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October 22, 2013

ACA, Unintended Consequences, and You - [tsrblke]

Hello Horde! I’m tsrblke (that’s Lke not ike).

I’ll be your host for today’s edition of “ACA, unintended consequences and you.” Today’s edition is called “NYT buries the lede.” The NYT recently ran a story that is quite tragic about a family that took their little girl in for work on her heart. Sadly, although they had insurance, they apparently got socked with tons of “out of network charges.”

Now people will likely want to hash blame all over the place here. It’ll be said the parents should have asked more questions (although do you ask who the assisting surgeon is going to be for your operation?) Or the hospital should have ensured everyone was a participating provider (that assumes a level of coordination I have yet to see at any hospital.)

So let’s pass on the blame for a moment and ask “How is Obamacare going to mes this up?”

Conveniently, the NYT sorta tells us:


"It is conceivable that the problem gets worse for some people if the Affordable Care Act encourages narrower networks, which some people think it might do" - claims Timothy Jost, a professor at the Washington and Lee University School of Law and expert on health care laws.

Ah, some people think there will be smaller networks. Ignore that link in the quote that goes to an article saying that there are, in fact, smaller networks. That’s just crazy talk! (by the by, at least one insurer in my area won’t have the largest provider in it’s network.)

Something the NYT doesn’t discuss, but really needs to be brought up, is another odd consequence of Obamacare. As a result of the whole “Accountable Care Organizations” part of the law, hospital systems have been buying up medical practices like hotcakes. I remember being at one conference where a system VP said something akin to “we’re not sure what to do with these practices, but we keep buying them.” (I’d note that my PCP got bought out, and the integration has not gone well.)

Now, the article seems to imply that the new out of pocket maximums may help dampen the blow, but let’s grab the first plan we can find on ehealthinsurance.com. Wow, those limits for out-of-network are just crazy. Well, there goes that.

So what does this mean? Well, I’m a PhD(c) so I have no real world advice for you. But here’s the lay of the land: Insurers, who are going to have to cut costs to avoid this “adverse selection death spiral” are going to use the biggest bargaining chip they have: cutting network size to pit providers against each other. Combined with the buyout of practices by hospitals, we could be in for a wild ride. I know very little about the nuts and bolts of provider/insurer negotiations, but if you live in a town with lots of competing providers (who may even move between hospitals) you’re going to need to pay special attention to everything going on. And what if your surgeon likes to work with an anesthesiologist who’s not in your network? Then you have some really hard choices to make.

And be prepared for doing bill analyses every time you have any major work done.

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posted by Open Blogger at 01:23 PM

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