Brief today (as I’m on dial up!) but go take a look at this article called tiers may have unintended side effects. Interesting that the Blues in Minnesota are trying the tiered approach, which hasn’t gone too great shakes in Claifornia, and some big names (like Mayo) are worried. One to watch.

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Tagged: Insurers May 9, 2005

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10 Responses for “HEALTH PLANS: Tiers’R'Us and the Blues in Minnesota”

1. Ron Greiner says:

   May 9, 2005 at 3:12 pm

   The article says that the insured deductible doubles if they use the second tier hospitals like Mayo. It didn’t say what the penalty was for going to a hospital that is not in any of their tiers. I know some Blue Cross plans that would only pay 50% for going to a hospital that is non approved. And 50% of a $350,000 cancer bill is a lot.
   Is the Mayo Clinic a Blue Cross of Iowa Preferred Provider? If the Mayo is not a Preferred Provder of MN Blue Cross, I doubt it would be in IA or CO.

   Reply
2. gadfly says:

   May 9, 2005 at 8:49 pm

   It seems to me that someone in an ambulance wouldn’t necessarily be able to direct the driver to the most cost effective hospital. Or is there a proviso for going to the nearest provider in case of an emergency?

   Reply
3. Ron Greiner says:

   May 10, 2005 at 6:53 am

   gadfly,
   I think the real question is; If survival rates go up 20% on your daughter at the Mayo Clinic, do you really want to go? If the insurance company only pays 50% of a non network provider you would owe $200,000 on a $400,000 illness.
   Then the admissions clerk would ask you if you brought your checkbook. That’s why I suggest clients get a cap of $1,000 maximum penalty for going out of network. Then the admissions clerk says, “Welcome, here is our Welcome Video of our clinic.” See the difference?
   How much is your penalty for going out of network gadfly?

   Reply
4. Sue says:

   May 10, 2005 at 7:18 am

   Of course Ron, you are totally omitting the underwriting argument. If a pre-existing condition exclusion can be applied to either the in or out of network hospital visit, you could have to pay the whole $400K and you might not find that out at the admissions desk. It might happen after the expenses were incurred and the claims were rejected because someone at the insurer found a creative way to tie the treatment to the exclusion–want to guess how creative you can get with an exclusion that reads: entire gastro-intestinal tract? All after paying premiums thinking you had some coverage…..

   Reply
5. Ron Greiner says:

   May 10, 2005 at 7:43 am

   Sue,
   We wouldn’t exclude the “entire gastro-intestinal tract’ with a hernia. We would limit the exclusionary rider to the treatment of the hernia.
   And you suggesting that a woman with ovarian cancer would not get treatment because of an “entire gastro-intestinal rider” is goofy.
   Besides in MI there are no exclusionary riders over a year so just put it truthfully on the application that you have been diagnosed.

   Reply
6. gadfly says:

   May 10, 2005 at 11:44 am

   //How much is your penalty for going out of network gadfly?//
   0 because I am uninsured.

   Reply
7. Ron Greiner says:

   May 10, 2005 at 11:50 am

   gadfly,
   If the government mandates you to get insurance, just like auto insurance, will you pay something then.
   You uninsured people, or gamblers, are driving up the cost for those of us with insurance.
   You do pay for auto insurance at least don’t you?

   Reply
8. gadfly says:

   May 10, 2005 at 2:25 pm

   //You do pay for auto insurance at least don’t you?//
   I do not own a car. Even if I had the money to buy one, I probably wouldn’t buy one, because I don’t want to contribute to traffic and pollution problems.
   //You uninsured people, or gamblers, are driving up the cost for those of us with insurance.//
   Yes, last year alone I added two ER bills to the public tab.
   Perhaps you ought to think about providing me with a job so I won’t be driving up your costs? Oh wait, the other unemployed 6% of the nation might come out of the woodwork and demand a means of supporting themselves, too.

   Reply
9. Ron Greiner says:

   May 10, 2005 at 3:02 pm

   gadfly,
   If you got cancer and the bill was $400,000, the rest of us will have to absorb your costs, that’s not fair.
   We need a law to help us get to universal coverage. Half the uninsured would get health insurance if they couldn’t get a drivers license. Sure gadfly will still go without but millions would get insurance so they couldn’t drive.
   gadfly needs some kind of penalty too.

   Reply
10. gadfly says:

    May 10, 2005 at 3:12 pm

    //If you got cancer and the bill was $400,000, the rest of us will have to absorb your costs, that’s not fair.//
    I agree. And I do have a genetic disorder that could potentially be quite costly. Also, my ability to contribute to society is reduced by the fact I go without “non-crisis” treatment now.
    //Half the uninsured would get health insurance if they couldn’t get a drivers license.//
    There’s an interesting idea. I bet it would reduce driving in the U.S. as well as raising the amount of insured.
    //gadfly needs some kind of penalty too.//
    Penalty from what? I don’t have a house, a car, or an income. You need to make someone part of society before you can run around trying to punish them.
    Are you now worried I’m costing you money? Good. Now perhaps you’re getting some perspective on the problem.

    Reply

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