Health Insurance Companies Already Gaming the New System... - GoFuckYourself.com

TheSenator · 03-31-2010, 06:47 AM

Health insurance companies are gonna be a thing of the past. Until then, they are gonna steal as much as possible on their way out leaving 1000s to die a quiet death. Single payer/Medicare for all is gonna be here sooner than you think.

source: http://www.huffingtonpost.com/2010/0..._n_519503.html
=========================================
Insurance Industry Already Finding Ways To Game New System

The insurance industry's attempt to weasel out of one of the few provisions of the new health care reform law that took effect immediately is a harbinger of what's to come.

In this case, the companies that were balking at covering sick children quickly relented under media, congressional and White House pressure.

But far from being satisfied with a windfall of new customers and massive government subsidies, the nation's insurance companies appear to already be busy devising ways to game the new system. Their goal, as ever: Maximizing profits by paying out as little on actual health care as possible.

And next time they start to weasel, Congress and the White House -- and the media -- may not be paying attention anymore.

"This is what you're going to see as each element in this plan comes up for implementation," said Marcia Angell, a former editor of The New England Journal of Medicine who now teaches at Harvard Medical School. "This insurance industry is going to give up nothing."

In the short run, companies are expected to keep doing what they've been doing, which means, among other things, jacking up their rates. "There's nothing to stop them from raising their premiums, and that's what they're going to do," said Angell, a supporter of "single-payer" health insurance.

The new law's ban on discriminating against adults with preexisting conditions doesn't kick in until 2014.
Story continues below

"In the meantime, they can continue to cherry pick the healthiest customers, while foisting the sick into the new high-risk pool," said Wendell Potter, a former senior health insurance executive at CIGNA who went rogue and became a consumer advocate.

That's only the beginning, though.

"They also will continue to try to shift more and more of the cost of health care from them to the people that are enrolled in their plans," Potter said. That involves moving people currently in managed care, with its relatively modest co-pays, "out of those plans and into high-deductible plans that make people pay thousands of dollars before the company will pay a dime," Potter said.

"Managed care was last decade's silver bullet," he told HuffPost. "The new silver bullet for the insurance industry is the high-deductible plan. More and more people will not get a dime from their insurance companies."

And for people who can't afford to pay the full deductible, that's a lot like not having insurance at all.

What else will the industry do? "The companies will certainly be tightening up internal practices to avoid paying claims," Potter said. "One way to do that is to make it more burdensome on providers and make it more difficult for providers to get the reimbursements that they're due. They already are difficult to work with for a lot of providers."

The more burdensome the paperwork, the more likely a provider is to make a mistake. "And if they make a mistake, the claim is kicked out," Potter said.

In the longer run, companies will still be in a race for more profits. The trick will be coming up with ingenious new ways to avoid covering the sick.

One particularly ripe area of speculation concerns how aggressively and imaginatively the insurance companies will market themselves to attract profitable healthy clients and avoid the sick and the old.

"You can do little things with marketing materials," said John Gorman, chief executive officer of Gorman Health Group, a Washington, D.C.-based managed care consulting firm. "How you set up your Web site" could make a difference, he said; so could "where you put certain drugs on your formulary" -- i.e. which drugs cost how much.

"And the plans will play those games," Gorman said. "You're going to see a lot of marketing materials with rocket bodies on the cover."

Potter agrees: "They'll certainly be offering programs that will appeal to people that are younger and more likely or able to exercise and otherwise lead healthier lifestyles."

Henry Aaron, a senior fellow at the Brookings Institution think tank, told HuffPost he recently overheard a major insurance company executive joking about the prospect of being forced to sell plans to the elderly. "We'll sponsor dances and make our pitch at 11 p.m.," Aaron recalled the executive saying. Another possibility Aaron mentioned, only half joking: putting the company's offices on the second floor -- with no elevator.

more...

Fletch XXX · 03-31-2010, 06:48 AM

theyve been denying children care for years that is what has sparked this whole thing. Children born with something they call it "pre-existing" like it pre-existed in the womb LOL

If we dont have healthy kids, we will never have healthy adults.

TheSenator · 03-31-2010, 06:51 AM

Health insurance companies bottom line is profit.

When will some of you understand that concept?

woj · 03-31-2010, 06:58 AM

Quote:

Originally Posted by TheSenator

Health insurance companies bottom line is profit.

