The Blue Cross-HMA fight moved to the legislature, as Senator Videt Carmichael introduced SB #2709. The Patient Protection Act. Senator Carmichael chairs the Insurance Committee. Let's not mince words. This bill is a direct shot at Blue Cross, since Blue Cross enjoys 80% of the health insurance market in Mississippi. Copy of bill and bill status update.
Here are the relevant sections of the bill:
The Legislature finds that a patient should be given the opportunity to see the health care provider of his or her choice. In order to assure the citizens of the State of Mississippi the right to choose a provider of their choice, it is the intent of the Legislature to provide the opportunity for providers to participate in health benefit plans.
SECTION 4. A health insurer shall not discriminate against any provider who is located within the geographic coverage area of the health benefit plan and who is willing to meet the terms and conditions for participation established by the health insurer.
SECTION 6. (1) A health care insurer shall not, directly or indirectly:Translation: There will be no more "in" or "out of" network health care providers. They will all be the same in regards to reimbursement rates from health insurance companies in Mississippi. The Mississippi State Medical Association (MSMA) supports this bill.
(a) Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those health care providers who participate in the health benefit plan according to the terms offered. "Monetary advantage or penalty" includes:
(i) A higher copayment;
(ii) A reduction in reimbursement for services; or
(iii) Promotion of one health care provider over another by these methods;
(b) Impose upon a beneficiary of health care services under a health benefit plan any copayment, fee or condition that is not equally imposed upon all beneficiaries in the same benefit category, class or copayment level under that health benefit plan when the beneficiary is receiving services from a participating health care provider pursuant to that health benefit plan; or
(c) Prohibit or limit a health care provider that is qualified under Sections 1 through 12 of this act and is willing to accept the health benefit plan's operating terms and conditions, schedule of fees, covered expenses and utilization regulations and quality standards, from the opportunity to participate in that plan.
The bill would allow a victim of such price discrimination to sue the insurance company for recovery of damages. The bill also empowers the Insurance Commissioner to seek an injunction against health insurance companies who break this law.
Kingfish note: JJ opined in an earlier post:
Ayn Rand wrote in Atlas Shrugged "Check your premise". This bill seeks to abolish the practice of paying health care providers at an amount that is contingent upon their relationship to the insurance company. Insurers pay lower reimbursements to out of network health care providers. This bill rests upon the premise that an insurer such as Blue Cross will raise the reimbursement rates of currently out-of network health care providers to those who are currently in the network. What will probably happen is Blue Cross will instead lower the reimbursement rates for the in-network health care providers while raising the rates for those that are out of network.
Thus this bill increases the amount of money an insured has to pay and remember, this will be done in the name of helping him. Hmmm......sounds familiar..... You can keep your Blue Cross plan, but you will likely pay more money if you need to use it. In other words, there is no such thing as a free lunch. This bill will cost health insurance companies more money. Who do you think will pay for it?
The acceptance of health care providers is a different matter and there may indeed be a need for such a law. This subject is sure to generate much controversy as the session proceeds. JJ will post more information as it becomes available. What the Kingfish would like to see is some bills opening up the state to more health insurance competition in Mississippi. Any suggestions?
42 comments:
The insurance-as-piggyback mentality is alive and well. Another misguided effort that will result in increased out-of-pocket costs for all hard working paying Mississippians. Videt should rename his bill The Mississippi Shared Misery Act. Barry has the country bent over and now Videt wants in on the action.
"The Legislature finds that a patient should be given the opportunity to see the health care provider of his or her choice. In order to assure the citizens of the State of Mississippi the right to choose a provider of their choice, it is the intent of the Legislature to provide the opportunity for providers to participate in health benefit plans."
How do you argue with this? This legislation is sound publicly policy and should be passed into law quickly. It will end BCBS's bullying of beneficiaries and providers with no other market choices.
The legislation appears to be about facilitating competition in medical community, which should decrease costs and increase choices for consumers. BCBS is a greedy monopoly, this bill would prevent them from unfairly controlling providers and beneficiaries health choices. Ultimately, allowing other insurance companies to compete in this market. I'm disturbed by your misguided perspective here and by your other posts on BCBS. It appears BCBS is not only buying certain medical providers but that they have an inordinate amount of influence with you, fish man.
This bill will help competition in the health care market place. Right now, BCBS has complete control over the market. To think that there is any such thing as a “free market” in health care in Mississippi is ridiculous. While 2:44 used “BCBS” type language to explain his/her disdain for this legislation, I would simply offer this: If BCBS has 81% of the market share and 90% of providers are already in the BCBS network, how is this going to “result in increased out-of-pocket cost” for patients? The HUGE 10% gap of providers that aren’t currently in the network is going to tilt BCBS profits to the point they have to start using that $500 million “non-profit” savings they have stored away in the islands?
Fish is exactly right on this.
