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Common
05-13-2015, 06:41 AM
I cant wait to here the responses to this



If you think you're paying too much for employer-sponsored health coverage, you might want to forward this to the HR department. It's possible, maybe even likely, that your health insurer has been ripping off both you and your employer -- to the tune of several million dollars every year -- for decades.

Many Americans, according to various polls, blame Obamacare for every hike in premiums despite the fact that the rate of increase for most folks was actually greater before 2010, the year the law went into effect.


Health insurers are delighted that many folks blame Obamacare for rate increases because it deflects attention away from them and, according to documents made public in a recent lawsuit against a big Blue Cross plan, the questionable activities they've been engaging in for years to boost profits.

It turns out that one of the reasons workers have been paying more for their coverage is allegedly a common practice among insurers: charging their employer customers unlawful hidden fees.

http://www.huffingtonpost.com/wendell-potter/court-case-shows-how-heal_b_7261812.html

exotix
05-13-2015, 06:45 AM
Peabody will be along shortly to blame Obama and reminisce on the good 'ol days of Bush Medicare Part D.

Captain Obvious
05-13-2015, 07:06 AM
The same shit would happen under Obamacare because it's the same Blue Cross insurer, same policy except for the ACA carve-outs like preexisting conditions.

I'm not sure many people understand this, Obama isn't insuring your health, it's the same commercial insurers.

And hell, the ACA did absolutely nothing to control costs, it sure as hell isn't going to find fraud and waste. Probably adds another layer of security for fraud.

exotix
05-13-2015, 07:11 AM
The same $#@! would happen under Obamacare because it's the same Blue Cross insurer, same policy except for the ACA carve-outs like preexisting conditions.

I'm not sure many people understand this, Obama isn't insuring your health, it's the same commercial insurers.

And hell, the ACA did absolutely nothing to control costs, it sure as hell isn't going to find fraud and waste. Probably adds another layer of security for fraud.
Ted Cruz was against it before he got on it.

Captain Obvious
05-13-2015, 07:13 AM
And, as a side note, I think a provider could have reasonably caught this. As an employer/provider, we don't "pay" claims to ourselves when employees use hospital services, that cash doesn't flow, it just adjusts off to cost. Wouldn't make sense since we pay 100% of claims (with a stop-loss insurance for big shit) and a 15% admin fee to the carrier. Matching those claims to our in-house charges would note the discrepancy unless the carrier didn't charge these "fees" to providers, but that would make it a slam-dunk fraud case IMO if caught.

Captain Obvious
05-13-2015, 07:14 AM
Ted Cruz was against it before he got on it.

Who cares.

Try to refrain what Zimmy's position on the issue is too please, your obsessions are kind of creepy.

exotix
05-13-2015, 07:15 AM
And, as a side note, I think a provider could have reasonably caught this. As an employer/provider, we don't "pay" claims to ourselves when employees use hospital services, that cash doesn't flow, it just adjusts off to cost. Wouldn't make sense since we pay 100% of claims (with a stop-loss insurance for big $#@!) and a 15% admin fee to the carrier. Matching those claims to our in-house charges would note the discrepancy unless the carrier didn't charge these "fees" to providers, but that would make it a slam-dunk fraud case IMO if caught.
Who cares.

Try to refrain what Zimmy's position on the issue is too please, your obsessions are kind of creepy.
Still must be a deal since Ted Cruz left his wife's' Goldman-Sachs plan for Obamacare ... which I'm sure Zimmy isn't.

Captain Obvious
05-13-2015, 07:19 AM
Still must be a deal since Ted Cruz left his wife's' Goldman-Sachs plan for Obamacare ... which I'm sure Zimmy isn't.

lol! My point proved, thanks for being a good subject, Eddie.

The ACA is just a regulatory legislation, the plans are all independent of one another. That's more of a reflection on the richness of the Congress's plan or the lacking on the Goldman Sachs plan. The ACA has absolutely nothing to do with how either plan is designed by way of benefits, even if plans fall into the Cadillac tax realm.

lol... liberals. Supporting shit they'll never understand "because it feels good".

