Affordable Care Act rebate

[highnote]

Got a letter from my health insurance company today with a refund check enclosed. The letter says the refund is required by the ACA.

Apparantly, the insurance company is required to spend 80% of the premiums they received on health care services and no more than 20% can be spent on admin. This is the called "Medical Loss Ratio". It has to be an 80/20 ratio.

They spent on 78.6% of all the premiums they received on services, therefore 1.4% of my premiums were refunded.

[NJ Stinks]

Got a letter from my health insurance company today with a refund check enclosed. The letter says the refund is required by the ACA.

Apparantly, the insurance company is required to spend 80% of the premiums they received on health care services and no more than 20% can be spent on admin. This is the called "Medical Loss Ratio". It has to be an 80/20 ratio.

They spent on 78.6% of all the premiums they received on services, therefore 1.4% of my premiums were refunded.

That damn Obama! :lol:

[vegasone]

Just the first step in the government trying to tell private companies how much to spend, where to spend it etc. Down the tubes we go.

[elysiantraveller]

Got a letter from my health insurance company today with a refund check enclosed. The letter says the refund is required by the ACA.

Apparantly, the insurance company is required to spend 80% of the premiums they received on health care services and no more than 20% can be spent on admin. This is the called "Medical Loss Ratio". It has to be an 80/20 ratio.

They spent on 78.6% of all the premiums they received on services, therefore 1.4% of my premiums were refunded.

That loss ratio is going to go into the 85% ranges for large groups. When your provider closes its doors because it can't operate at those levels I'm sure you will be happy about it too right? If you have a small provider you should be worried, if you have a powerhouse like Aetna, the Blues, UHC, or any of the others don't worry... they'll make billions...

:jump: :jump: Yay! :jump: Less Competition! :jump: Fewer Choices! :jump: Corporatism! :jump: :jump:

[bigmack]

If you have a small provider you should be worried, if you have a powerhouse like Aetna, the Blues, UHC, or any of the others don't worry... they'll make billions...
Not entirely 'on sub' but I would like to get your take on these alternative ideas floating about once OCare is squished such as allowing citizens to become members of the Federal Insurance Program or a similar large gathering like entity?

Would that draw down costs to the policy holder by sheer volume of the organization?

[highnote]

When your provider closes its doors because it can't operate at those levels I'm sure you will be happy about it too right?

I did not say anything in my post about being happy. I just stated the fact and thought it might be of interest to people whether they are pro or con Obamacare or Romneycare.

Maybe it should be called Obamneycare or O'Romneycare?

[mostpost]

Just the first step in the government trying to tell private companies how much to spend, where to spend it etc. Down the tubes we go.
The nerve of them telling private industry how much they can spend on overhead when they can't even control costs on Medicare which run as high as-as what? As high as 5%. Maybe they do have the right.

Not only does the government have the right, it has the duty. Private companies do not have the right to do whatever they want. GM does not have the right to make cars without brakes. Oscar Mayer does not have the right to make hot dogs out of used bubble gum and old shoos. An insurance company does not have the right to skimp on payments for services so it can improve its bottom line.

[PaceAdvantage]

Pretty soon, gov't. will tell us all when and where we can fart.

Only then will mostpost by completely happy.

[boxcar]

Pretty soon, gov't. will tell us all when and where we can fart.

Only then will mostpost by completely happy.

And then only when the government also mandates that the wind-breakers have to don full space suits before letting 'em rip.

Boxcar

[vegasone]

Myth #6: Medicare has low administrative costs.

The Center for Medicare and Medicaid Services (CMS, formerly called HCFA or the Health Care Financing Administration) claims to spend less than 2% of Medicare benefit outlays on program management.

This totally disregards the enormous administrative expenses they have foisted onto hospitals and doctors, the real costs of complying with the 132,000 pages of ever-changing Medicare rules and regulations. A typical hospital spends about 38,400 man-hours per year just sorting through Medicare billing requirements alone.

Moreover, the “administrative simplification” provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kassebaum-Kennedy Law), which the Department of Health and Human Services (HHS) estimated would cost about $3.8 billion over 5 years, actually cost $43 billion (Kathleen Murray, American Hospital Association, quoted in AAPS News Suppl July 2000)
http://www.aapsonline.org/index.php/article/medicare_myths_and_facts/

[Tom]

Not only does the government have the right, it has the duty.

Where in the constitution is that?
What happens when they tell you you can only collect a cap of $20 on any wager at the track? By your lemming logic, they have that right.


No mostie, they do NOT have that right.
You are thinking of 1939 Germany again.

[Saratoga_Mike]

The nerve of them telling private industry how much they can spend on overhead when they can't even control costs on Medicare which run as high as-as what? As high as 5%. Maybe they do have the right.

Not only does the government have the right, it has the duty. Private companies do not have the right to do whatever they want. GM does not have the right to make cars without brakes. Oscar Mayer does not have the right to make hot dogs out of used bubble gum and old shoos. An insurance company does not have the right to skimp on payments for services so it can improve its bottom line.

The MLR guidelines also apply to commerical insurance, not just Medicare Advantage.

[Saratoga_Mike]

Not entirely 'on sub' but I would like to get your take on these alternative ideas floating about once OCare is squished such as allowing citizens to become members of the Federal Insurance Program or a similar large gathering like entity?

Would that draw down costs to the policy holder by sheer volume of the organization?

...like Medicare?

