Is Universal Health Insurance the Impossible Dream? Here’s an excerpt from a story in this morning’s New YorkT Times:
Insurer Steps Up Fight to Control Health Care Cost
By ANEMONA HARTOCOLLIS
A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.
The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare, which includes Oxford health plans and has 25 million members across the country, one million of them in New York.
While Congress has been haggling over covering as many as 15 million uninsured Americans, the prestigious hospitals and the major health insurer have been in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half.
UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away. The hospitals say that having their reimbursement cut in half is too much to pay for a clerical error, and that the revenue drain would ultimately hurt their patients.
UnitedHealthcare is negotiating or imposing similar rules at hospitals across the country, and often meeting fierce opposition. Tennessee passed a law saying the penalty would not apply on weekends or federal holidays, when hospitals are short-staffed. Florida hospital officials said that the new rule could play a role in coming contract negotiations there, and that the state hospital association had asked Florida’s insurance regulators to monitor the situation.
The dispute signals a “ratcheting up” of a long tradition of insurers trying to cut costs, said Jeffrey Rubin, an economics professor at Rutgers University.
But Dr. Rubin said UnitedHealthcare’s approach is particularly aggressive and might be part of a wave of pressure insurance companies feel from employers to cut costs and to keep premiums lower to avoid penalties, like the “Cadillac tax” on expensive insurance plans.
“It’s an example of the insurance company getting between you and your doctor,” Dr. Rubin said.
lonecat, there are hundreds of thousands of examples of insurance companies getting between physicians and their patients. It’s their M.O. The healthcare reform debate got so sidetracked by death panels, Medicare Advantage cuts, government takeover of healthcare false claims that we lost sight of the very real issue of the harm big insurance giants cause every day.
United Healthcare is one of the largest health insurers and it carries a big stick; threatens medical providers with not signing them up as a provider if they don’t accept cuts in reimbursement rates.
The example in the article you posted also illuminates how insurers add costs to medical providers by shifting administrative burdens onto their shoulders. Notifying an insurer within 24 hours sounds like a simple thing, but when patients enter hospitals via ER they bypass the admission office and process, with 8-5 workers, M-F.
I saw a specialist a few times for torn ligament and his office staff wore bluetooths because the average hold time for reaching insurance personnel was about 40 mins, they said.
omQR- have a print by James Dean- creator of “Pete the Cat” (kids books) with Pete taking Sancho’s place on the burro- a neat take on the Picasso.(www.petethecat.com)
kreole over 14 years ago
Tom, you got that one right!
comYics over 14 years ago
Don’keyote Obama.
OmqR-IV.0 over 14 years ago
I’m always keen on ‘toons who use Don Quixote. I had thought his death signaled the end of knights-errant.
krisjackson01 over 14 years ago
Tom, nice Picasso reference there on Obama’s mount.
Dtroutma over 14 years ago
Sancho was a lot more helpful than Pelosi, Reid, Boehner, McConnell, or the “media”.
The don only had windmills, no land mines or EIDs constantly being placed in his path, by both friend and foe.
OmqR-IV.0 over 14 years ago
The trouble with Don Quixote was that he was delusional…
(My Picasso avatar is modeled on him for a reason)
davesmithsit over 14 years ago
The next boogie man please? Have to point the blame somewhere. Afterall someone else allways has to take the blame , its becoming the American way?
d_legendary1 over 14 years ago
<=======Yes omQ R! I became pwesident! Dweams do come twue…for a pwice!
OmqR-IV.0 over 14 years ago
No worries, DrC/d_l, ol’ Quixote is still my anti-hero ;-)
lonecat over 14 years ago
Is Universal Health Insurance the Impossible Dream? Here’s an excerpt from a story in this morning’s New YorkT Times:
Insurer Steps Up Fight to Control Health Care Cost
By ANEMONA HARTOCOLLIS
A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.
The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare, which includes Oxford health plans and has 25 million members across the country, one million of them in New York.
While Congress has been haggling over covering as many as 15 million uninsured Americans, the prestigious hospitals and the major health insurer have been in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half.
UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away. The hospitals say that having their reimbursement cut in half is too much to pay for a clerical error, and that the revenue drain would ultimately hurt their patients.
UnitedHealthcare is negotiating or imposing similar rules at hospitals across the country, and often meeting fierce opposition. Tennessee passed a law saying the penalty would not apply on weekends or federal holidays, when hospitals are short-staffed. Florida hospital officials said that the new rule could play a role in coming contract negotiations there, and that the state hospital association had asked Florida’s insurance regulators to monitor the situation.
The dispute signals a “ratcheting up” of a long tradition of insurers trying to cut costs, said Jeffrey Rubin, an economics professor at Rutgers University.
But Dr. Rubin said UnitedHealthcare’s approach is particularly aggressive and might be part of a wave of pressure insurance companies feel from employers to cut costs and to keep premiums lower to avoid penalties, like the “Cadillac tax” on expensive insurance plans.
“It’s an example of the insurance company getting between you and your doctor,” Dr. Rubin said.
believecommonsense over 14 years ago
lonecat, there are hundreds of thousands of examples of insurance companies getting between physicians and their patients. It’s their M.O. The healthcare reform debate got so sidetracked by death panels, Medicare Advantage cuts, government takeover of healthcare false claims that we lost sight of the very real issue of the harm big insurance giants cause every day.
United Healthcare is one of the largest health insurers and it carries a big stick; threatens medical providers with not signing them up as a provider if they don’t accept cuts in reimbursement rates.
The example in the article you posted also illuminates how insurers add costs to medical providers by shifting administrative burdens onto their shoulders. Notifying an insurer within 24 hours sounds like a simple thing, but when patients enter hospitals via ER they bypass the admission office and process, with 8-5 workers, M-F.
I saw a specialist a few times for torn ligament and his office staff wore bluetooths because the average hold time for reaching insurance personnel was about 40 mins, they said.
Dtroutma over 14 years ago
omQR- have a print by James Dean- creator of “Pete the Cat” (kids books) with Pete taking Sancho’s place on the burro- a neat take on the Picasso.(www.petethecat.com)