When will some of you understand that concept?

no kidding, shocking that they would try to maximize profits...

In other news.... it has been rumored that adult paysite owners added crossales on their join pages...

martinsc · 03-31-2010, 06:59 AM

TXXXTN · 03-31-2010, 07:25 AM

Quote:

Originally Posted by martinsc

AmeliaG · 03-31-2010, 07:32 AM

Quote:

Originally Posted by woj

no kidding, shocking that they would try to maximize profits...

In other news.... it has been rumored that adult paysite owners added crossales on their join pages...

Fletch XXX · 03-31-2010, 07:33 AM

Quote:

Originally Posted by TheSenator

Health insurance companies bottom line is profit.

When will some of you understand that concept?

Hopefully if you breed your child wont be born with a "preexisting" condition and we will see you change your tune when you try to get your child health insurance and are denied becuase your kid was born with a problem.

Thats what is happening now and anyone who supports profit over helping children has some mixed up priorities.

As a father now, these things concern me.

IllTestYourGirls · 03-31-2010, 09:03 AM

It is pretty easy for them to game the system since they helped write the bill behind closed doors and the politians that got the most money from insurance and big pharm lobbies were Obama, Pelosi, Reid ect.

Big pharm spent more money lobbying (mostly democrats) last year than any other lobby in history. You really thought this bill did not help them?

bbobby86 · 03-31-2010, 09:14 AM

yes it is profit...

baddog · 03-31-2010, 10:15 AM

Quote:

Originally Posted by TheSenator

Health insurance companies are gonna be a thing of the past.

Really? Who told you that?

Quote:

Originally Posted by TheSenator

Health insurance companies bottom line is profit.

Really? Who told you that?

Vendzilla · 03-31-2010, 10:30 AM

Quote:

Originally Posted by IllTestYourGirls

It is pretty easy for them to game the system since they helped write the bill behind closed doors and the politians that got the most money from insurance and big pharm lobbies were Obama, Pelosi, Reid ect.

Big pharm spent more money lobbying (mostly democrats) last year than any other lobby in history. You really thought this bill did not help them?

Well, I feel it's ok, Harry Reid and Pelosi are going to need a new job in november and Im sure they have made deals with the health care insurance companies

TMM_John · 03-31-2010, 10:40 AM

TheSenator, What type of profit margins do health insurance plan providers run at?

Sausage · 03-31-2010, 10:53 AM

Um ... are people over there stupid? I thought Americans were fairly smart .. but honestly what did you think that bill was going to do?

My health, pharma and insurance stocks are doing nicely over there, and while I reside in a country with real healthcare, i am happy that the idiots who pushed that bill have made me money

Anyone with 2 braincells knew it was good for the industry, not so good for the people. Mandating the buying of health insurance just for being alive ... man that is fucking sensational! You think you got back at the rich? No way .. they are laughing all the way to the bank on the back of this one

GregE · 03-31-2010, 11:02 AM

Quote:

Originally Posted by TheSenator

"Managed care was last decade's silver bullet," he told HuffPost. "The new silver bullet for the insurance industry is the high-deductible plan. More and more people will not get a dime from their insurance companies."

And for people who can't afford to pay the full deductible, that's a lot like not having insurance at all.

And yet in four short years we'll all be obliged, by law, to purchase this virtually worthless insurance

IllTestYourGirls · 03-31-2010, 11:09 AM

Quote:

Originally Posted by GregE

And yet in four short years we'll all be obliged, by law, to purchase this virtually worthless insurance

But but but everyone will have insurance!

Making insurance illegal is looking better everyday.

TheSenator · 03-31-2010, 11:43 AM

Quote:

Originally Posted by TMM_John

TheSenator, What type of profit margins do health insurance plan providers run at?

Some of the best/worst(depends on how you look at it) health insurance companies run at 25% profit margin. Meaning that for every dollar a customer pays 75% go towards medical care.

The new law requires that they use between 80 to 85% of every dollar towards medical care.

So, what this will create is more bloat in the system requiring health care providers to run more test before actually giving care. The more bloat the bigger the profit.

TMM_John · 03-31-2010, 11:51 AM

Quote:

Originally Posted by TheSenator

Some of the best/worst(depends on how you look at it) health insurance companies run at 25% profit margin. Meaning that for every dollar a customer pays 75% go towards medical care.

