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modernhomeowner t1_ivicz2b wrote

Reply to comment by Accomplished_Ad_9288 in Rant: MA healthcare is among the best in the country, but insurance is wicked expensive by nebirah

It was in network. The negotiated price with MA BCBS was $850. The point isn't about the insurance coverage, it's the high rates doctors charge here, that's what makes the insurance so expensive here.

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Beck316 t1_ivjbnc6 wrote

Did you pay 850 out of pocket?

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modernhomeowner t1_ivjctly wrote

Heck no, I offered them $250 and when they said "that's not how we operate" I said then either $0 or take me to court and I'll tell a judge how you tried charging me $2400 an hour for an office visit, your choice. They opted for the $0.

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Accomplished_Ad_9288 t1_ivjryse wrote

If it’s in network, all doctors, not just the ones in M.A have rates that are negotiated with the payers they accept. The payers create those rates, not the doctors.

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modernhomeowner t1_ivjw1ag wrote

Doctors are the ones negotiating the rates with the insurers. In MA, really much of the northeast, a person is very loyal to their doctor, its why Massachusetts BCBS has close to 100% doctor participation, they want everyone, and they are willing to pay higher rates for it. Doctors have formed large bargaining groups to make sure they take advantage of that. If doctors request large contracts, and the insurer declines, the physician group threatens to pull out and send letters to their XX,XXX customers to tell them to find new insurance. (I've seen that done countless times). The insurer finally gives in and pays what the doctor wants, and raises insurance premiums.

If you look at states with lower doctor participation in their health plans, premiums are less. Florida Blue, I can't find the statistic right now, but I believe I saw it was in the mid 70%'s of doctors in the state participating. Florida prices insurance by age and smoking for the under 65 market, so I can't compare very well between them, so I'll compare the over 65 market where rates are the same regardless of age or smoking. The lowest price MA BCBS plan is $0 a month, the lowest Florida Blue is negative $75 a month, yes they put $75 a month into your social security check. Doctor copays, drug deductible, hospital copay, ambulance copay, it's all lower with the Florida Blue plan. Because if a doctor wants an excessive amount of money, Florida Blue, says no, we want to provide the best deal for our members. They still have doctors in every field and geographic region of the state, covering the vast majority of the doctors, but the ones who want payments that are well more than average, aren't helping medical costs, they are hurting them, so insurance companies pass on their participation. If we did that in MA, our insurance could be 10-15% cheaper, maybe even more.

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Accomplished_Ad_9288 t1_ivkui7t wrote

Sure, IPAs, MSOs, ACOs and any other independent physician groups, or IDNs will have more bargaining power.

I’m lucky and have a great plan through my employer, but I know there are many who are much less fortunate.

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modernhomeowner t1_ivkvuej wrote

I have a fantastic plan too, the plan isn't the point, its how much they pay physicians that dictate the cost of the plan. They agreed to pay that otolaryngologist $850, when it would have been $250 with a provider in any other state, that raises our insurance costs, which was the OP's self-described rant.

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