Hopkins is dropping CareFirst

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So as consumers, do we call CareFirst and press them on this? I’m lucky I can go through DH’s insurance which isn’t CareFirst if they don’t reach and agreement… what are our best options here?

I am planning on contacting them about it. I can also switch to my husband's health insurance, but I'd rather not. I may as well tell them that I would. Also federal employees, which probably make up a big chunk of their local customers, have a lot of insurance options and can drop them for someone else. Not sure they give a shit but whatever...I'll try.

The weird thing about this is that I would think the set of people that would actually drop BCBS insurance over Hopkins would be money-losers (as a group) for BCBS. It seems like they’d have a financial incentive to encourage those people to switch to different insurance companies.

What makes you say so?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So as consumers, do we call CareFirst and press them on this? I’m lucky I can go through DH’s insurance which isn’t CareFirst if they don’t reach and agreement… what are our best options here?

I am planning on contacting them about it. I can also switch to my husband's health insurance, but I'd rather not. I may as well tell them that I would. Also federal employees, which probably make up a big chunk of their local customers, have a lot of insurance options and can drop them for someone else. Not sure they give a shit but whatever...I'll try.

The weird thing about this is that I would think the set of people that would actually drop BCBS insurance over Hopkins would be money-losers (as a group) for BCBS. It seems like they’d have a financial incentive to encourage those people to switch to different insurance companies.

What makes you say so?

Because most people don’t go to the doctor so often that they care who they go to.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So as consumers, do we call CareFirst and press them on this? I’m lucky I can go through DH’s insurance which isn’t CareFirst if they don’t reach and agreement… what are our best options here?

I am planning on contacting them about it. I can also switch to my husband's health insurance, but I'd rather not. I may as well tell them that I would. Also federal employees, which probably make up a big chunk of their local customers, have a lot of insurance options and can drop them for someone else. Not sure they give a shit but whatever...I'll try.

The weird thing about this is that I would think the set of people that would actually drop BCBS insurance over Hopkins would be money-losers (as a group) for BCBS. It seems like they’d have a financial incentive to encourage those people to switch to different insurance companies.

What makes you say so?

Because most people don’t go to the doctor so often that they care who they go to.

Said another way- the only people who care are those are sick- remove those from the pool and bam, rates are lower for the rest.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So as consumers, do we call CareFirst and press them on this? I’m lucky I can go through DH’s insurance which isn’t CareFirst if they don’t reach and agreement… what are our best options here?

I am planning on contacting them about it. I can also switch to my husband's health insurance, but I'd rather not. I may as well tell them that I would. Also federal employees, which probably make up a big chunk of their local customers, have a lot of insurance options and can drop them for someone else. Not sure they give a shit but whatever...I'll try.

The weird thing about this is that I would think the set of people that would actually drop BCBS insurance over Hopkins would be money-losers (as a group) for BCBS. It seems like they’d have a financial incentive to encourage those people to switch to different insurance companies.

What makes you say so?

Because most people don’t go to the doctor so often that they care who they go to.

Said another way- the only people who care are those are sick- remove those from the pool and bam, rates are lower for the rest.

I’m sure they’d keep rates the same but I see your point. Gross that this is like chess

and jeopardizing patients’ lives. It is so hard to get into a new practice these days.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:thank the greedy doctors and big pharma.

Actually Hopkins doctors don’t get paid much at all.

+1
I used to be one.
I had 10+ years of experience in a speciality with moderate salaries (ie not peds or rheumatology or another low-paying speciality), and made 180K/year working 60-70 hours/week.
Many have family money or a higher-earning spouse.
Couldn’t swing it anymore financially, and left.

Also, because of the structure of medical reimbursement for Maryland Hospitals, costs are more contained in Maryland than in other states.
https://www.nytimes.com/2021/10/24/opinion/maryland-medical-bills-lower.html

Doctors in Maryland actually have fairly low salaries relative to the cost of living.

But the whole system is broken and needs to be burned down and rebuilt.
Essentially every physician I know who is 50 or younger wants single-payrr.
We are all burned out and miserable.

There’s a huge divide between old and young doctors when it comes to single-payer and private practice versus employed positions.

Then in the middle there's a bunch of doctors that had to drop a boatload of money to buy into a practice. And while they might prefer single-payer, they're going to be (understandably) nervous about getting screwed on the return from their buy-in.

