Even More Obamacare Follies

[Carl Pickens]

I have to buy my insurance, but obviously if an employer was paying then stopped the employee would pay more.

We're what, four or five years into this, and some of you are arguing about what website to get enrollment figures from?

Far cry from the healthcare Armageddon that was predicted five years ago if this is what it has come to.

I'm paying more than double with an incredibly shi**y plan compared to the one I had three years ago..... Thanks to this damn abortion.
Are you single?.... I bet you are.... If you had a family and made over $90k you'd be mad as hell

 

[TNsnyper20]

I was doing a bit more research on BCBS of Tennesse. Just got curious and it's Friday. They are asking for a 36.3% average increase in premium costs. According to the previous article and this one.

http://finance.yahoo.com/news/health-insurers-seek-hefty-rate-213400612.html

Especially after setting a record 221 Million Net Income in 2013. Now given they are nonprofit so they aren't going to be setting any industtry records like some that publicly owned companies. But, that still a big increase over the previous years.

BlueCross BlueShield of Tennessee earns record $221 million | Business - Around the Region | Times Free Press

And after reading everyone's reasons behind the ask for the increase is because they've had a year of hard data to go on. So one would assume they've had a large increase in health care paid and a large increase in members served or taken on. But according to their release report for 2014 they only had an increase of 5% to their members served taking them to 3.3 Million (an impressive number I want to add) and an 8% increase to their Members care paid to 11.6 billion.

http://www.bcbst.com/docs/why-bcbst/about-us/online-annual-report-2014.pdf

So after a record year in 2013 for Net Income followed by a year with an 8% increase in Members Services Paid they're asking for a 36% increase to their premiums? Doesn't that seem a bit high based on the hard data?

I don't think they will get approved for the 36% increase. According the first article just about every provider asks for more than what they settle on.

 

[Biopsyman]

I was doing a bit more research on BCBS of Tennesse. Just got curious and it's Friday. They are asking for a 36.3% average increase in premium costs. According to the previous article and this one.

http://finance.yahoo.com/news/health-insurers-seek-hefty-rate-213400612.html

Especially after setting a record 221 Million Net Income in 2013. Now given they are nonprofit so they aren't going to be setting any industtry records like some that publicly owned companies. But, that still a big increase over the previous years.

BlueCross BlueShield of Tennessee earns record $221 million | Business - Around the Region | Times Free Press

And after reading everyone's reasons behind the ask for the increase is because they've had a year of hard data to go on. So one would assume they've had a large increase in health care paid and a large increase in members served or taken on. But according to their release report for 2014 they only had an increase of 5% to their members served taking them to 3.3 Million (an impressive number I want to add) and an 8% increase to their Members care paid to 11.6 billion.

http://www.bcbst.com/docs/why-bcbst/about-us/online-annual-report-2014.pdf

So after a record year in 2013 for Net Income followed by a year with an 8% increase in Members Services Paid they're asking for a 36% increase to their premiums? Doesn't that seem a bit high based on the hard data?

I don't think they will get approved for the 36% increase. According the first article just about every provider asks for more than what they settle on.

Any correlation of increased demand for services by an aging populsation? Younger adults simply do consume a lot of healthxare

 

[TNsnyper20]

Any correlation of increased demand for services by an aging populsation? Younger adults simply do consume a lot of healthxare

Maybe, but I would think that data would be included in their Memebers Services paid. With an increase of 8% I don't see it as being worthy of asking for a 36% increase in their premiums.

 

[Biopsyman]

Maybe, but I would think that data would be included in their Memebers Services paid. With an increase of 8% I don't see it as being worthy of asking for a 36% increase in their premiums.

Wonder if the cost is due to all of the baseline testing and work up on the influx of new patients from Obamacare...Meaning the non Obamacare enrollles are footing the difference in cost for a standard test or servixe

 

[TNsnyper20]

Wonder if the cost is due to all of the baseline testing and work up on the influx of new patients from Obamacare...Meaning the non Obamacare enrollles are footing the difference in cost for a standard test or servixe

36% though?

