PPACA’s Election Results: Bad for Insurers, Great for Hospitals

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Comments (2)
No one seems to be talking about the elephant in the room and that is unnecessary and harmful treatments, scans and drugs. In my estimation this is going to save trillions in avoidance and prevention. This is excellent news for the patient population and I believe we will start to see real studies not the rigged by pharma kind. And the insurance companies are going to be big players in all this for if they don't reduce cost they will fail.
Posted by Sharon H | Tuesday, November 13 2012 at 4:30PM ET
We are a small employer funded group. The exchange doesn't do a single thing to help us. It's not like we have a product to offer to the public. So far this year we are about $1.8m in the red and the employers have already said they will not pay for any more increases. We have hospitals in cap states or with oversight billing around 200% about Medicare PFS rates, while we have others charging 60000% 7 miles away in another state for the exact same procedure. All of this health care garbage didn't do a single thing to reduce any of the cost. What about Rx cost ? with all of it's smoke and mirror pricing schemes ? The are already wide spread problems with billing fraud, PHI security is a joke with reports of multiple breaches all of the time and now the latest is the Medicare auditing reversing payments to hospitals years after a claim has been closed. Our outlook for 2014... 10 people unemployed and 3,000 men, women and children without health insurance. The reason we had limits was to provide coverage for all of our participants, so now i have to tell a mother with a sick child sorry but we spent all of the fund money on a 90 year old who just had a heart transplant. They made rules to apply to all when they should have only applied to some. All plans are not created equal and not all insurers are the money grubbing bastards the media has portrayed them to be. It's a shame that after 50+ years of helping local families enjoy better health, that Big Brother will finally get to control all. The hospital gravy train will dry up as more people will be forced into Medicare and Medicaid and the hospital payments reduced to the Medicare PFS, that is if the audit department doesn't decide to deny the claim just so they can say they saved a dollar and get a nice fat bonus check.
Why do we even need to have a doctor, the auditors are going to decide what we need and when we need it, and then they will dictate to the hospital what they will be paid for it, no matter what the cost is. And with the other mention of paying a set amount for a procedure and hospitals are allowed to keep the extra, wow, no chance of diminished services there. I think it would be cheaper to just pay the fine and find a new doctor in canada or mexico. Just a personal curiosity, but how many congressmen or senators either sit on the board or have stock in an insurer or hospital ? I mean I'd hate to see a conflict of interest arise.
Posted by BUDDY L | Wednesday, November 14 2012 at 11:37AM ET
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