You can go back to sleep now.

:biglaugh:

exotix
05-13-2015, 07:24 AM
lol! My point proved, thanks for being a good subject, Exotix.

The ACA is just a regulatory legislation, the plans are all independent of one another. That's more of a reflection on the richness of the Congress's plan or the lacking on the Goldman Sachs plan. The ACA has absolutely nothing to do with how either plan is designed by way of benefits, even if plans fall into the Cadillac tax realm.

lol... liberals. Supporting $#@! they'll never understand "because it feels good".

You can go back to sleep now.

:biglaugh:Obamacare has one important design ... competition by free market that drives the price down ... that is, the same product and service once dictated by greed is now adjusted to it's real cost .... simple economics since the advent of democracy and capitalism ...

Educate yourself.

http://i59.tinypic.com/2dqm689.gif

Archer0915
05-13-2015, 07:44 AM
I cant wait to here the responses to this



If you think you're paying too much for employer-sponsored health coverage, you might want to forward this to the HR department. It's possible, maybe even likely, that your health insurer has been ripping off both you and your employer -- to the tune of several million dollars every year -- for decades.

Many Americans, according to various polls, blame Obamacare for every hike in premiums despite the fact that the rate of increase for most folks was actually greater before 2010, the year the law went into effect.


Health insurers are delighted that many folks blame Obamacare for rate increases because it deflects attention away from them and, according to documents made public in a recent lawsuit against a big Blue Cross plan, the questionable activities they've been engaging in for years to boost profits.

It turns out that one of the reasons workers have been paying more for their coverage is allegedly a common practice among insurers: charging their employer customers unlawful hidden fees.

http://www.huffingtonpost.com/wendell-potter/court-case-shows-how-heal_b_7261812.html

It is a racket and you know they have to help pay for all those that would be at a higher rate. They must insure them.

Captain Obvious
05-13-2015, 07:46 AM
Obamacare has one important design ... competition by free market that drives the price down ... that is, the same product and service once dictated by greed is now adjusted to it's real cost .... simple economics since the advent of democracy and capitalism ...

Educate yourself.

http://i59.tinypic.com/2dqm689.gif

:biglaugh:

What, the same plans that were in existence, already competing with each other before the ACA?

Laugh... My... Fucking... Ass... Off

The only thing that changed is that there are more individual plans, the employer plans, you know - the vast majority of covered lives are still there, no change.

You don't have a fucking clue.

exotix
05-13-2015, 07:47 AM
:biglaugh:

What, the same plans that were in existence, already competing with each other before the ACA?

Laugh... My... $#@!ing... Ass... Off

The only thing that changed is that there are more individual plans, the employer plans, you know - the vast majority of covered lives are still there, no change.

You don't have a $#@!ing clue.
Too bad Billionaire Healthcare Insurers can't move their operations to China ... LOL

Archer0915
05-13-2015, 07:56 AM
Obamacare has one important design ... competition by free market that drives the price down ... that is, the same product and service once dictated by greed is now adjusted to it's real cost .... simple economics since the advent of democracy and capitalism ...

Educate yourself.

http://i59.tinypic.com/2dqm689.gif

Competition? Perhaps in some areas but I believe most of the growth has been in tax supported programs. The insurance companies are taking in billions.

Well they are not going to lose money
http://blogs-images.forbes.com/theapothecary/files/2014/06/8.6aDATA.png

Note the Pharma is UP and the insurance is down. Why? Should not the insurance and managed care be up?

Health Plan Premiums Are Skyrocketing According To New Survey Of 148 Insurance Brokers, With Delaware Up 100%, California 53%, Florida 37%, Pennsylvania 28%
http://www.forbes.com/sites/scottgottlieb/2014/04/07/health-plan-premiums-are-skyrocketing-according-to-new-survey-of-148-insurance-brokers-analysts-blame-obamacare/

exotix
05-13-2015, 07:59 AM
Competition? Perhaps in some areas but I believe most of the growth has been in tax supported programs. The insurance companies are taking in billions.