 

[Carl Pickens]

I was doing a bit more research on BCBS of Tennesse. Just got curious and it's Friday. They are asking for a 36.3% average increase in premium costs. According to the previous article and this one.

http://finance.yahoo.com/news/health-insurers-seek-hefty-rate-213400612.html

Especially after setting a record 221 Million Net Income in 2013. Now given they are nonprofit so they aren't going to be setting any industtry records like some that publicly owned companies. But, that still a big increase over the previous years.

BlueCross BlueShield of Tennessee earns record $221 million | Business - Around the Region | Times Free Press

And after reading everyone's reasons behind the ask for the increase is because they've had a year of hard data to go on. So one would assume they've had a large increase in health care paid and a large increase in members served or taken on. But according to their release report for 2014 they only had an increase of 5% to their members served taking them to 3.3 Million (an impressive number I want to add) and an 8% increase to their Members care paid to 11.6 billion.

http://www.bcbst.com/docs/why-bcbst/about-us/online-annual-report-2014.pdf

So after a record year in 2013 for Net Income followed by a year with an 8% increase in Members Services Paid they're asking for a 36% increase to their premiums? Doesn't that seem a bit high based on the hard data?

I don't think they will get approved for the 36% increase. According the first article just about every provider asks for more than what they settle on.

They ask for 36% to get approval for 15%..... It's a game.
3.3 million members insured and a net profit of 221 million?...... Does that sound like an obscene profit margin?

 

[Carl Pickens]

You continuously hear about insurance companies making millions in profit...... And they typically do.... But their profit margin is Congo thin.....I'm talkng feed the children commercials with flies swarming around thin.

 

[TNsnyper20]

They ask for 36% to get approval for 15%..... It's a game.
3.3 million members insured and a net profit of 221 million?...... Does that sound like an obscene profit margin?

They're non profit. So it's actually a net income that they put back into the business. This is the amount they net after putting back the required amount in their reserves. So the actual gross income is far greater.

I understand its a game and I even started before that they do this as a form of negotiating power. I just think that a company coming off of its largest new income year only had an increase of 8% in paid services is asking for a 36% increase in their premiums.

Surely you can see my point here.

 

[Carl Pickens]

They're non profit. So it's actually a net income that they put back into the business. This is the amount they net after putting back the required amount in their reserves. So the actual gross income is far greater.

I understand its a game and I even started before that they do this as a form of negotiating power. I just think that a company coming off of its largest new income year only had an increase of 8% in paid services is asking for a 36% increase in their premiums.

Surely you can see my point here.

Gross income is always greater than net income. .... But I do see your point regarding the 8% vs the 36% and why you question the large difference in the two numbers.....I don't know their reasoning. with the profit margins of insurance companies running as thin as they do, I'm sure their predictive modeling gave them a very accurate percentage increase needed and as a result asked for much more. The real number is probably around 16-18%, but they have to ask for 36 to get 16-18 approved.
When you consider the net profit vs the number of individuals insured it's about $78/year per participant. Most companies would close the damn place down if their margins were that slim.

 

[marcusluvsvols]

Bcbs. Authorized a spinal fusion surgery on my back 7 weeks aGo. Got rods and screws of titanium holding some vertebrae in place and a few disks and bone fragments removed. My surgeons office called Thursday and said they are refusing to pay 22000 I already owe 5000 as a copay.They authorized the surgery and are now refusing to pay. insurance is the biggest scam Ever conceived and I hate them. BcBs. Sucks.

Due to auto correct I have to put a period after any word it doesn't recognize or it won't let me leave it without changing it.haTe them too.

