The “burden” of high deductibles is really not a burden at all compared to what you pay for a lower deductible, month after month, year after year.

So families with “high deductibles” of $3,500 or less are “burdened” even though they would have to pay $7,190 in higher premiums to avoid the deductible. Keep in mind that the premium is lost money.

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More government insurance mandates? Times have never been so good for insurance brokers.

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 Victor Lustig

By William Rusteberg

Hospitals dismiss the significance of chargemaster prices? (See link to article below). That is totally misleading. Chargemaster prices are extremely significant and gives rise to a billion dollar business for intermediaries such as insurance companies, audit firms, law firms, claim re-pricers, and third party administrators.

The scheme is tied up in “savings” to be realized through the difference between arbitrary and unreasonable chargemaster prices and what is actually paid. The quantative differential  can be enormous.

Percentage of savings fees is the greatest fraud foisted upon consumers since Vicor Lustig sold the Eiffel Tower in 1925.

It is clear to all that chargemaster rates are “totally around the bends.” No one will disagree with that. Yet many ancillary industries, given rise by our current health care delivery system including managed care companies, audit firms and third party administrators depend on chargemaster pricing without which they could not survive.

If the average differential between chargemaster pricing and the actual price paid is 50-80%, there is a lot of “money” contained in the “spread” to be earned. Many PPO networks, for example, will charge 30% of savings for out-of-network claims. 30% of 80% is 24%. To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.

A well oiled conspiracy requires sharing.  Commonly formed side-agreements are forged between willing partners. Health care intermediaries are in a competitive business.

Thus, hospital chargemasters have fueled the fortunes of many health care intermediaries and the scheme continues…………………………

http://www.fiercehealthfinance.com/story/hospitals-dismiss-significance-chargemaster-prices/2013-02-25

Editor’s Note: See previous posting: http://blog.riskmanagers.us/?p=11495

http://washingtonexaminer.com/insurers-predict-100-400-obamacare-rate-explosion/article/2529523

Medicare’s popular prescription-drug program now serves more than 35 million people, but the names of prescribers and the drugs they choose have never previously been public. Use this tool to find and compare doctors and other top prescribers in 2010.

http://projects.propublica.org/checkup/

The Cost Plus Dental model is very simple.  Like Costco or Sam’s Club, patients pay an annual membership fee.  Cost Plus Dental uses these membership fees to help offset the cost of care which allows members to have high quality care for extremely low cost.  In addition, care can be provided without the limits and restrictions associated with traditional dental benefits plans.

https://costplusdental.com/Home_Page.html

When setting health premiums, insurers balance covering their financial risk and administrative overhead with offering competitive rates.  Insurance companies consider factors like age, medical history and cost of care to set premiums for the coming year.

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