Proposed Rules Rankle Insurers

[TomCADem]

Source: Wall Street Journal

One of the most critical aspects of the federal health overhaul for insurers is shaping up as a mixed bag for the industry, as regulators issued draft rules Thursday on how the companies must account for how much they spend directly on patients' medical care.

The overhaul stipulates that insurers' medical-care spending for individual and small-business health plans must equal at least 80% of the premiums they collect on those plans. For large-company health plans, the spending requirement is at least 85% of the collected premiums.

That will limit how much money insurers have left for administrative expenses and profits. If their medical spending falls below the new thresholds, they will have to pay out rebates.

Just what insurers can count as medical expenses and how they must tally the numbers have been left up to regulators at the National Association of Insurance Commissioners. The regulators hope to finalize the rules at an Oct. 21 meeting in Orlando, Fla., and then the Department of Health and Human Services will have the final say.


Read more: http://online.wsj.com/article/SB10001424052748704062804575510292297937642.html?mod=googlenews_wsj

[bluestateguy]

1. Shut your mouth and obey the law

nt

[No Elephants]

2. PROPOSED rules are a MIXED bag for the industry. Let's see what the final rules say.

Their peeps will be all over the rulemaking process. Will your lobbyists?

Oh, you don't have any lobbyists? Too bad.

[iamjoy]

3. Don't Worry

They'll find a way to reduce administrative costs. Don't look for such cuts to come to the executive offices. They'll fire the people answering the phones and doing all the back office stuff that helps provide customer service and process claims. Providers will have to wait even longer to get paid. If you call because you need to find out why a claim was paid the way it was, expect a long hold before talking to some one in Bangalore.

[kirby]

7. How could it be worse than now?

I mean seriously, it takes HOURS on hold to get through to a BlueCross customer service. They freqently deny claims that should be paid. Maybe they will stop denying claims and having to process the same thing two or three times to save money.

[Scuba]

8. Had some experience here, have you? Your answer is right on.

Although I expect them to claim all cost are direct patient care, including the CEO's $9,000,000 / year compensation.

[pattmarty]

4. Now is your chance to prove to us that the private sector can.................

...........deliver a product CHEAPER and more EFFICIENTLY than the government. :sarcasm: :sarcasm: :sarcasm:

[Scuba]

9. Hah!

[pattmarty]

10. Yeah, that is one of the BIGGEST lies that we have been told over.......

........the years, that the "private sector" can ALWAYS be cheaper and more efficient than government. In truth there are very few things the private sector can provide more cheaply/efficiently.

[Scuba]

13. Just compare the salaries of the top Medicare / Medicaid ......

...officials with the salaries of any insurance company.

[annabanana]

5. If it didn't "rankle" them, I'd deem the exercise useless.

They got damn near everything they wanted anyway.. How typical for them to be pissy over the crumbs that we won.

[bemildred]

6. Good. nt

[PSPS]

11. So, private insurers can rake 20% off the top while medicare does the same for 3%. Sweet!

Of course, they probably allocate 1 or 2% to launder back to their paid-for politicians as "protection money" (AKA "campaign contributions.") That leaves their CEO free to continue getting hundreds of millions in premiums to buy more mansions/islands/yachts/hookers which, of course, enrichens us all via the magic of the "trickle down."

[drm604]

12. Poor widdle insuwance companies...

:cry:

:nopity: