BCBS of Texas to drop individual PPO plans in 2016

[ML]

For Fulltimers that domicile in Texas and pay for your own health insurance this article may be of interest.


About 367,000 Texans will lose their individual health insurance policies next year when BlueCross BlueShield of Texas stops offering its Blue Choice PPO (preferred provider organization) plans.
The Richardson-based insurer started notifying customers and agents of the change this week, noting that it paid out $400 million more in claims last year than it collected in premiums.


The complete article is here: BlueCross BlueShield of Texas to drop individual PPO plans in 2016

[ML]

Food for thought (no pun intended) Click link for complete article...

"Chronic diseases and conditions—such as heart disease, stroke, cancer, diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems"

Chronic diseases and conditions—such as heart disease, stroke, cancer, diabetes, obesity, and arthri...

[westernrvparkow]

GMandJM wrote:

wannavolunteerFT wrote:
GMandJM, like you, I am excited to see the Self plus One option coming out...Maybe this January my check will go up instead of down, due to insurance increases outweighing any increase in pay.

I'm with you on that, but with no COLA next year (for me, anyway) I'm thinking it's gonna pretty much a wash. That could be just wishful thinking on my part though. 😉

It will be interesting when the actual numbers come out, but I've been looking some of the "hypotheticals" and they're all over the place price wise.

With FEBH it's really going to be a smaller, defined pool of people: Retirees plus one "dependent" (spouse, presumably) who are not age-eligible for Medicare.

And I guess that's what bothers me so much about the BCBS TX thing. That was also a smaller, defined pool of people they're shuttling into HMOs or offloading to other insurers. (Or "shedding", for those who might disagree with the term "offloading".)

BCBS TX is still offering PPO plans to people who have insurance through their employer.

They're just not going to offer PPO plans to people who self-pay for private policies. Self-payers will be offered only HMO's (which most people would not prefer.)

Apparently that unemployed/self-employed, pool of people in TX who pay for health insurance out of pocket, on its own, was too expensive to BCBS.

And it makes me wonder what "pool of people" BCBS (or any other insurer" is going to target next.

The fact they are stopping PPOs for individuals and not employer groups would indicate that BCBS got severe "adverse selection" in their enrollment. Many people predicted this. To me, it was obvious the most likely people to buy insurance under the ACA were those people who had pre-existing conditions, were older, those who could only afford a policy with the financial supplements (and you can easily document that poverty is linked to poorer health) and those people who already were paying for a policy and had to make the jump to an ACA approved policy.
The entire financial structure of the ACA was to force younger, healthier, and hence profitable, people into the system to offset the costs of those other people. This obviously has not happened. Employer group policies do not have this adverse selection. Businesses tend to hire younger, healthy people.
And finally, I would guess that BCBS of Texas has determined that out of Texas claims cost them more than claims from in state. Somewhat logical, since there is more paperwork, and less local control. Logic again would suggest that employees based in Texas are more likely to seek treatment in Texas than members of Escapees.
Now for my political comment: If the government tells you they are going to help you, it is most likely they mean they are going to help you empty your wallet.

[GMandJM]

I've read the same thing about people using ERs because they can't legally be turned away. I wonder if the new requirement that everyone must have insurance or pay a fine will change that.

Half price for cash sounds like a win-win-win:
You pay less (presumably)
Your insurance pays nothing
Your doctor gets paid without having to hassle with the insurance co and wait for payment

The only downside I can think of is that it's not applied to your yearly deductible that way.

There was an opthalmologist's (sp) office in our area that had a sign saying they accepted payment in gold. Never tried it though. Seemed odd to me.

[ML]

Our ER experience in Arizona we were told by locals that because there were so many uninsured coming to the ER and since by law the hospitals could not turn them away they hiked the bills of those with insurance to defray the costs.

Our insurance paid for our visit then we get a bill from the Hospital?? Our adjustor told us it is common practice and if you pay by mistake you will never get it refunded. He told us to write a letter saying the "usual and customary fee" was paid any questions contact him.

