Quoted Text

Renewed regulation possible for insurers
Oversight of health care premiums sought
Sunday, June 14, 2009
By Sara Foss (Contact)
Gazette Reporter

NEW YORK STATE — Deregulation of health insurance premiums has resulted in excessive rate increases, forcing many New Yorkers to pay more than they should for health insurance and even drop coverage altogether, according to a new state report.
The report, released last week by the state Insurance Department, found that health insurers can increase premiums with virtually no oversight and that insurers’ profits have increased, while health insurance has become less affordable.
In the wake of the report, Gov. David Paterson has submitted a bill to the state Legislature that would reinstate the Insurance Department’s authority to review health insurance premiums before insurers raise rates. The bill would also require insurers to increase their minimum medical loss ratios — the amount that health plans spend on claims — from 75 percent for small groups and 80 percent for individuals to 85 percent for both.
Until 1996, the state Insurance Department did review and approve premium increases under a system called prior approval. But then the state switched to a “file and use” system under which New York health insurers are allowed to increase premium rates without the approval of the Insurance Department by meeting minimum filing requirements.
“The rationale was that the marketplace would do a better job of setting rates than the government,” said Troy Oechsner, deputy superintendent for health at the Insurance Department. “In most areas of our lives, yes, the marketplace is better. But we came to the conclusion that, in health care, it doesn’t work.”
Regulation, he said, protects consumers from overcharging.................>>>>.......................>>>>.................................

Quoted Text

Deregulation of health insurance premiums has resulted in excessive rate increases, forcing many New Yorkers to pay more than they should for health insurance and even drop coverage altogether, according to a new state report.
The report, released last week by the state Insurance Department, found that health insurers can increase premiums with virtually no oversight and that insurers’ profits have increased, while health insurance has become less affordable.

what exactly does that mean??? I mean really....we could all sit here and in honest truth say we pay more than we should in taxes
if P then Q......
what I find interesting is that the state/government wants to have national healthcare(oxymoron) and cant even give value for the
taxes we pay now.....
the he/she has and I dont have and what you have and what I have keeps all of us from looking up......
the 'state' makes up reports as they go along the propaganda machine......it will just be ANOTHER slush fund.....
now the IRS wants to tax cellphones......WTH!!!!

DONT TREAD ON ME

It is puzzling, because I am positive that I remember as recently as last year seeing notices in the paper, at least I think, the legal notices in the paper inviting the public to comment on rate increases for such and such health plan or insurance co, similar to those things for Nimo and Nyseg rate increae.  They'd be held I think by the state Insurance Dept.   A relative of mine who works for the state says he constantly know how late info about premiums for state employees is made available because they'd get notices saying "once the rates are approved"

But figure this, the state comes up with legislation or orders on health plans to cover this, that, and the other thing, but then it wants to limit the amount the health plans can charge in premiums, and remember, premiums cover things like wages for employees of the health plan, like claims reviewers.  So, health plans in order to exist with the mandates and limits set by the government turn to laying off employees which means claims don't get paid timely then the government sticks is nose in demanding that claims be paid within a certain amount of time, so maybe they hire claims reviewers but layoff member services representatives and then we can't get answers over the phone and.....well, you fill in the rest.

Hey, I'm not advocating no regulation at all, surely we can't have insurance plans, say, doubling their premiums without just cause.  It's like the president saying he's cutting medicare and medicaid to fund the new health care.  Come on, how much more cuts can be made....when they discharge people from the hospital much earlier than private insurers and pay so little to doctors that doctors drop out.  And like medicare has an approved amount so low compared to what most doctors charge and what most insurance plans pay that when doctors lose out and raise their charges on those without insurance.

Don't look to the government to fix our health care problem we face today. Cause it was the government (Hillary) who created this rise in health care costs to begin with. This was orchestrated over a decade ago. The government (hillary) in the early 90's created this HMO fiasco! So each insurance company had to add on yet another layer of employed people to handle this huge HMO bureaucracy! They needed to employ doctors and nurses to oversee YOU and your care. It is all bullsh*t at best.

From the time the clinton's were in office, not to mention Ted Kennedy, the liberals have been pushing for universal health care. For some bizarre reason, they wanted to get into the health care business! So now obama is in and thanks to all who voted for him, has created a PERFECT STORM for universal health care. So hang on to your seats folks...cause you will get what you wished for!

Quoted from bumblethru

... This was orchestrated over a decade ago. The government (hillary) in the early 90's created this HMO fiasco! So each insurance company had to add on yet another layer of employed people to handle this huge HMO bureaucracy! They needed to employ doctors and nurses to oversee YOU and your care. It is all bullsh*t at best.

