New Health Cost Controls Get Go-Ahead From Feds

[Purveyor]

Source: Associated Press

WASHINGTON (AP) -- The Obama administration has given the go-ahead for insurers and employers to use a new cost-control strategy that puts a hard dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements.

Some experts worry that such a move would surprise patients who pick more expensive hospitals. The cost difference would leave them with big medical bills that they'd have to pay themselves.

That could undercut key financial protections in President Barack Obama's health care law that apply not just to the new health insurance exchanges, but to most job-based coverage as well.

Others say it's a valuable tool to reduce costs and help check premiums.

Read more: http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_COST_SHIFT?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2014-05-15-13-03-40

[passiveporcupine]

2. Yep

And they said there would be no death panels.

Until we have single payer, we are up a creek without a paddle.

[Yo_Mama]

3. This will be a disaster for some - essentially a denial of coverage

Say the limit is $30,000. The plan offers you a choice of hospitals within its provider network. If you pick one that charges $40,000, you would owe $10,000 to the hospital plus your regular cost-sharing for the $30,000 that your plan covers.

The extra $10,000 is treated like an out-of-network expense, and it doesn't count toward your plan's annual limit on out-of-pocket costs.

That's crucial because under the health care law, most plans have to pick up the entire cost of care after a patient hits the annual out-of-pocket limit, currently $6,350 for single coverage and $12,700 for a family plan. Before the May 2 administration ruling, it was unclear whether reference pricing violated this key financial protection for consumers.

Hospital prices vary so widely largely because they serve highly varying groups of patients. And some of the networks offered under Obamacare have very little choice in hospitals. This could easily be used to effectively deny care. And if it can, it will.

[cap]

4. Problem is that level I trauma centers are the most expensive

If you have an accident you go to a neighboring hospital. If it's more serious, you go to a regional trauma center. If it's really bad, you go to an expensive major center.


So tell me, what freedom of choice do you have?

Also, for knee and hip replacement, you may need a certain doctors care.

[quadrature]

5. Liverpool care pathway coming soon ....nt

[Mojorabbit]

6. This is outrageous! nt