Another trend Hospitals Eliminate 1 in 4 U.S. Emergency Rooms in Past 20 Years

New Urgent Care centers have become quite a new booming business and provided relief in the flow of non-emergency situations into ER's. Some are more reasonable in price for office visits and walk in or next day appointments are an option in some areas.

Many times if you offer to pay cash instead of using insurance doctors will give you a substantial break in the prices. In Florida we receive 1/2 off our bill when we paid cash instead of using our insurance.

[GMandJM]

carl2591 wrote:
problem i see is medical cost are too high for the amount of service provided. Too many doctors living in million dollar homes, driving expensize cars, having million dollar yachts with million suffering higher and higher insurance cost do to this and other facts.

I'm not sure it's the doctors, Carl. My latest BCBS EOB for a follow-up office visit reads:

Medical care:
Submitted charges $244.00
Plan allowance $140.01

Doesn't seem all that outrageous, but I'm not sure.

After opening a half-dozen EOB's this morning relating to an emergency room visit, though, it would seem hospital charges can be a bit over the top.

[BarbaraOK]

ML wrote:
….

A couple years ago a friend was in the hospital curiosity prompted my DH to go the accounting office to ask how much a particular outpatient procedure would cost? They asked if he had insurance? He asked for both prices $800 for cash and $2000 for insurance. If we got rid of the middleman healthcare costs might go down? I have met a couple of people on the road that have paid their own medical bills by making arrangements directly with the hospital or doctor's office instead of an insurance company. …

Please note that while they may bill the insurance company $2000 for your example above, they probably settle with them at $1000 or less. The rest is written off as a lost so that they always remain non-profit. The difference between what you might pay with cash versus what the insurance company pays also goes to covering those people with no insurance who get treated at the hospital. We still have millions of people who are the working poor - they make to much for Medicaid and make to little for ACA and their states didn't go with the expanded Medicaid.

Barb

[GMandJM]

The RV Insurance Exchange web site that 2Gypsies mentioned is now up and running.

Thanks again, 2G.

(EDIT: Not an Advert nor an Endorsement)

[ML]

This is not a simple situation there are many factors involved.

I don't begrudge dr's their salaries the cost of their schooling and the smarts, stamina and discipline required to earn the MD are not for everyone:

The median four-year cost of medical school (including expenses and books) was $278,455 for private schools, and $207,866 for public schools in 2013 according to the Association of American Medical Colleges. While grants and scholarships account for some of this total, lowering eventual debt to an average of $170,000–interest accrues while doctors are still completing their residencies, sometimes adding as much as 25% to the total debt load. Added to the lost potential income above, and assuming a modest 10% increase in debt burden through interest during school, doctors are routinely $416,216 more in the hole when compared to the average college graduate. In other words, comparing doctors to average college graduates, doctors are half a million dollars behind in real and potential losses, all by their early thirties.

Source: http://www.bestmedicaldegrees.com/is-medical-school-worth-it-financially/

Another problem is the Corruption in the Medicare System:National Medicare Fraud Takedown Results in Charges Against 243 Individuals for Approximately $712 M...


I was surprised to see Medical Malpractice has gone down

A new study reveals that the cost of medical malpractice in the United States is running at about $55.6 billion a year – $45.6 billion of which is spent on defensive medicine practiced by physicians seeking to stay clear of lawsuits.

Source: http://www.forbes.com/sites/rickungar/2010/09/07/the-true-cost-of-medical-malpractice-it-may-surpris...


A couple years ago a friend was in the hospital curiosity prompted my DH to go the accounting office to ask how much a particular outpatient procedure would cost? They asked if he had insurance? He asked for both prices $800 for cash and $2000 for insurance. If we got rid of the middleman healthcare costs might go down? I have met a couple of people on the road that have paid their own medical bills by making arrangements directly with the hospital or doctor's office instead of an insurance company.

We are all going to have to do a lot of homework when it comes to health insurance especially if we want to stay on the road full time.