Wouldn't it will increase out of pocket costs because it removes any incentive for healthcare providers to charge the lower in network rate? If the bill says I can charge whatever I want and the insurer has to pay the same percentage of my charge as a provider that is in network, why would I want to be an in network provider anymore and charge a lower rate? Seems to me this has the potential to let the profit motive run wild, since any insurer would be required to pay no matter how high the charge is.
Let's not give Kingfish too much credit here. He merely regurgitates what a few of his handlers tell him is the case.
The bill will increase deductibles+co-pays while decreasing the percentage the insurer pays of the total medical bill. Obama will love this legislation.
It is funny because for years and years UMMC -- our state flagship hospital -- was out-of-network for United Health Care and no Senator or House member lifted a finger to do a thing about it.
The BCBS "problem" may get "fixed" but the solution will be the result of a further screwing of the consumer.
Bathe all you want in your hate for BCBS. Should this bill pass you'll shortly be paying for your catharsis.
436 is right. This will simply mean higher premiums and higher deductibles to us. This bill does nothing but put the screws to us policy holders of BCBS.
This has brought me out of the weeds of being a long time viewer. What idiot thinks that regulating or dictating to a monopolistic corporation what they must provide will be good to their customers or potential providers? How about deregulation? Take a look at TX energy deregulation and its economic impact if you are too stupid to uderstand economics 101. Only the idiots in the legislature don't understand that their directives drive up the costs for everyone affected and subsequently drive up BCBS profits. I am not against profitable corporations but I own a business that is forced to use BCBS and we have seen exponential deductible and copay increases in the last 4 years and more to come. I am related to a high ranking officer and get the same shaft that others get so I have no agenda here.
Will KF's handlers please step forward!
But I thought tort reform was going to change all this? Lower insurance for doctors? No? Lower bills for patients? No?
Keep buying the load being sold folks...
BCBS pays providers from a fee schedule. It does not matter what the provider charges, the provider is paid a prevailing rate. How does giving BCBS customers their choice of provider increase deductibles or rates. These rise because BCBS chooses to make more profit.
8:13-- our BCBS policies have gone up over the last three years tremendously. We have tired to find other companies to write our health insurance with but there is no competition in the state
8:35, does the fee schedule apply only to in network providers?
So an insurer has to pay the shittiest,most incompetent doctor in this state the same thing they pay to the best and brightest..No wonder this state is last in everything
10:44 I believe it works that way in every state. They
pay for the services performed, not for the quality of
the doctor.
10:44- read the legislation - 'Shitty Physicians' can still be weeded out by an insurance companies credentialing process. This legislation gives the consumer choices and will hopefully generate some much needed competition. I would argue that there are plenty of excellent physicians at MD Anderson that are 'out of network' according to BCBS plans in MS. By limiting choice BCBS prevents their customers from making superior provider choices and limits them to certain providers BCBS forces into their network here in the Magnolia State.
Limiting choice? Considering how few providers are actually out-of-network to BCBS your premise is absurd.
Hope you are getting paid for all that spin and crapola.
"Considering how few providers are actually out-of-network to BCBS your premise is absurd."
Your ignorance is appalling. The poster quite accurately noted that physicians at MD Anderson, the world's best cancer hospital, are out of network here. The same goes for great physicians in 49 other states.
11:15 is correct.
"So an insurer has to pay the shittiest,most incompetent doctor in this state the same thing they pay to the best and brightest"
Well, it is supposed to be the patient's choice as to their physician, not BCBS's, and not yours. The patient's choice. If they choose the "most incompetent doctor" that may be poor judgment, but they should have the right to pick a doctor they feel most comfortable with, no matter why they made that choice.
The point in other states I have practiced, which have adopted "any willing provider" legislation, is that BCBS is supposed to pay any provider who performs service X for a BCBS client the same payment, which would be the lowest payment BCBS pays their "in-network" physicians. They would not pay out-of-network doctors some higher fee that they might charge, just the same fee they pay to in-network physicians. The payments would NOT go up to any doctor; the patients would just have more choices of physicians.
Hopefully they would choose their physicians more widely than they choose their state reprentatives, but that's another topic :-)
I hope you all realize that if the insurers have to contract with any physician,that they will simply decrease the amount that they pay all physicians.
2:28, you sound like you know something about this. What if the out of network provider is not willing to accept the lower in network payment offered by an insurer? Would the patient be required to make up the difference? Would the provider just choose not to treat that patient? Do either of these options happen often in other states that already have this legislation?
They also pay the same for care given to healthy patients vs care to people who are total train wrecks.
What people haven't tied together is the BCBS wants to funnel their patients to only a few select hospitals. They will then pay those docs less because of the "garrenteed" patient flow. Probably. If you live in Greenwood and want a knee scope you can pay 90/10 and come to Baptist or pay 70/30 and stay In greenwood.
Got to have better options for insurance
Thanks, 2:28. I was waiting for someone to point out that MS isn't inventing this kind of statute. What experience have other states had?
