Well this year the annual increase to our health insurance costs are only 19% but the plan has a higher out of pocket maximum and slightly fewer covered benefits so it isn't exactly the same plan. I thought I would be clever and call my Provider reps for the different plans and tell them that I would be shopping and purchasing based on information they could give me regarding 2012 fee schedules. Historically, even though the cost for these plans goes up exponentially the amount of increase that any provider might see is just a tiny fraction (and often even ZERO PERCENT) of that increase. Also, what happens each year is that the co-pays are increased so even though allowable fees might go up the costs are passed entirely to the consumer with higher deductibles and higher co-pays. In other words, the insurance company's objective is to put all of YOUR skin in the game and as little of their own as possible.
The mechanisms that allow this to happen are primarily attributed to a farce of a regulatory environment, absolute lack of serious competition in the marketplace, increasing federal and state mandates, and gross profiteering.
For the record, corrections and controls for these mechanisms were exactly what was LEFT OUT of the hilariously entitled Patient Protection and Affordable Care Act.
Anyway, I thought I would purchase a plan that at least dropped a few crumbs from the trough where the insurance company pigs feed. No such luck, because even though we are in the fourth quarter and they obviously have the actuarial data to set rates for insurance plans next year they all report that they don't have the data on what the fee schedules will be for providers. I individually asked the local insurance companies why they think I am stupid and why they are trying to make me believe that they set plan costs without already knowing reimbursements and cost outlays to providers. They were all really good at towing the company lines though - I have to give them credit for that. I am not sure if they really think they are fooling anyone and I also don't know if they sleep with a clear conscience at night but oh well.
I will continue to post these things here because I think it is important for people to know that when the insurance company sets a co-pay amount that is IN EXCESS of the allowed reimbursement to a provider - that means you are having your premium money STOLEN from you. Yes, this year we have plans that actually have $50 co-pays for specialist visits (which is what therapy is identified as) and the amount that they allow for reimbursement is just $42.50.
That means that you pay it all - and it also effectively means that your therapy is no longer a covered benefit - except that they are artificially price controlling your medical care to make sure that they will continue to make as much profit as possible.
The net result is that receiving many services like therapies will be restricted to larger hospitals and institutions that cover the cost by other revenue-enhanced activities like $1000 toothbrushes.
More next year... stay tuned...