I see if you have any insights would be interested. Not as educated on the cost side of medicine as I should be. Anything in the works to make that a thing?
Medication costs are set by the NDC number. Even the bottle of Asprin you have in your cabinet has one. Medicare is who sets the rates. Insurance companies usually pay the medicare reimbursement fees. Go find any medication of any kind in your house, there is an NDC number on it. I guarantee it.
There is no law currently, that requires hospitals to sell medication to patients at those rates. If hospitals don't accept the NDC/Medicare rates from the insurance carrier then the insurance carrier won't cover visits to that hospital or pharmacy. That is how the system works now.
What Trump has done is lower the medicare rate, by preventing it from being higher than foreign rates for the same medication. You as an individual will not see a difference. You cannot bargain for the medicare rate. Insurance companies are going to pay less. This in theory should lower insurance premiums. Most likely it won't, and it will just increase insurance profits, or prevent a rate hike this year until inflation from the stimulus hits.
Will this lower the cost for people on medicare? NO! Medicare is just not going to pay as much towards the medication. Hospitals will have to rethink their rates if suddenly most of their customers now cannot afford the medications. Do you want to lose the customer or reduce your profit margin? Overall the sticker price will go down, but individuals may pay more out of pocket.
Medical fee schedules vary by state and is what insurance companies accept as the acceptable rate for medical procedures. There is usually metro and rural modifiers to these rates. Doctors and hospitals are under no obligation to offer these rates to you, as an individual.
TL:DR The industry is designed to suck the maximum amount of money out of individuals without the bargaining power of a mega corporation insurance company behind them.
You are referring to preferred provider networks, and yes insurance companies can negotiate discounted rates. Most of my experience is with Kaiser which is a non-profit and typically the negotiated rates are 80% of medicare. I don't know how this will impacted for-profit medical providers.
My understand of the impact of this again, just goes back to medication reimbursement. Rates will go down. I don't know how this will impact offices visits etc under the complexity ranges. I would suspect only a small percentage of patients are actually doing uninsured walk ins and paying out of pocket rates.
I think the impact of this might only impact people shopping around for for certain non-critical care if they are paying out of pocket. I would think certain specializations will be more heavily impacted. Dermatology with cosmetic removals comes to mind. People might shop around for that. If you are planning on paying for a major inpatient surgery, you probably have insurance or couldn't afford it out of pocket. If you could afford it, you probably aren't concerned about the price.
I don't need to. Lets just say I know this subject.
I see if you have any insights would be interested. Not as educated on the cost side of medicine as I should be. Anything in the works to make that a thing?
Medication costs are set by the NDC number. Even the bottle of Asprin you have in your cabinet has one. Medicare is who sets the rates. Insurance companies usually pay the medicare reimbursement fees. Go find any medication of any kind in your house, there is an NDC number on it. I guarantee it.
There is no law currently, that requires hospitals to sell medication to patients at those rates. If hospitals don't accept the NDC/Medicare rates from the insurance carrier then the insurance carrier won't cover visits to that hospital or pharmacy. That is how the system works now.
What Trump has done is lower the medicare rate, by preventing it from being higher than foreign rates for the same medication. You as an individual will not see a difference. You cannot bargain for the medicare rate. Insurance companies are going to pay less. This in theory should lower insurance premiums. Most likely it won't, and it will just increase insurance profits, or prevent a rate hike this year until inflation from the stimulus hits.
Will this lower the cost for people on medicare? NO! Medicare is just not going to pay as much towards the medication. Hospitals will have to rethink their rates if suddenly most of their customers now cannot afford the medications. Do you want to lose the customer or reduce your profit margin? Overall the sticker price will go down, but individuals may pay more out of pocket.
Medical fee schedules vary by state and is what insurance companies accept as the acceptable rate for medical procedures. There is usually metro and rural modifiers to these rates. Doctors and hospitals are under no obligation to offer these rates to you, as an individual.
TL:DR The industry is designed to suck the maximum amount of money out of individuals without the bargaining power of a mega corporation insurance company behind them.
You are referring to preferred provider networks, and yes insurance companies can negotiate discounted rates. Most of my experience is with Kaiser which is a non-profit and typically the negotiated rates are 80% of medicare. I don't know how this will impacted for-profit medical providers.
My understand of the impact of this again, just goes back to medication reimbursement. Rates will go down. I don't know how this will impact offices visits etc under the complexity ranges. I would suspect only a small percentage of patients are actually doing uninsured walk ins and paying out of pocket rates.
I think the impact of this might only impact people shopping around for for certain non-critical care if they are paying out of pocket. I would think certain specializations will be more heavily impacted. Dermatology with cosmetic removals comes to mind. People might shop around for that. If you are planning on paying for a major inpatient surgery, you probably have insurance or couldn't afford it out of pocket. If you could afford it, you probably aren't concerned about the price.