[carl2591]

problem i see is medical cost are too high for the amount of service provided. Too many doctors living in million dollar homes, driving expensize cars, having million dollar yachts with million suffering higher and higher insurance cost do to this and other facts..

US is only county in world that CAN NOT negotiated drugs cost, that alone is a lot of the issue and don't check out what the drugs companies are making in GROSS profit..

For those of you that don't know, gross profit is the amount of money left after ALL cost, including payroll, telephone, elec etc is subtracted..

like for Merck in 2014 total revenue 42.2B dollars,, gross profit show at 26.4B dollars. Net Income Applicable To Common Shares 11.2B dollars.. That billion dollars folks..

I know companies need profit to stay alive and Merck is showing a 26.5% profit.. that is on drug sold to families like mine and yours.. I don't mind a healthy profit but the gross revenue number are what tell me drugs are over priced.. Same with Apple they had a 43 billion profit i believe i was seeing. the means all I-pads, i-phones are over priced plus they are made in fricken CHINA.. bring the manf back to USA..

Just sayin.

[GMandJM]

wannavolunteerFT wrote:
GMandJM, like you, I am excited to see the Self plus One option coming out...Maybe this January my check will go up instead of down, due to insurance increases outweighing any increase in pay.

I'm with you on that, but with no COLA next year (for me, anyway) I'm thinking it's gonna pretty much a wash. That could be just wishful thinking on my part though. 😉

It will be interesting when the actual numbers come out, but I've been looking some of the "hypotheticals" and they're all over the place price wise.

With FEBH it's really going to be a smaller, defined pool of people: Retirees plus one "dependent" (spouse, presumably) who are not age-eligible for Medicare.

And I guess that's what bothers me so much about the BCBS TX thing. That was also a smaller, defined pool of people they're shuttling into HMOs or offloading to other insurers. (Or "shedding", for those who might disagree with the term "offloading".)

BCBS TX is still offering PPO plans to people who have insurance through their employer.

They're just not going to offer PPO plans to people who self-pay for private policies. Self-payers will be offered only HMO's (which most people would not prefer.)

Apparently that unemployed/self-employed, pool of people in TX who pay for health insurance out of pocket, on its own, was too expensive to BCBS.

And it makes me wonder what "pool of people" BCBS (or any other insurer" is going to target next.

[wannavolunteerF]

GMandJM, like you, I am excited to see the Self plus One option coming out. Now to see if it really is less expensive option. I could have used this option years ago, but instead I have been subsidizing those families with multiple children and lots of medical visits. Maybe this January my check will go up instead of down, due to insurance increases outweighing any increase in pay.

[TechWriter]

tsetsaf wrote:
Politically neutral comment here...

Reminds me when someone says "It's not about the money" . . . you can be certain that it is about the money.

tsetsaf wrote:

I LOVE dealing with insurance companies now that a government agency is involved! Be glad you are not in CA... Covered California just announced they will be collecting ALL member health records to "help save money". Oh they are negative budget right now and paid an outside company $9m to help.

Sounds like a privacy issue . . .

The California Health Exchange just announced an average rate increase of 4% in 2016.

When I was working, I remember the double-digit rate increases every year. So only some of the sky may be falling.

[tsetsaf]

Politically neutral comment here... I LOVE dealing with insurance companies now that a government agency is involved! Be glad you are not in CA... Covered California just announced they will be collecting ALL member health records to "help save money". Oh they are negative budget right now and paid an outside company $9m to help.

[BarbaraOK]

dahkota wrote:
Interesting. I'm left wondering if it is bad management by BCBS Texas, really high medical charges in Texas, or general poor health of Texans.

All three.

Barb

[dahkota]

Interesting. When shopping for Domicile states last year, we noted that Texas BCBS silver PPO plans were more than double what we paid in our own state. So we are not domiciled in Texas, which would have been the easiest. I'm left wondering if it is bad management by BCBS Texas, really high medical charges in Texas, or general poor health of Texans.