Here’s the latest on my Colleague’s battle with his/her health plan over accessing their negotiated rate for non-covered care. While the health plan (United Healthcare/Golden Rule) promised to respond, the customer service folks had not resolved the question by the end of last week. So, s/he is still waiting.
The contention of Colleague is that since the marketing materials and policy did not state that UHC’s negotiated rates did not apply to these services, and in fact stated that one of the advantages of the plan was that access, the marketing materials are misleading at best.
Meanwhile, Hank Stern and Bob Vineyard at InsureBlog invested a considerable amount of time investigating this, and have written an excellent synopsis of the situation and the insurer’s perspectives. Hank and Bob also asked insurance companies to explain why they would adopt a policy that is so obviously consumer unfriendly; as of yesterday they are still waiting for a response…
The net from InsureBlog is that the insurance companies reprice the services to reflect their negotiated rates, but it is up to the provider to determine if they will accept that rate . So, the health plan informs the consumer what their cost could be, and the provider then says “nope, you’ve got to pay the full boat”.
Boy is this dumb. The consumer is now “educated”; they know what they could pay, and they also know that they have to pay the higher rate. Result – really angry consumers, who feel they have been bait-and-switched. Yes, the insurance companies are technically within their rights to do this, as are providers, but this will undoubtedly stoke the anger of voters, an anger that may well be directed at both offending parties.
Jul
25
It’s easy to understand why insurers are viewed so negatively by so many. It shouldn’t take a rocket scientist to figure out that it’s just good business to treat people the way you would like to be treated if circumstances were reversed. Of course, part of the problem may be that health insurers see the employer as the customer and not the individual employee / patient / consumer, and the employer just wants the premium to be as low as possible.
Joe: Thanx for the kind words, and the link.
Something which I haven’t mentioned (so far) in this is that *it gets worse:*
You mention above that the consumer is “now educated.” Well, I’ve been writing about “transparency” in my TMBN column, and it just occurs to me that publishing this info actually exacerbates this problem. That is, now folks have instant, real-time numbers, which (if it’s for a non-covered expense) *they can’t get.*
Sheesh.