Yes indeed things are becoming  more complex with insurance and in this case WellPoint is capping what they will pay on some services and procedures. Again this is a data creation windfall for Castlight, the 3rd party consultant who  creates the models and algorithms that will be used by employeesimage to search and find the providers who are within the range of the caps.  If employees do not learn how to use the software then phone service will be provided.  More and more in order to save money it is dependent on the use of software. The new insurance exchanges are the same with millions in grants being put out to fund “navigators’, which again is basically learning how to use the software and how filters work to make a selection for health insurance

Of course a simpler answer would be to have the same caps on all services everywhere in the US and not as many insurance plans to choose from but that would put some of the third party consultants out of business who do well with both hospitals and insurance companies to design software and consulting solutions so the middle man cut seems it’s here to stay as complexities continue to grow.  It’s an education process in order to have and use health insurance.  Sometimes though today as business models are changed so frequently, the minute you have one website or software service down pat, it’s time to learn another one.  We see that all the time. 

Folks at the top of all this, like lawmakers don’t have to worry about learning software though as they have a staff that does what they need so they remain kind of bliss and non participating for the most part which leaves them without the hands on experience the rest of us get.  There will always be bumps in the road to see if this works and basically how far it can be extended I think.  Hips and knees seems to do well but when it is done on a bigger basis remains to be seen. 

Doctor Wins 3.8 Million Dollar Law Suit Against Anthem Blue Cross In California–He Was Turned Away for Challenging Denial of Patient Claims

The “quality” information provided is just that, data and some of this is good but price is going to be the big call here.  All providers, imaging services, labs are not created equal and that’s been the entire issue with coming up with some kind of ranking service and the current rating/information sites are losing viewers anyway as most sites imageare there just to promote some kind of advertising anymore and the files are dated.  If you read here often enough you know that story.  Yes indeed it would be a lot nicer to have one set of numbers to work with instead of having to shop doctors, labs and imaging centers.  It’s a royal pain and of course you are always on your own dime doing so.  So here we go, more money for the middle companies and consumers need to learn more software techniques to filter and shop from the employer provided insurance side. 

One last thought…does software and 3rd party training expenses fall under the MLR as being part of a claims process?  Thought just kicked through my head after writing this post.  So if consumers don’t learn how to use the software to find those who are within the capped price, they might be paying more for every dollar that exceeds the amount will be out of their pocket.    Blue Cross is also buying up your Visa and Master Card purchase records, as they say they are mining to see if you are buying clothes that are a size larger.  I guess with these records and if you use a debit or credit card they will also be able to see what you pay above and beyond the capped amounts too?  Only the query masters know for sure.  BD

Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too

As companies seek ways to curb health-care spending, insurer WellPoint Inc. WLP +0.40% is rolling out a program that lets employers pay only a set amount for a medical service, asking workers who select costlier care to pay the difference.

The idea has been tested for years by a limited number of large employers. But the new option from the second-biggest U.S. insurer, which will be available for coverage that kicks off next January, will be offered broadly to any client with at least 100 employees.

The new approach "encourages a member or employee to shop and become a smarter health-care consumer," said Ken Goulet, chief executive of WellPoint's commercial business unit, who said the company has seen "strong interest" from employers.

WellPoint said its program can include more than 900 different services. The vast majority are routine things like lab tests, but the list also includes some more complex procedures like hip and knee replacements and bariatric surgeries.

Cigna Corp. CI +0.99% said it has been piloting the approach with a big client since 2011, but has seen mixed results, and is considering whether to launch more pilots. The Cigna test found that employees ended up paying around $600 on average out of their pockets for imaging scans, signaling that they may not have been shopping around as the program intended. "We do not want to roll out solutions that will be riddled with consumer gotchas," said Wendy Sherry, vice president for product development at Cigna.

WellPoint is working with Castlight Health Inc., which has an online tool that gives pricing and other information about health-care providers. The companies will offer Web and printed materials and a call-in line for employees, and Castlight will send people to employers' work locations to train workers on how to use the service. WellPoint and Castlight said workers would get quality information about providers drawn from multiple sources.


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