The new law requires that they use between 80 to 85% of every dollar towards medical care.

So, what this will create is more bloat in the system requiring health care providers to run more test before actually giving care. The more bloat the bigger the profit.

You're answering a different question.

Your thread was about profit margins. I asked what their profit margins are.

Yes, they have salaries to pay, office space to pay for and maintain, benefits for their employees outside of healthcare, legal expenses, marketing costs, and on and on. Therefore, yes, a % of their revenue does not go "directly to medical care". You may think its too high, and you have every right to, however that wasn't the question that was asked.

So again, what profit margin do they operate at?

GregE · 03-31-2010, 11:57 AM

Quote:

Originally Posted by IllTestYourGirls

But but but everyone will have insurance!

Making insurance illegal is looking better everyday.

Single payer is the civilized way to go.

Failing that, leaving insurance optional (like it was) is the next best choice.

What we have now is the worst of both worlds.

Then again, most of us knew that right from the get go

hypedough · 03-31-2010, 12:23 PM

Quote:

Originally Posted by GregE

Single payer is the civilized way to go.

Failing that, leaving insurance optional (like it was) is the next best choice.

What we have now is the worst of both worlds.

Then again, most of us knew that right from the get go

+100000000000000 for single-payer

Naechy · 03-31-2010, 01:29 PM

Quote:

Originally Posted by martinsc

theking · 03-31-2010, 01:43 PM

Quote:

Originally Posted by TheSenator

Some of the best/worst(depends on how you look at it) health insurance companies run at 25% profit margin. Meaning that for every dollar a customer pays 75% go towards medical care.

The new law requires that they use between 80 to 85% of every dollar towards medical care.

So, what this will create is more bloat in the system requiring health care providers to run more test before actually giving care. The more bloat the bigger the profit.

Those figures are not profit margins. Those figures are what they must keep in a "lock box" for payouts on medical care.

03-31-2010, 06:47 AM	#1
TheSenator Too lazy to set a custom title Industry Role: Join Date: Feb 2003 Location: NJ Posts: 13,332	Health Insurance Companies Already Gaming the New System... Health insurance companies are gonna be a thing of the past. Until then, they are gonna steal as much as possible on their way out leaving 1000s to die a quiet death. Single payer/Medicare for all is gonna be here sooner than you think. source: http://www.huffingtonpost.com/2010/0..._n_519503.html ========================================= Insurance Industry Already Finding Ways To Game New System The insurance industry's attempt to weasel out of one of the few provisions of the new health care reform law that took effect immediately is a harbinger of what's to come. In this case, the companies that were balking at covering sick children quickly relented under media, congressional and White House pressure. But far from being satisfied with a windfall of new customers and massive government subsidies, the nation's insurance companies appear to already be busy devising ways to game the new system. Their goal, as ever: Maximizing profits by paying out as little on actual health care as possible. And next time they start to weasel, Congress and the White House -- and the media -- may not be paying attention anymore. "This is what you're going to see as each element in this plan comes up for implementation," said Marcia Angell, a former editor of The New England Journal of Medicine who now teaches at Harvard Medical School. "This insurance industry is going to give up nothing." In the short run, companies are expected to keep doing what they've been doing, which means, among other things, jacking up their rates. "There's nothing to stop them from raising their premiums, and that's what they're going to do," said Angell, a supporter of "single-payer" health insurance. The new law's ban on discriminating against adults with preexisting conditions doesn't kick in until 2014. Story continues below "In the meantime, they can continue to cherry pick the healthiest customers, while foisting the sick into the new high-risk pool," said Wendell Potter, a former senior health insurance executive at CIGNA who went rogue and became a consumer advocate. That's only the beginning, though. "They also will continue to try to shift more and more of the cost of health care from them to the people that are enrolled in their plans," Potter said. That involves moving people currently in managed care, with its relatively modest co-pays, "out of those plans and into high-deductible plans that make people pay thousands of dollars before the company will pay a dime," Potter said. "Managed care was last decade's silver bullet," he told HuffPost. "The new silver bullet for the insurance industry is the high-deductible plan. More and more people will not get a dime from their insurance companies." And for people who can't afford to pay the full deductible, that's a lot like not having insurance at all. What else will the industry do? "The companies will certainly be tightening up internal practices to avoid paying claims," Potter said. "One way to do that is to make it more burdensome on providers and make it more difficult for providers to get the reimbursements that they're due. They already are difficult to work with for a lot of providers." The more burdensome the paperwork, the more likely a provider is to make a mistake. "And if they make a mistake, the claim is kicked out," Potter said. In the longer run, companies will still be in a race for more profits. The trick will be coming up with ingenious new ways to avoid covering the sick. One particularly ripe area of speculation concerns how aggressively and imaginatively the insurance companies will market themselves to attract profitable healthy clients and avoid the sick and the old. "You can do little things with marketing materials," said John Gorman, chief executive officer of Gorman Health Group, a Washington, D.C.-based managed care consulting firm. "How you set up your Web site" could make a difference, he said; so could "where you put certain drugs on your formulary" -- i.e. which drugs cost how much. "And the plans will play those games," Gorman said. "You're going to see a lot of marketing materials with rocket bodies on the cover." Potter agrees: "They'll certainly be offering programs that will appeal to people that are younger and more likely or able to exercise and otherwise lead healthier lifestyles." Henry Aaron, a senior fellow at the Brookings Institution think tank, told HuffPost he recently overheard a major insurance company executive joking about the prospect of being forced to sell plans to the elderly. "We'll sponsor dances and make our pitch at 11 p.m.," Aaron recalled the executive saying. Another possibility Aaron mentioned, only half joking: putting the company's offices on the second floor -- with no elevator. more... __________________ ISeekGirls.com since 2005

