Not mine.
Under my PPO I pay 100% of the DISCOUNTED price of medical service.
Thus, instead of $60 for an office visit at my family practice as I would pay were I a wholly uninsured consumer, I pay $48.73.
Not that great a deal.
However, on certain speciality procedures the discount can be as good as 80%, even if I haven’t met my deductible.
But if you say that’s how YOURS works, I believe it. There’s some fool insurance out there for any description of coverage.
Actually I realized tghat i misspoke after I left my computer. The patient does indeed pay a discount if we are part of their PPO, usually 80%, but that is not always what the insurer would pay … they often pay less yet, to a max of 80% of our fee.
Sorry for my confuson.
That isn’t how my PPO works.
I have a bill right in front of me. We haven’t met the deductible yet this year.
01/11/06 Staff Physician 73110 -26 wrist; 3 or more views 719.43 $37.00
These charges have been applied toward your deductible. This bill is now your reponsibility.
01/27/06 Staff Physician 1390 Write off MMO $19.96-
Due $17.04Dammit. I didn’t check page 3. Sorry for the redundancy.
Mine is about 13k a year. Out of pocket maximum $1500 a year. Deductible 300. Once exceeded, 100%paid. Some big limits, like 500k hospital etc…, but that is about it.
I now work for a hospital network that also provide 4 insurance programs: Medicaid, Medicare, Public employee, and hospital employee. The Medicaid patients are the worst offenders, because they don’t have any penalty for using a newer more expensive medicaion vs an older generic.
Our medicaid plan covers very few extended release versions of drugs because they are usually much more expensive per day than the immediate release versions.
The biggest complaints I hear come from mothers of children who don’t understand why they can’t have Ritalin ER. They don’t want to have to remember to dose their kids 2x or 3x a day, so they claim that the ritalin immediate release doesn’t work for their kid. That’s BS in 95% of cases, but they don’t care - it’s all the same price to them.
Our more commercial products - the employee’s plans- go with a tiered system ($5/month generic, $25/month preferred brand, $40/month non-preferred brand, etc). We don’t have nearly as many restrictions on what drugs they have, because we don’t need them - the members will naturally try the cheaper (to them) drug first.
I’d be all for HSAs - if 1) having health insurance was as mandatory as car insurance, and 2) there were no employer-sponsored programs to hide the true cost of health care from patients.
If HSAs are supposed to be great for young, healthy people, then where exactly are all the young people who have $5k a year to stuff into a health savings account? I know I’d be absolutely fucked if I had any major medical expenses during the first, oh, at least two years of having an HSA.
But then you wouldn’t be healthy: the HSA works best when you’re not sick.
Those hoping for great cost savings from HSA’s might recall the adage that 80% of medical costs come from 20% of the population. Dubiousness seems appropriate. [1]
But hey, every little bit helps. There’s been some research on what consumers do when forced to pay for routine health expenses, specifically the RAND Health Insurance Experiment. Apparently for upper and middle income individuals (but not low income folks) higher copayments mostly did not result in worse health outcomes. There were exceptions: those with higher copayments tended to have poorer blood pressure control, vision and oral health. (See abstract in pdf file). And spending was lower than when the deductable was zero or when copayments were lower. The savings were driven by consuming less health care rather than by price shopping.
Offsetting this, HSA promotion by W will stimulate health care spending for some people, due to the HSA’s favorable tax treatment. Maybe they’ll be able to afford a set of flashy designer sunglasses - prescription of course.
[1] Recall also high shares of GDP that the US devotes to health care relative to other advanced countries. Methinks emulating what works abroad –as well as at home– might be a sound approach.
Er, I mean health care spending was lower when individuals had to pay more out of pocket…