 

[marcusluvsvols]

Btw. I will never pay that money. I will pay a lawyer to sue bcbs. Before I pay 22000 they authorized and agreed to pay. Crooks

 

[TNsnyper20]

Bcbs. Authorized a spinal fusion surgery on my back 7 weeks aGo. Got rods and screws of titanium holding some vertebrae in place and a few disks and bone fragments removed. My surgeons office called Thursday and said they are refusing to pay 22000 I already owe 5000 as a copay.They authorized the surgery and are now refusing to pay. insurance is the biggest scam Ever conceived and I hate them. BcBs. Sucks.

Due to auto correct I have to put a period after any word it doesn't recognize or it won't let me leave it without changing it.haTe them too.

My sister had something similar happen with my neice. It wasn't BCBS, but it took about two years and several back and forth conversations, and an eventual call from an attorney for them to finally agree to pay. Good luck.

 

[apevol]

You continuously hear about insurance companies making millions in profit...... And they typically do.... But their profit margin is Congo thin.....I'm talkng feed the children commercials with flies swarming around thin.

Don't all those kids have huge, bloated bellies?

 

[Gramps]

Btw. I will never pay that money. I will pay a lawyer to sue bcbs. Before I pay 22000 they authorized and agreed to pay. Crooks

Good luck Marcus. Why some on here praise the insurance industry is beyond ridiculous.

 

[apevol]

^ truth. And Marc, hmu sometime tommorow if you can.

 

[apevol]

(Or now)

 

[Carl Pickens]

Good luck Marcus. Why some on here praise the insurance industry is beyond ridiculous.

There's a difference between praising and telling it like it is. The media and government have waged a massive propaganda campaign against it in order to ram the biggest POS of legislation in history down America's throat.

Businesses exist to make a profit not to give handouts..... That's what politicians and government do

 

[Carl Pickens]

Bcbs. Authorized a spinal fusion surgery on my back 7 weeks aGo. Got rods and screws of titanium holding some vertebrae in place and a few disks and bone fragments removed. My surgeons office called Thursday and said they are refusing to pay 22000 I already owe 5000 as a copay.They authorized the surgery and are now refusing to pay. insurance is the biggest scam Ever conceived and I hate them. BcBs. Sucks.

Due to auto correct I have to put a period after any word it doesn't recognize or it won't let me leave it without changing it.haTe them too.

Did the doctor's office get the approval initially? I'm assuming they did or they wouldn't have moved forward. Was the doctor/hospital in network?
Is your health plan an individual or group? What reasoning is BCBS using to refuse payment?
A good friend of mine is on BCBS's advisory council and has gone to bat many times for his customers with cases just like this. Are you in TN?

 

[Gramps]

There's a difference between praising and telling it like it is. The media and government have waged a massive propaganda campaign against it in order to ram the biggest POS of legislation in history down America's throat.

Businesses exist to make a profit not to give handouts..... That's what politicians and government do

Businesses do exist to make profits. Pay a claim on a policy is not giving a handout, it is what they are agreeing to do when they sell someone a policy. In many cases they do people the way BCBS is doing Marcus.

As a lover of insurance companies do you think his claim should be paid?

The ACA is a train wreck but it has put a stop to insurance companies from selling
people policies, collecting premiums for years then cancel their policy when they become sick.

As a lover of insurance companies do you think that is the way business should be done?

 

[Gramps]

Did the doctor's office get the approval initially? I'm assuming they did or they wouldn't have moved forward. Was the doctor/hospital in network?
Is your health plan an individual or group? What reasoning is BCBS using to refuse payment?
A good friend of mine is on BCBS's advisory council and has gone to bat many times for his customers with cases just like this. Are you in TN?

IIRC, Marcus is in North Carolina

 

[Carl Pickens]

Businesses do exist to make profits. Pay a claim on a policy is not giving a handout, it is what they are agreeing to do when they sell someone a policy. In many cases they do people the way BCBS is doing Marcus.

As a lover of insurance companies do you think his claim should be paid?

The ACA is a train wreck but it has put a stop to insurance companies from selling
people policies, collecting premiums for years then cancel their policy when they become sick.

As a lover of insurance companies do you think that is the way business should be done?