03-31-2010, 06:48 AM	#2
Fletch XXX GFY HALL OF FAME DAMMIT!!! Join Date: Jan 2002 Location: that 504 Posts: 60,840	theyve been denying children care for years that is what has sparked this whole thing. Children born with something they call it "pre-existing" like it pre-existed in the womb LOL If we dont have healthy kids, we will never have healthy adults. __________________ Want an Android App for your tube, membership, or free site? Need banners or promo material? Hit us up (ICQ Fletch: 148841377) or email me fletchxxx at gmail.com - recent work - About me

03-31-2010, 06:51 AM	#3
TheSenator Too lazy to set a custom title Industry Role: Join Date: Feb 2003 Location: NJ Posts: 13,332	Health insurance companies bottom line is profit. When will some of you understand that concept? __________________ ISeekGirls.com since 2005

03-31-2010, 06:59 AM	#5
martinsc Too lazy to set a custom title Industry Role: Join Date: Jun 2005 Location: 127.0.0.1 Posts: 27,047	__________________ Make Money

03-31-2010, 09:03 AM	#9
IllTestYourGirls Ah My Balls Industry Role: Join Date: Feb 2007 Location: Under the gold leaf ICQ 388-454-421 Posts: 14,311	It is pretty easy for them to game the system since they helped write the bill behind closed doors and the politians that got the most money from insurance and big pharm lobbies were Obama, Pelosi, Reid ect. Big pharm spent more money lobbying (mostly democrats) last year than any other lobby in history. You really thought this bill did not help them? __________________

03-31-2010, 09:14 AM	#10
bbobby86 partners.sexier.com Industry Role: Join Date: Jan 2007 Location: San Francisco, CA Posts: 11,926	yes it is profit... __________________

03-31-2010, 10:40 AM	#13
TMM_John Confirmed User Industry Role: Join Date: May 2004 Posts: 6,659	TheSenator, What type of profit margins do health insurance plan providers run at? __________________ Skype: JohnA1078 Too Much Media - Makers of the Industry's Leading Payite Management Platform, NATS!

03-31-2010, 10:53 AM	#14
Sausage Confirmed User Join Date: Oct 2002 Location: Australia Posts: 3,012	Um ... are people over there stupid? I thought Americans were fairly smart .. but honestly what did you think that bill was going to do? My health, pharma and insurance stocks are doing nicely over there, and while I reside in a country with real healthcare, i am happy that the idiots who pushed that bill have made me money Anyone with 2 braincells knew it was good for the industry, not so good for the people. Mandating the buying of health insurance just for being alive ... man that is fucking sensational! You think you got back at the rich? No way .. they are laughing all the way to the bank on the back of this one