My dad, who died in 2020, was a pediatrician. He graduated from medical school in 1960 and loved practicing medicine. When we had his memorial service, we were stunned at how many former patients and their parents showed up. We got letters from three people who said they had named their sons after my dad. But I can tell you that he encouraged all three of his kids to do anything other than go to medical school. He hated insurance companies and the enormous waste of time and money they represented. He was for single-payer health care -- possibly because my mum was British and her whole family loved the NHS. I'm a CareFirst subscriber and my PCP is a Hopkins doc. In the unlikely event that Hopkins and CareFirst part ways, I'm going to bite the bullet and go concierge. I'm fortunate to be able to afford that, but I'm disgusted by disgraceful joke of a health care system the US has.

[Anonymous]

I’m glad they are calling attention to CareFirst’s extremely low reimbursements. We’ve had CareFirst for years through my husband’s job. Over time nearly all of our doctors have stopped accepting their insurance because their reimbursements were so low. Our pediatrician, PCP, obgyn, ortho, dermatologist, etc. we have watched over 15 years as providers have dropped them while continuing to accept other insurers.

[Anonymous]

I live in Maryland and am on Hopkins' side on this one after seeing the reimbursements paid to my super-cardiologist--actually an electrophysiologist--for a cardiac ablation.

Carefirst reduced his bill by more than two-thirds, paying $113 out of $700 for his medical services and $16 out of $200 for his x-ay services (required for this procedure).

That's just ridiculous. I would never defend Hopkins as a paragon of moral virtue--it's a Byzantine bureaucracy with sometimes sketchy motives--but declining to pay reasonable rates to the doctors is insulting to them and dangerous to people like me who need them.

I'm wondering if people even pay attention to the rates insurers are paying doctors and hospitals. Maybe that's what the insurers are relying on, hoping we'll blame the greedy medical establishment rather than them.

If you belong to Carefirst, read your EOBs. You might be surprised.

[Anonymous]

Anonymous wrote:I live in Maryland and am on Hopkins' side on this one after seeing the reimbursements paid to my super-cardiologist--actually an electrophysiologist--for a cardiac ablation.

Carefirst reduced his bill by more than two-thirds, paying $113 out of $700 for his medical services and $16 out of $200 for his x-ay services (required for this procedure).

That's just ridiculous. I would never defend Hopkins as a paragon of moral virtue--it's a Byzantine bureaucracy with sometimes sketchy motives--but declining to pay reasonable rates to the doctors is insulting to them and dangerous to people like me who need them.

I'm wondering if people even pay attention to the rates insurers are paying doctors and hospitals. Maybe that's what the insurers are relying on, hoping we'll blame the greedy medical establishment rather than them.

If you belong to Carefirst, read your EOBs. You might be surprised.

That's in the contract that hospitals make with insurance companies, though. Then they purposely overbill even though they know what insurance will pay them. I'm not defending Carefirst, those amounts are very low. That's just the stupid game we all have to play.

[Anonymous]

Anonymous wrote:I live in Maryland and am on Hopkins' side on this one after seeing the reimbursements paid to my super-cardiologist--actually an electrophysiologist--for a cardiac ablation.

Carefirst reduced his bill by more than two-thirds, paying $113 out of $700 for his medical services and $16 out of $200 for his x-ay services (required for this procedure).

That's just ridiculous. I would never defend Hopkins as a paragon of moral virtue--it's a Byzantine bureaucracy with sometimes sketchy motives--but declining to pay reasonable rates to the doctors is insulting to them and dangerous to people like me who need them.

I'm wondering if people even pay attention to the rates insurers are paying doctors and hospitals. Maybe that's what the insurers are relying on, hoping we'll blame the greedy medical establishment rather than them.

If you belong to Carefirst, read your EOBs. You might be surprised.

I have a question about reimbursements. When you submit an out-of-network claim to Carefirst, is the allowable benefit the same as the amount that would be paid to the provider if the provider is in-network? If so, I can totally understand why providers are lobbying for higher reimbursements.

[Anonymous]

Anonymous wrote:I live in Maryland and am on Hopkins' side on this one after seeing the reimbursements paid to my super-cardiologist--actually an electrophysiologist--for a cardiac ablation.

Carefirst reduced his bill by more than two-thirds, paying $113 out of $700 for his medical services and $16 out of $200 for his x-ay services (required for this procedure).