Folks my employer uses BCBS and we've had a rate increase twice in 2 years with deductibles increased both times and now coverage changed over from 80/20 to 60/40. BCBS SUCKS!!! It's a sad day when I'm surfing the Obamacare website at a job that offers BCBS health insurance to it's employees.
"2:28, you sound like you know something about this. What if the out of network provider is not willing to accept the lower in network payment offered by an insurer? Would the patient be required to make up the difference? Would the provider just choose not to treat that patient? Do either of these options happen often in other states that already have this legislation? "
2:28 here. I honestly don't know. For your first question, the out-of-network could accept the amount BCBS pays its in-network physicians. If he/she won't accept that payment then the patient may have to find another physician.
As far as charging the patient the difference between the BCBS in-network payment and the physician's usual fee, that I also don't know for sure. I do know if a patient has Medicare it is illegal for the physician to charge the patient the difference (i.e., "balance billing") if the physician participates in Medicare at all. That's a federal policy. Private insurance, OTOH, is regulated in each state by its Insurance Commissioner, so the policy may vary between states.
The problems where I have practiced before has been that the patient wants a particular, non-participating physician to perform the procedure, the physician is willing to perform the procedure for the lower rate the insurance company pays its in-network physicians, but the insurance company refuses to pay anything at all to an out-of-network physician.
"They also pay the same for care given to healthy patients vs care to people who are total train wrecks. "
Highly unlikely. A complicated patient with multiple problems with have a different billing code, or multiple billing codes, compared to a much less complicated case.
Michael, your employer selected the plan, not Blue Cross. Your employer raised your percentage to 40%.
The Obamacare mandate raised the BCBS rates most likely.
Please explain how Obamacare has caused BCBS to raise their premiums. They don't insure poor people. Hasn't Governor Bryant refuses to implement it in MS?
Will someone please explain how it is that for over a hundred years, patients could choose their provider and their provider determined their treatment and STILL insurance companies profited?
If one bothers to look throughout our economy, a real part of the answer is that we no longer know the difference between profit and gouging.
We haven't compared the percentage of top executive perks, bonuses and salaries as business costs then and now.
We haven't compare what was a typical profit margin then and now.
So what is a profit for BCBS these days? 20% 100% 200%. What are their management costs compared to profit these days compared to the past?
Find out what CEOs made in 1963 and multiply that number by 7.63. The difference in that number and their actual salaries today will be staggering.
Do the same for doctors. You actually won't be left reeling.
Do the same for teachers. That will be stunningly sad.
To answer 11:24, ObamaCare is funded in part by taxing health insurance companies based on the number of lives they insure. This amounts to tens of millions of dollars,hundreds of millions for the Aetnas and Cignas.Guess who pays that tax
Baptist health systems is in cohoots with Blue Cross. They exchange discounted fees for patient referrals and preferred status, and get a year end payment that cuts out the doctors for this arragement.
I want to choose my own attorney, not a court appointed one. I want to choose my own doctor, not just one in a network. I want to choose my own insurance, not a govt provided one.
Bill-
His company doesn't have any other choice but to use BCBS--that's the PROBLEM!!!
Yes, there are alternatives to BCBS. My husband's company just switched to another insurer after they received notice of a pending increase from BCBS. So, there are other options out there.
Call a TPA ( third Party administrator)
They will pay your claims very promptly and efficiently. at probably half the cost of what you are paying BCBSMS
I'm a local small employer, we struggle financially to provide health insurance with a reasonable deductible for our 15 employees. After great frustration with BCBS for many years, plus after following the media accounts of their attempt to run HMA hospitals out of business this summer, I decided to shop our small group coverage and received bids from 2 other carriers. Much to my dismay, the costs of rather basic policies from these insurance carriers were very high and not competitive. Not only does BCBS's exhibit draconian policies toward providers that prevents competition, their monopolistic strangle hold on the Mississippi market make it costly for other carriers to offer competitive/affordable products.
2:22, keep looking. There are options out there for companies your size that are more cost effective than BCBS. Call Ross & Yerger. I know a number of small businesses that have switched to policies booked through them.
Anonymous Anonymous said...
Please explain how Obamacare has caused BCBS to raise their premiums. They don't insure poor people. Hasn't Governor Bryant refuses to implement it in MS?
I've had an individual policy with BCBS of Mississippi for several years. My premiums will increase effective 2-1-14, despite my having filed no claims. BCBS said in its correspondence the increase was due to "healthcare reform related taxed and fees."
Sorry...my last comment should read "taxes," not "taxed."
Interesting discussion today on the Money-For-Water network about this bill. Appears that the Legislature is far from any consensus regarding the need.
Post contract deals that further reduce fees in exchange for patient flow should be investigate and stopped. All the parties involved, meaning BCBS and baptist health systems, should be prosecuted. Nothing but racketeering.
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