A lover of insurance companies? That's a little strong don't you think? Should I respond by referring to you as a crybaby/whiner?
Yes I think Marc's claim should be paid and if he gets the right assistance it likely will be. There has to be documentation of the approval somewhere.
The ACA/POS did nothing to address insurance companies cancelling a policy if someone became sick. It only addressed pre-existing conditions.
Everyone that wants to demonize insurance companies and insurance costs need to redirect their anger elsewhere. My lover of insurance companies point of view is this......the costs associated with health care are "x".... They price their coverage options accordingly..... and they also negotiate price reductions in their network to get network pricing. This keeps their costs down which works to keep policyholders costs down.

 

[Danl]

Bcbs. Authorized a spinal fusion surgery on my back 7 weeks aGo. Got rods and screws of titanium holding some vertebrae in place and a few disks and bone fragments removed. My surgeons office called Thursday and said they are refusing to pay 22000 I already owe 5000 as a copay.They authorized the surgery and are now refusing to pay. insurance is the biggest scam Ever conceived and I hate them. BcBs. Sucks.

Due to auto correct I have to put a period after any word it doesn't recognize or it won't let me leave it without changing it.haTe them too.

Sorry to hear about your back and the insurance cock up.

From bitter experience, we have learned a few things about surgery vs. insurance. I'm sure others have, too.

The biggest issue that we have found is that, although your main surgeon and the hospital are in network and the insurance company pre-approves them, a host of other entities involved in your surgery may not be. Such as the anesthesiologist(s), the in-house lab for blood-work, the assisting surgeons/physicians, and any post-op specialists that attend you in recovery/rehab.

Now we always acquire a list of ALL the various entities that MAY be involved and have the insurance company separately pre-approve each of them. They don't always like to do this, but they will. It is sometimes difficult to get a list of everyone that may be involved beforehand as, apparently, not many people ask the question. Don't be surprised if the hospital administrative staff can't provide the list immediately because THEY DON"T KNOW!! Weird. Stay after them and they will provide the list.

Good luck with your back.

 

[Gramps]

A lover of insurance companies? That's a little strong don't you think? Should I respond by referring to you as a crybaby/whiner?
Yes I think Marc's claim should be paid and if he gets the right assistance it likely will be. There has to be documentation of the approval somewhere.
The ACA/POS did nothing to address insurance companies cancelling a policy if someone became sick. It only addressed pre-existing conditions.
Everyone that wants to demonize insurance companies and insurance costs need to redirect their anger elsewhere. My lover of insurance companies point of view is this......the costs associated with health care are "x".... They price their coverage options accordingly..... and they also negotiate price reductions in their network to get network pricing. This keeps their costs down which works to keep policyholders costs down.

Yes, you always post in favor of insurance companies.

If you call speaking the truth as whining go for it. I have old thick skin.

You need to check the records. The ACA did put a stop to companies dropping policy holders when they become sick. That was one thing that needed to be done.

If it only worked the way you posted there would never be a need for Heathcote reform. Sadly it has not worked that way.

 

[TNsnyper20]

A lover of insurance companies? That's a little strong don't you think? Should I respond by referring to you as a crybaby/whiner?
Yes I think Marc's claim should be paid and if he gets the right assistance it likely will be. There has to be documentation of the approval somewhere.
The ACA/POS did nothing to address insurance companies cancelling a policy if someone became sick. It only addressed pre-existing conditions.
Everyone that wants to demonize insurance companies and insurance costs need to redirect their anger elsewhere. My lover of insurance companies point of view is this......the costs associated with health care are "x".... They price their coverage options accordingly..... and they also negotiate price reductions in their network to get network pricing. This keeps their costs down which works to keep policyholders costs down.

Yes it did.

Prohibit insurance companies from dropping people from coverage when they get sick and ensure more consumer protections and rights when appealing insurance company decisions.

As much as people don't like the law. This was one of the parts that I'm a huge fan of.