Years ago, probably before 1980, people who had insurance had indemnity type plans---the plans with the deductible followed by a percentage reimbursement.  Preventive visits, well baby care, those childhood immunizations, the visits to the pedeatrician every year to check the child's height, weight, etc, were not covered.  So when you went to the doctor for some flu bug (or he came to your house), the cost of that visit probably was not going to exceed the annual deductible.  Insurance---at that time--was never intended, back then, to cover every conceivable medical expense.  

Insurance is one thing, receiving health care was another.  Everyone had a family doctor, not saying all members of the family had the same doctor, but each person had their own.  Typically the kids had a pediatrician, adults had a family practice doctor or a GP (general practitioner).  Some families had kids go to the family practice or GP as well.  Family practice doctors could deliver a baby, though I don't think they could to a C section.   If you were having ache in your chest, you did not call a cardiologist office telling them your heart was bad.  You called your family doctor.  The family doctor would have asked you a bunch of questions, listened to your heart with the stethoscope, checked your blood pressure. and stuff.  Then he would tell you you have heart burn.  Or he would say he has ideas about such and such and feels you should see a cardiologist.  And his receptionist would make the appointment for you with the cardiologist.  If you were having aches in your joint areas, you called and then went to see your family doctor.  Again questions, possibly some tests.  "Gee, it sounds like arthritis, I want you to go to a rheumatologist."   Have a rash?  You would not have been the person picking up the phone and calling a specialist.  Do you call a dermatologist?  Or would you call an allergist?  Or would you call an infectious disease specialist.  You called your family doctor and he (or she) again would do the question thing, run some tests, and make the probable diagnosis.  Then he would refer you to the appropriate specialist.  I mean really, could you imagine choosing on your own to go to the dermatologist and he in turn would send you to the allergist.  No wonder your medical expenses were high, you just made a wasted doctor visit.  In all those instances, the specialists to whom you were referred, likely made the appropriate diagnoses, starts treating you, and made contact with your family doctor.  The family doctor coordinated all your care, sort of overseeing it.  When you saw a specialist, the specialist would  call your family doctor with medical questions and your family doctor knew everything about you, even some things from when you were a baby that you didn't know.  

In the 1970's, times were tough, unemployment was high, gas prices hit a dollar a gallon, and it made it difficult for people to pay medical expenses even if they had insurance.  Paying $20 for a doctor visit for one of those winter bugs, was difficult for many.  And some insurance plans began to use the "participating provider" idea.....go to one of those doctors and you would not be subject to the deductible and very possibly you didn't have a co-pay either.

In the 1970's, well, locally, the first HMO opened here....CHP.....on Troy Schenectady Rd.  It was a staff model HMO, meaning all care is provided at that location by medical staff who work exclusively for them, get their salary from CHP, it was kind of a clinic setting.  The one location was favored by some people.  Other people stayed away because of the clinic image.  Ultimately, CHP opened more locations, do you remember in Schenectady, it was at the location currently housing Schenectady Regional Orthopedic (corner of Lafayette and Liberty St).

Locally, in the early 1980's a very popular HMO was started....that was MVP.  It was a different kind of HMO from CHP.  MVP was an IPA model HMO, meaning Individual Practice Association.  MVP contracted with private, existing doctors in our communities.  Wow, you like your doctor(s), you could continue going to them.  You chose a "primary care physician."  The PCP would coordinate all your care, be involved, be there to dicuss your care.  If you have been doing things in the traditional way, everything stays the same, you see your PCP first who sends you to a specialist.  And because the primary care is involved, you are assured of all medical information being shared among the specialist and prevent serious situations.  Having one doctor coordinate or be involved in your care is like getting all your prescriptions at the same pharmacy because the pharmacist knows  the medicines that shouldn't be taken with something else.  The pharmacist would then call the prescribing doctor and let him know that your also taking such and such.  Yes, when you go to a doctor you've never been to before, you in theory give him your history, but you might just forget one Rx that you are taking, or you get the name wrong, maybe even small misspellings will result in having a record of a med you dont' even take.  And how many of us know a brand name, it's generic name, and it's category.  When we buy some over the counter med and the instructions say "on't take if....," how many of us know all our "ifs."  How many people who buy OTC meds know what an MOIA inhibitor is (is that the term often seen, "don't take if you are taking MOIA..."  But your pharmacist, who has gone through years of education in biology, chemistry, and all those technical and medical things knows all this stuff.

We ourselves have been with MVP about since it started here, so that's been 25 years, and we couldn't be happier with this HMO.  Since we had been with our doctors prior to MVP, and since we have been people who made use of a family doctor to "oversee" (as you call it) our care, nothing changed.  The feared "gatekeeper" term intended to scare people away from HMO's is nothing like that in most cases.  At least not with MVP.  We have never had our "gatekeeper" refuse to give us a referral to a specialist.  We'd call the PCP, talk to the receptionist and tell her "hey, it's time for my semi annual visit to the allergist, I need that referral thing."  Our "gatekeeper" never required us to come to the office.  The receptionist just sent the referral, that's all.  Well surely, they would check that we've been seeing the specialist.  Or it might be saying, "gee, that certain rash has appeared again, that one that I had five years ago, I am plannning on going back to Dr Dermatologist, would you send over the referral.  