Well they are not going to lose money
http://blogs-images.forbes.com/theapothecary/files/2014/06/8.6aDATA.png

Note the Pharma is UP and the insurance is down. Why? Should not the insurance and managed care be up?

Health Plan Premiums Are Skyrocketing According To New Survey Of 148 Insurance Brokers, With Delaware Up 100%, California 53%, Florida 37%, Pennsylvania 28%


http://www.forbes.com/sites/scottgottlieb/2014/04/07/health-plan-premiums-are-skyrocketing-according-to-new-survey-of-148-insurance-brokers-analysts-blame-obamacare/I don't see the Goldman-Sachs Plan ... you know, the one Ted Cruz left for Obamacare.

Captain Obvious
05-13-2015, 08:01 AM
Too bad Billionaire Healthcare Insurers can't move their operations to China ... LOL

Punting. Smart move, you bit off more than you could chew.

This is the smoke-and-mirrors that's the ACA. There is no cost containment in there, the ACA's way of reducing healthcare costs is by reducing utilization by making the out-of-pocket costs higher, disincenting people to use healthcare services. So cool, we use less and die more. Less to insure I suppose.

Same for this "competition" baloney, there's no material competition element by adding a marginal segment of individual covered lives. What a crock of shit.

exotix
05-13-2015, 08:06 AM
Punting. Smart move, you bit off more than you could chew.

This is the smoke-and-mirrors that's the ACA. There is no cost containment in there, the ACA's way of reducing healthcare costs is by reducing utilization by making the out-of-pocket costs higher, disincenting people to use healthcare services. So cool, we use less and die more. Less to insure I suppose.

Same for this "competition" baloney, there's no material competition element by adding a marginal segment of individual covered lives. What a crock of $#@!.
Let's ask Rominee why he invented Romneycare ... bizzare since he made his millions outsourcing even yo mama to China ... LOL

Captain Obvious
05-13-2015, 08:08 AM
Let's ask Rominee why he invented Romneycare ... bizzare since he made his millions outsourcing even yo mama to China ... LOL

Now you're doing what you do best, nonsensical trolling.

Good, leave the brainy-thinky stuff to the adults.

exotix
05-13-2015, 08:11 AM
Now you're doing what you do best, nonsensical trolling.

Good, leave the brainy-thinky stuff to the adults.
Not my problem you're all wrapped-up-like-a-douche in your little socialized medicine world ... billionaire healthcare insurers appreciate it.

PattyHill
05-13-2015, 09:04 AM
The same $#@! would happen under Obamacare because it's the same Blue Cross insurer, same policy except for the ACA carve-outs like preexisting conditions.

I'm not sure many people understand this, Obama isn't insuring your health, it's the same commercial insurers.

And hell, the ACA did absolutely nothing to control costs, it sure as hell isn't going to find fraud and waste. Probably adds another layer of security for fraud.


I agree it is the same health insurance companies; that was deliberate - to get the ACA passed, insurance companies had to be on board, so they are still used.

I disagree that it did nothing to control costs. There are incentives within the ACA for hospitals and doctors to reduce costs through better quality patient care. For example, if a patient is re-admitted to the hospital for the same problem within 30 days (or something like that) the hospital doesn't get paid again.

Now whether these cost savings get reflected in insurance premiums is a different issue. But at least insurers are held to no more than 20% profit. Of course, we know numbers can be entered creatively.

Captain Obvious
05-13-2015, 09:06 AM
I agree it is the same health insurance companies; that was deliberate - to get the ACA passed, insurance companies had to be on board, so they are still used.

I disagree that it did nothing to control costs. There are incentives within the ACA for hospitals and doctors to reduce costs through better quality patient care. For example, if a patient is re-admitted to the hospital for the same problem within 30 days (or something like that) the hospital doesn't get paid again.