[iwearpurple]

Not only does the government have the right, it has the duty. Private companies do not have the right to do whatever they want. GM does not have the right to make cars without brakes. Oscar Mayer does not have the right to make hot dogs out of used bubble gum and old shoos. An insurance company does not have the right to skimp on payments for services so it can improve its bottom line.

Private companies should have the right to do whatever they want. If GM makes cars without brakes, nobody would buy them as nobody would buy hot dogs from Oscar Mayer made out of used bubble gum and old shoes. Clearly these companies would go out of business if nobody buys there product.

If an insurance company would skimp on payments for services, people would go to another insurance company.

What will we do when the government skimps on payments or denies a procedure to an individual who is too old (which they will)?

Nothing. We will no longer have a choice.

[Tom]

The IRS is revealing their new summer and winter uniforms for the new Health Care Cops.

Of course, white is summer.

[highnote]

Where in the constitution is that?
What happens when they tell you you can only collect a cap of $20 on any wager at the track?


I seem to recall some of the more conservative people here in off-topic advocating that the government place caps on lawsuits.

Caps on lawsuits sounds like government control to me.

[mostpost]

Myth #6: Medicare has low administrative costs.

The Center for Medicare and Medicaid Services (CMS, formerly called HCFA or the Health Care Financing Administration) claims to spend less than 2% of Medicare benefit outlays on program management.

This totally disregards the enormous administrative expenses they have foisted onto hospitals and doctors, the real costs of complying with the 132,000 pages of ever-changing Medicare rules and regulations. A typical hospital spends about 38,400 man-hours per year just sorting through Medicare billing requirements alone.

Moreover, the “administrative simplification” provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kassebaum-Kennedy Law), which the Department of Health and Human Services (HHS) estimated would cost about $3.8 billion over 5 years, actually cost $43 billion (Kathleen Murray, American Hospital Association, quoted in AAPS News Suppl July 2000)
http://www.aapsonline.org/index.php/article/medicare_myths_and_facts/

You could not have picked a worse organization to back up your claims than AAPS. It has no credibility in mainstream medicine. I looked at one of their claims in the article that a typical hospital spends 38,500 man hours on Medicare paperwork. That seems like a lot until you realize that they never define what a typical hospital is. Does the hospital handle 500 medicare patients a year? 10,000?

It also ignores the fact that hospitals have to do the same paperwork for private insurance companies.

Here are some interesting tidbits about AAPS according to Wikipedia.
It opposes mandatory vaccination.
It opposes universal heathcare.
It considers Medicare and Medicaid "evil and immoral"
Many of its leaders are also members of the John Birch Society.
It does not believe in climate change.
It does not think HIV causes AIDS.
It thinks abortion causes breast cancer.
It thinks vaccination is harmful.
It does not believe in evolution.
The term "anchor babies" has been used more than once in it's "Journal of Physicians and Surgeions"
Its house publicantion "JPAS" has been called "untrustworthy and not recommended by Quackwatch. a highly respected medical watchdog group.

[mostpost]

Where in the constitution is that?
What happens when they tell you you can only collect a cap of $20 on any wager at the track? By your lemming logic, they have that right.


No mostie, they do NOT have that right.
You are thinking of 1939 Germany again.
False assumption and false equivalency.

False assumption that I ever win more than $20 on any wager. Just ask the guys who were at Arlington last month.

False equivalency in that what I win at the track does not affect the lives of others whereas what insurance companies do does affect them.

[mostpost]

Private companies should have the right to do whatever they want. If GM makes cars without brakes, nobody would buy them as nobody would buy hot dogs from Oscar Mayer made out of used bubble gum and old shoes. Clearly these companies would go out of business if nobody buys there product.
Those were extreme examples on my part, but what if GM made a car with inferior brakes that might work or might not. What if someone was killed when the brakes failed. There are numerous examples of companies cutting corners and hoping they get lucky. Or that nobody notices. The idea that private companies have the right to do whatever they want is an idea you will have until someone in your family suffers because of an inferior product. Then you will be all over stricter controls.

If an insurance company would skimp on payments for services, people would go to another insurance company.
Where do you go when all the companies are doing the same thing. When they are all in collusion. When you only have one or two options in many states.

What will we do when the government skimps on payments or denies a procedure to an individual who is too old (which they will)?
Show me where medicare is denying any more payments than private companies.

Nothing. We will no longer have a choice.

What option do we have when a private company rejects a claim or refuses to cover a procedure. At least with the government we can throw the rascals out. Well, we could if you guys would ever get a clue as to who the rascals are. :bang:

[Tom]

False assumption and false equivalency.

What is that.....your essence?

[Robert Goren]

Private companies should have the right to do whatever they want. If GM makes cars without brakes, nobody would buy them as nobody would buy hot dogs from Oscar Mayer made out of used bubble gum and old shoes. Clearly these companies would go out of business if nobody buys there product.

If an insurance company would skimp on payments for services, people would go to another insurance company.

What will we do when the government skimps on payments or denies a procedure to an individual who is too old (which they will)?

Nothing. We will no longer have a choice. When you go to the hospital and you have private insurance they have you sign a form that states that they will submit your bill to your company, but that you are responsible for the bill. I have signed plenty of them. Now that I have Medicare I no longer have to sign that form. Why do you think that is?

[Saratoga_Mike]

When you go to the hospital and you have private insurance they have you sign a form that states that they will submit your bill to your company, but that you are responsible for the bill. I have signed plenty of them. Now that I have Medicare I no longer have to sign that form. Why do you think that is?

Hmm, the taxpayer is perceived to have endless pockets?