Reply to Drs office charging monthly fee for "better service"??

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[quote=Anonymous]I am a health care actuary, we set rates and reserves for health insurance including Medicaid and Medicare.  Many of you are way off base.

The one poster was right that the profit margins made on health insurance are pretty small.  Many insurance companies are not for profit entities.  Profit is heavily regulated.  Sure some executives make very large salaries, but it is quite literally a drop in the bucket when you look at your premium.  Insurance companies make small profit in return for taking on risk and in health insurance they often lose money on products, health costs have a lot of variables.  You win some and lose some.  They are not the underlying problem, most people who understand how the system works see that.

Most of the Fed insurance is administered by insurance companies, but they simply pay the claims.  The insurance company makes a small fee for that and having a network with contracts, they aren't raking in the profits on it.  The reason insurance companies have resorted to low reimbursements, squeezing the doctors and having the endless paperwork to save money is to keep the claims down (which determines premium) and prevent fraud/waste/abuse.  If they didn't do that, premiums would sky rocket and no employer, state or federal gov't could pay them, they barely can now.   Fraud, waste and abuse in the system is huge.  Health care costs are increasing at alarming rates as people have developed more cancer, diabetes etc. and demanded more prescription drugs and treatment.  That is a result of a society with growing health concerns and new technology.  A person may need $300,000 annually for some treatments and someone has to pay for it.  Insurance companies could care less if in the future a doctor was paid $200 for a visit vs. $50.  If it's high though, you bet premiums will be higher and people complain about that too.  Someone besides the insurer must sponsor and pay for it.  It is not sustainable to keep increasing costs, someone needs to pay for it.  Insurance companies want to pay less to keep premium down, otherwise they won't have anyone using their services.  Insurance companies are the middleman only.

One way out of this mess is keeping the waste down and increasing the health of the people in this country. Until then it will be a constant pull between big pharma, government, insurance companies and people.  We need more consolidation and pooling of risk, there is a lot of red tape and people employed in the industry to set up and administer complicated uneccessary benefit plans.  I'd start with the Feds and their open season, you all do realize those fairs, gifts and choices all jack up your premium.   Some choice is okay and keeps costs down, but most of it creates waste.  Making insurance the boogyman only allows us to skip past the real issues.[/quote]

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