These days, the government has stuck it's nose in, often with HMO's, sometimes perhaps making laws that mandate HMO's to let people bypass their PCP or prohibit the coordination of care throgh the PCP, i.e., the referral.  That defeats their whole idea.  

I have friends of ours that were in MVP when the guy had some surgery in NYC and when the local specialist wanted our friend to go, the specialist contacted MVP and by 3 that afternoon (from morning), everything was approved by MVP.  No, this was not a life and death situation.  And MVP paid in full.  This friend also told us about going to a neighboring out of state location of a doctor instead of going to the doctor's NYC location for mere personal preference.  MVP had no problem with it and took only two days to give approval.

What I don't want to see is the government single payer

Quoted Text

1in·sur·ance  
Pronunciation:\in-ˈshu̇r-ən(t)s also ˈin-ˌ\
Function:noun
Date:1651
1 a: the business of insuring persons or property b: coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril c: the sum for which something is insured
2: a means of guaranteeing protection or safety

does anyone see the oxymoron for national health care in the definition?

coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril

what peril? what contingency and who deems it appropriate?


: a means of guaranteeing protection or safety [/

can anyone visualize the government doing this? too expensive,,, hell, time to cut off aunt sally and disabled brother from anymore
treatment......

the sum for which something is insured

who chooses the value????

If goverment would get out of the way of telling health plans what they had to cover and who they had to cover, then I'm sure that they would see the prices of premiums come down.  Each time there's another rule made by the government, it means that those who already have the plan need to pay more for the coverage they were previously getting so someone else can get more coverage or ANY coverage for nothing.  Less government regulation means lower premiums.

Many larger corporations are "self-insured" where they write their own policy and just pay the insurance companies to administer them.  For the most part, these policies are exempt from government mandates.  Meaning if Company X only wants to cover broken noses for their employees, then they'll tell the insurance company to pay for broken nose claims and deny everything else.  This is one way some companies and keep costs down for themselves and their employees.  The flip-side, is that some self-insured plans have terrible coverage.  One reason of many I am glad I'm no longer in the business.

Anyway, it all goes back to what we want our society to be.  If we want to hold on to capitalism, then we must treat healthcare as a priviledge rather than a right, and eliminate any and all entitlement programs (Medicare, Medicaid, Child Health Plus etc.).  Not saying I necessarily agree with it, but the capitalism-socialism mix isn't working out too well.

Quoted from Kevin March

If goverment would get out of the way of telling health plans what they had to cover and who they had to cover, then I'm sure that they would see the prices of premiums come down.  Each time there's another rule made by the government, it means that those who already have the plan need to pay more for the coverage they were previously getting so someone else can get more coverage or ANY coverage for nothing.  Less government regulation means lower premiums.

All larger companies that I know that are self insured have great coverage. Many have doctors or nurses or physician's asst. on premises. I say keep health care under the heading of capitalism. The part of social medicine and capitalistic medicine that doesn't work is the 'social' part. In my opinion, it is a piss poor example of health care. I call it 'restrictive health care'.

Greed was and always will be a part of the system, be it socialist or capitalism. However, 'we the people' can put a capitalistic business right out of business by boycotting it. Can't do that with a socialist system. That would clearly be a dictatorship and WE'D BE STUCK!

If health care is a privilege, than so is driving a car. When you drive a car, you are required to carry insurance. You shop around for the best coverage and the lowest price. I say do the same with health care. Encourage the  development of new health care companies to stimulate competition.

we need to end the money making on the heatlth and put the people in charge with the congress and president making all the rules to protect us from the rich and people who want to make the moeny on us over there

Quoted from 191

we need to end the money making on the heatlth and put the people in charge with the congress and president making all the rules to protect us from the rich and people who want to make the moeny on us over there

The sad part is that the public has been lured into the...."gotta go to the doctor"....it's the BEST advertising(especially
the aging crap) since cereal commercials......

I'm not saying going to the doctor is a bad thing.....but, to feel lousy does have alot to do with out lifestyle and genes
....if we are not going to sleep when we should, drink too much, eat too much, smoke etc etc.....
what the hell do we think 'priviledged healthcare' will do for us......
what are the numbers of sick folk without reason,,,,compared to sick folk due to lifestyle choices????
to be honest, and I'm not proud of this, but I really really dislike going to the MD......I'm not saying I would never
go to the MD and I would be looking for treatment just like everyone else if something serious came up.....and my
lifestyle choices certainly are not squeeky clean by any means.....

Hey, push it through, please.  Sal, when this goes through, you can just start sending me my check.  I'll expect it directly from you, not from some lackey somewhere.