In-network? Out of network? Which hospital should I use? Does my insurance company cover my doctor? Such questions about health care may be irrelevant in Mississippi if the legislature passes a proposed "any willing provider" bill. The bill has not yet been introduced although JJ obtained a copy of the draft. It is posted below. The bill will bar insurance companies from using "network status" to determine reimbursement rates for health care providers. The bill will also force health insurance companies to accept "any willing health care provider" in a geographic area who meets the plan's qualifications.
The Mississippi State Medical Association (MSMA) supports this bill. The legislative handlers are Representative Gary Chism and Senator Videt Carmichael. Both men are chairmen of their chamber's insurance committees. The draft states the name of the bill is the "Patient's Right to Health Care" Act. The purpose is to "define a patient's right to choose a health care provider". Section 4 states:
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.
Interesting change but here is the real purpose of the bill. Section 6 states:
(1) A health care insurer shall not, directly or indirectly: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.
(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;
Blake Bell, Government Affairs Liason for MSMA, told JJ doctors enjoy any willing provider protection in 24 states and 40 states provide it to other industries such as pharmacists as well. He further stated pharmacists, psychologists, and counselors in Mississippi had such treatment as well with no noticeable rise in costs. He said health care providers in rural parts of the state did not have the resources of large health care corporations and thus need further protection.
Kingfish note: That was the news. Now for the editorial comment. 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 lowering the rates for those that are out of network.
Thus this bill increase 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.
18 comments:
so will this give UHC the providers it does not have now?
I think its a good idea. Let's say I've got a doctor I like, been with him/her for a while, got a good relationship, then boom, insurance company decides they don't like him/her anymore so now I either pay MORE to get the same doctor or I have someone sitting behind a desk telling me I have to shut up and go to the one they tell me to.
Sounds like a stroke of genius.
Currently no insurance carrier considers AMR 'in network' although residents of several metro counties have no choice as to ambulance service. How frackin' stupid if that.
As it is, the patient has to pay an out of network amount to ride with AMR.
2:25; That's the way your policy has worked for decades. It not in network (usually the provider's choice not to be), you pay a higher amount if you choose to use him/her/it.
Stupid bill. Will increase out-of-pocket costs for all paying Mississippians.
I am insured by Blue Cross Blue Shield of Mississippi. My doctor is not in network. I went to get my prescription filled that she prescribed to me and I was told Blue Cross would not cover because my doctor was out of network and if I wanted my prescriptions paid for (by MY insurance provider) I would have to go an approved, in network provider or pay full cost for my prescriptions. My doctor told me they would get in network if Blue Cross Blue Shield would let her, but they won't because she's not affiliated with a large hospital. Now I'm stuck leaving my doctor who I have built a relationship and built trust with and paying tremendous amounts for my prescriptions or going to another doctor I don't know and getting a cheaper deal. Is Blue Cross the Obamacare of Mississippi ?
6:49, anyone who thinks that legislation is going to fix problems such as yours is a fool.
Who is the Senator sponsoring this bill? I know that it is not a Republican, as they want less government intervention into our personal lives and decisions. O wait maybe that is like they want government to be in women's reproductive lives.
6:49pm. Wow. Something does not sound right about your answer from BCBS about your prescription. If you can use an out of network doctor and BCBS will pay her then why won't they pay for prescriptions she gives you? You better read your policy and see if something has changed. You may be now limited to using only network doctors.
BCBS is the Granddaddy and Grandmomma of healthcare ripoff in this entire nation. They laugh when they read these poses. Like Romans pigging out in the stadium laughing as the lions ate Christians. It ain't no big deal.
The bottom line regarding network is that BCBS bullies providers into either accepting their terms or the provider is not allowed to join the network. A provider who will not accept the goofy terms is labeled a 'high priced provider' and is red-lettered in the media by BCBS.
12:52--- I received a new policy from BCBS and effective Feb 1, they will not be covering prescriptions written by out of network providers. They will only cover BCBS providers.
Would like to see that challenged in court. A prescription is a 'service' of a healthcare provider. Can an insurance company willy-nilly decide it won't cover a service if it accepts the provider (even as OON)? And if it does that, would it not have to refuse to cover that identical service offered by ALL providers, network and otherwise?
Once upon a time ( some of you are too young to remember this) you got to pick your doctor and your doctor got to decide on your treatments.
It worked. Insurance companies were not going broke.
It still works when the insurance company is owned by those insured ( USAA).
Then the insurance industry, wanting to increase profits and grow and use business rather than service models, convinced Insurance Commissions that doctors and hospitals were abusing their responsibilities.
They made have been. But, rather than go to the legislature to pass laws that would punish those abusing the system, insurance companies were given control over health care decisions.
Insurance companies could have been allowed to refuse to cover those who abused the system but guidelines of establishing proof of abuse should have been legislated .
If neither the insurance industry, the insured or the providers can be trusted not to be greedy, then you need objective intervention. That was supposed to be the Insurance Commission but politics corrupted that so you need the legislative system and judicial system.
We have been deluded into believing that a business model works for everything and that profit taking is always honorable.
Business practices that would and did land people in prison in the 1950's is now legal thanks to laws and regulations being erased from the books. No one's arrested for " loan sharking" anymore, are they?
We've lost our minds.
10:19 I've had a USAA credit card for 38 years, and auto and homeowners insurance with them since I bought my first car and home. I don't remember them every offering health insurance. I've always had that through my jobs, so maybe I missed something, but I doubt that.
Kingfish- you didn't include the fact that BCBS holds 80+% of the market share which they built by being protected by the state for 50 years without paying one dime of taxes. Now they are for profit and want to continue building their monopoly.
6:49, If you are unhappy with your insurance you can switch companies. My guess is you won't because BCBS is probably the cheapest. Now how did that happen? That's right they "bullied" providers into accepting lower reimbursement. The same providers you can't afford to pay out of pocket which is why you need insurance in the first place. Also I don't know how you managed to find a provider that is out of BCBS's network. Theirs is probably the largest in the state.
7:28, If BCBS is a true monopoly then I'm sure Jim Hood will soon initiate antitrust proceedings.
So you want your doctor who is not board certified and who has several malpractice claims pending against them to receive the same reimbursement that Dr Keeton,the head of UMC,would get for the same procedure. Really bright. You deserve your doctor
Y'all need to stop freaking out about this. Any minute now, the trickle down savings from Tort Reform are going to kick in and drastically reduce our medical bills.
Or, at least, keep them from rising.
Right?
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