Now whether these cost savings get reflected in insurance premiums is a different issue. But at least insurers are held to no more than 20% profit. Of course, we know numbers can be entered creatively.

Those have been around for a decade now, the old term was "pay for performance". The new term is "PQRS" which is quality reporting that will ultimately be discounted if you don't meet certain standards.

The ACA had nothing to do with the implementation of this stuff, it was already in place. It would be going in the same direction now if the ACA was never passed.

Adelaide
05-13-2015, 11:16 AM
It isn't just a problem in the US. Canadian private insurance companies are up to some funky shit. I pay about $50/month (which my employer matches) for everything not covered by my provincial insurance. Recently, I've actually started paying attention to the letters I get from my insurance company and they'll find any reason to not pay something even though I'm supposed to have 100% coverage (up to $5000/year for dental, $1000000/year for out of country incidents, $500/year for optometry, and $2500/year for "other" services like massages, chiropractors, and psychologists - those are a few aspects of my plan). They recently tried to deny a claim for a root canal because the dentist used extra freezing which made the entire procedure deemed unnecessary or exceptional or however they worded it to me. I called them up and screamed at them and they caved.

Complete bullshit. I work for a company that actually provides services to my insurer so my plan is supposed to basically be bullet proof. But one extra injection of Lidocaine, literally, and they try to deny the claim.

I'm convinced private insurers are all a bunch of assholes who will experience hell. I know I'm not the only Canadian who thinks their private insurer is the fucking devil-incarnate.

Captain Obvious
05-13-2015, 11:20 AM
It isn't just a problem in the US. Canadian private insurance companies are up to some funky shit. I pay about $50/month (which my employer matches) for everything not covered by my provincial insurance. Recently, I've actually started paying attention to the letters I get from my insurance company and they'll find any reason to not pay something even though I'm supposed to have 100% coverage (up to $5000/year for dental, $1000000/year for out of country incidents, $500/year for optometry, and $2500/year for "other" services like massages, chiropractors, and psychologists - those are a few aspects of my plan). They recently tried to deny a claim for a root canal because the dentist used extra freezing which made the entire procedure deemed unnecessary or exceptional or however they worded it to me. I called them up and screamed at them and they caved.

Complete bullshit. I work for a company that actually provides services to my insurer so my plan is supposed to basically be bullet proof. But one extra injection of Lidocaine, literally, and they try to deny the claim.

I'm convinced private insurers are all a bunch of assholes who will experience hell. I know I'm not the only Canadian who thinks their private insurer is the fucking devil-incarnate.

There really is no magic to the process.

Blue Cross puts it's name on the product (your plan), your employer pays all the claims, Blue Cross takes an "administrative" fee.

That's it, aside for the fraud mentioned in the OP which is why this is news.

People think insurers are this billionaire white guy thing, lol.

PattyHill
05-13-2015, 11:47 AM
It isn't just a problem in the US. Canadian private insurance companies are up to some funky $#@!. I pay about $50/month (which my employer matches) for everything not covered by my provincial insurance. Recently, I've actually started paying attention to the letters I get from my insurance company and they'll find any reason to not pay something even though I'm supposed to have 100% coverage (up to $5000/year for dental, $1000000/year for out of country incidents, $500/year for optometry, and $2500/year for "other" services like massages, chiropractors, and psychologists - those are a few aspects of my plan). They recently tried to deny a claim for a root canal because the dentist used extra freezing which made the entire procedure deemed unnecessary or exceptional or however they worded it to me. I called them up and screamed at them and they caved.

Complete bull$#@!. I work for a company that actually provides services to my insurer so my plan is supposed to basically be bullet proof. But one extra injection of Lidocaine, literally, and they try to deny the claim.

I'm convinced private insurers are all a bunch of $#@!s who will experience hell. I know I'm not the only Canadian who thinks their private insurer is the $#@!ing devil-incarnate.


I know plenty of Americans that would agree with you.

I sure do like your plan!