That's just ridiculous. I would never defend Hopkins as a paragon of moral virtue--it's a Byzantine bureaucracy with sometimes sketchy motives--but declining to pay reasonable rates to the doctors is insulting to them and dangerous to people like me who need them.

I'm wondering if people even pay attention to the rates insurers are paying doctors and hospitals. Maybe that's what the insurers are relying on, hoping we'll blame the greedy medical establishment rather than them.

If you belong to Carefirst, read your EOBs. You might be surprised.

I mean even if he spent 30 minutes with you, his hourly rate is 226. Was there a separate facility bill because that normally covers the hospital, their employees, and equipment and specific to Hopkins (and many other Bmore hospitals) is billed separately so it isnt awful. The xray reimbursement is pretty bad but again it takes 30 min tops for an xray appt.

[Anonymous]

A. Single payer health care systems do not pay doctors the big bucks
B. Carefirst is a nonprofit organization while Johns Hopkins made $200 million in profit last year

What that means for this discussion is up for debate but I think this is a complex issue.

[Anonymous]

Our HR department is implying that they will reach an agreement prior to December 5th as well. Fingers crossed.

[Anonymous]

Anonymous wrote:A. Single payer health care systems do not pay doctors the big bucks
B. Carefirst is a nonprofit organization while Johns Hopkins made $200 million in profit last year

What that means for this discussion is up for debate but I think this is a complex issue.

My wife's side of the family has a few of people in the medical industry and they make really good money. Unsurprisingly, not one of them will be in a room with a patient this week.
CareFirst may meet the IRS definition of a non-profit but they feed a lot of money to a lot of millionaires.

Is the American healthcare system more complex? That's the intention. More pockets to be stuffed. It's the same reason the F35 jet fighter uses components from over 200 Congressional districts. I cannot imagine how many billions they spend to assure that we never convert to a single payer system. Besides, it would put my relatives out of work.

My doctor works for Hopkins and made a weak argument for me to stay with the practice. Alas, we have the golden handcuffs to BCBS so off we go.

[Anonymous]

Anonymous wrote:

Anonymous wrote:A. Single payer health care systems do not pay doctors the big bucks
B. Carefirst is a nonprofit organization while Johns Hopkins made $200 million in profit last year

What that means for this discussion is up for debate but I think this is a complex issue.

My wife's side of the family has a few of people in the medical industry and they make really good money. Unsurprisingly, not one of them will be in a room with a patient this week.
CareFirst may meet the IRS definition of a non-profit but they feed a lot of money to a lot of millionaires.

Is the American healthcare system more complex? That's the intention. More pockets to be stuffed. It's the same reason the F35 jet fighter uses components from over 200 Congressional districts. I cannot imagine how many billions they spend to assure that we never convert to a single payer system. Besides, it would put my relatives out of work.

My doctor works for Hopkins and made a weak argument for me to stay with the practice. Alas, we have the golden handcuffs to BCBS so off we go.

Totally agree that nonprofit doesn't always mean they're not trying to enrich somebody. But Hopkins is making a profit, most of which I suspect does not go to the people providing patient care. So there is that.

Totally agree the US healthcare system sucks. But if your goal is to pay doctors more than they are currently being paid, then single payer is not the answer.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I live in Maryland and am on Hopkins' side on this one after seeing the reimbursements paid to my super-cardiologist--actually an electrophysiologist--for a cardiac ablation.

Carefirst reduced his bill by more than two-thirds, paying $113 out of $700 for his medical services and $16 out of $200 for his x-ay services (required for this procedure).

That's just ridiculous. I would never defend Hopkins as a paragon of moral virtue--it's a Byzantine bureaucracy with sometimes sketchy motives--but declining to pay reasonable rates to the doctors is insulting to them and dangerous to people like me who need them.

I'm wondering if people even pay attention to the rates insurers are paying doctors and hospitals. Maybe that's what the insurers are relying on, hoping we'll blame the greedy medical establishment rather than them.

If you belong to Carefirst, read your EOBs. You might be surprised.

That's in the contract that hospitals make with insurance companies, though. Then they purposely overbill even though they know what insurance will pay them. I'm not defending Carefirst, those amounts are very low. That's just the stupid game we all have to play.

Carefirst reimburses significantly lower than every other insurance company, it’s pushing Hopkins into financial peril which is the reason for the hard stance. I can’t imagine what it has done to private practice doctors who don’t have the same resources.