what they pay for care or be fined, allowing consumers and employers to comparison shop for health services or negotiate better rates.

Starting July 1, health insurers and self-insured employers must post on websites just about every price they've negotiated with providers for health care services, item by item.

Everyone will know everyone else's business: for example, how much insurers Aetna and Humana pay the same surgery center for a knee replacement.

"What we're learning from the hospital data is that insurers are really bad at negotiating," said Gerard Anderson, a professor in the department of health policy at the Johns Hopkins Bloomberg School of Public Health, citing research that found that negotiated rates for hospital care can be higher than what the facilities accept from patients who are not using insurance and are paying cash

https://www.npr.org/sections/health-shots/2022/07/01/1108653439/how-much-health-insurers-pay-for-almost-everything-is-about-to-go-public

[crickets]

1. K&R for visibility.

[Grolph_]

2. It's a feature, not a flaw.

One of the features of our for-profit healthcare is that it is a conveyor that takes money from those who cannot afford to give any more and puts it in the pockets of those who don't need any more.

This was designed into the plan given to us by Bill Frists' father when he handed us healthcare turdburger, HCA Healthcare.
Before HCA we had non-profit healthcare and it worked. I had an appendectomy at age twelve, Dad had to pay for the TV rental at the time. $1.50/day. Everything else was covered by BC/BS non-profit which his employer paid $35/month for (family of eight).

Hospital-Owning Frist Family 'Made a Killing' During Pandemic, With Wealth Soaring by $8.1 Billion
[link:https://www.commondreams.org/news/2021/03/08/hospital-owning-frist-family-made-killing-during-pandemic-wealth-soaring-81-billion|

I will admit that modern healthcare campuses are beautiful (food still sucks); we have the world's greatest healthcare infrastructure that most cannot afford to access.

[yellowdogintexas]

3. Hope it includes comparisons on Big Pharma

There is a huge difference between the negotiated prices on drugs for a large commercial insurance plan as opposed to Medicare Plan D.

The Medicare prescription plan is one of the biggest betrayals in the history of insurance coverage. Big Pharma is evil.

[Wounded Bear]

4. That should prove interesting...

[Hotler]

5. This is a win. Insurance companys hate sunshine, so do employers.

I've kind of wondered if my employer makes a few bucks off of my insurance payroll deductions. Insurer goes to the employer, $225.00 per month, employer comes to me, $255.00 per month. I'm sure there is a law but.......

[Pobeka]

6. I have no idea if this is correct, but if insurers' profits are limited to a max % of the base cost.

Then a sure fire way to increase profit is to allow the base cost to rise as fast as possible.

[Grolph_]

7. Math works that way.

You are correct

[Pobeka]

8. What I don't know is how the profits are regulated through the ACA.

The math, as you point out, is solid.

[Grolph_]

12. It was how the ACA was allowed to pass

The math works this way, take all of your expenses cap your margin at 20% and we will quit looking at insurance company malfeasance. Now, go make a campaign donation.

[ProfessorGAC]

9. They're Not Bad At Negotiating

They just don't need to. The overall consumer base is dependent on that coverage so the premiums just rise to meet costs & margins.
They actually have no incentive to keep prices down because there are no healthcare insurers that compete for the role of low cost provider/best value.
This new requirement may change that.

[lostnfound]

10. They are not "really bad at negotiating"

The big scary numbers they claim to pay on our behalf are the good cop part of a protection racket.

[JCMach1]

11. We need a 'Truth in Medical Billing' law

Which makes billing disclosure mandatory before treatment...