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Anthem drops controversial new plan to cap anesthesia coverage after backlash

usatoday.com

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Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#11

Post by lotsofpulp »

bushbaba wrote: post #6
ndsipa_pomu wrote: post #3

Just how is the U.S. healthcare system so broken that this can even be considered? It sounds like some dystopian fiction.

The profit margin of anthem insurance is ~5%. The profit margin of all state insurance is ~7%. The us health INSURANCE system is not hugely profitable. as care costs go up, the insurance deductible/premium must also go up or the amount of services covered needs to decrease. The way to fix this is to fix the system. Lower Doctor pay, lower drug cost, showing pricing up front, allowing medical suicide, removal of middl…

Elevance Health (aka Anthem) has a profit margin of 3% to 4% most years:

https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...

It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins.

Although, this doesn’t take away from the fact that MCOs have been getting away for too long with criminal prior authorization practices that waste a lot of people’s time (and health). But I bet fixing this would involve spending a lot more on labor, which people also would not like (higher premiums/deductibles/taxes).

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#12

Post by crawftv »

ryaniscool wrote: post #9

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not s…

There is a specific type of nurse called a CRNA that is basically a replacement for anesthesiologists. And half the nurses I know are going to school for that. It seems like hospitals and insurers want to replace the MD here.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#13

Post by jauntywundrkind »

ryaniscool wrote: post #9

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not s…

Just passing along some heresay here... I'm not fit to judge but this thread does have some support if trying to reel in anesthesiologist billings. Second hand report of an anesthesiplogist being in support of BCBS trying to limit unneeded expenses. https://bsky.app/profile/nemoblue.bsky.social/post/3lcllzxje...

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#14

Post by anotherhue »

ryaniscool wrote: post #9

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not s…

Remove / equalise the reasons that it makes sense for your employer to control your insurance provider. It was an act of government that caused it in the first place.

ACA needs 2 sequels before anything resembling a market can emerge.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#15

Post by intrepidlemon »

ryaniscool wrote: post #9

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not s…

This is not an informed perspective. Anesthesiologists are some of the most highly trained physicians in a hospital.

Human physiology is complicated and on the surface, any job can seem simple if you have no understanding of what is happening. While a large portion of the time, the surgeries go smoothly, sometimes it doesn’t and it can go downhill fast. In that moment, you want an anesthesiologist that can quickly and thoroughly think through a patients medical history, what drugs they’re on at home, the current surgery, variant anatomy, what drugs they’ve given so far, etc to decide on the correct next drug to give or action to take. That takes training and experience.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#16

Post by intrepidlemon »

intrepidlemon wrote: post #15
ryaniscool wrote: post #9

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not s…

This is not an informed perspective. Anesthesiologists are some of the most highly trained physicians in a hospital. Human physiology is complicated and on the surface, any job can seem simple if you have no understanding of what is happening. While a large portion of the time, the surgeries go smoothly, sometimes it doesn’t and it can go downhill fast. In that moment, you want an anesthesiologist that can quickly an…

The assertion that physicians are a primary driver of excess US healthcare costs requires evidence.

See here https://www.commonwealthfund.org/publications/issue-briefs/2...

Physician salaries are a driver, but the far bigger portion lies with insurance’s take, and the administrative costs required to respond to insurance shenanigans.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#17

Post by jkestner »

bushbaba wrote: post #6
ndsipa_pomu wrote: post #3

Just how is the U.S. healthcare system so broken that this can even be considered? It sounds like some dystopian fiction.

The profit margin of anthem insurance is ~5%. The profit margin of all state insurance is ~7%. The us health INSURANCE system is not hugely profitable. as care costs go up, the insurance deductible/premium must also go up or the amount of services covered needs to decrease. The way to fix this is to fix the system. Lower Doctor pay, lower drug cost, showing pricing up front, allowing medical suicide, removal of middl…

Pricing up front is a start. Hospital overbilling is probably a bigger issue than doctor pay. They have billing departments equivalent to a corporation’s team of accountants, but instead of paying no tax, their mission is to maximize what you’ll pay. Procedure costs vary wildly, and hospitals will often bill for a doctor’s time when an NP or technician did the work.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#18

Post by filoeleven »

> "To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."

Additionally, according to Vox,

> Critically, contrary to Sen. Murphy’s claims, this policy would not have saddled patients with surprise bills, if their operations went over time. The burden of this cost control would have fallen on participating anesthesiologists

https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#19

Post by hyperliner »

ryaniscool wrote: post #9

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not s…

[dead]

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#20

Post by gruez »

intrepidlemon wrote: post #16
intrepidlemon wrote: post #15

Earlier quoted context omitted.

This is not an informed perspective. Anesthesiologists are some of the most highly trained physicians in a hospital. Human physiology is complicated and on the surface, any job can seem simple if you have no understanding of what is happening. While a large portion of the time, the surgeries go smoothly, sometimes it doesn’t and it can go downhill fast. In that moment, you want an anesthesiologist that can quickly an…

The assertion that physicians are a primary driver of excess US healthcare costs requires evidence. See here https://www.commonwealthfund.org/publications/issue-briefs/2... Physician salaries are a driver, but the far bigger portion lies with insurance’s take, and the administrative costs required to respond to insurance shenanigans.

This report, linked in a vox article a sibling post, comes to the opposite conclusion.

https://www.healthsystemtracker.org/brief/what-drives-health...

It calculates US's spending on healthcare to be 87% higher than "Comparable Country Average", and attributes only a 10 percentage point of the price increase to "administration" costs, as opposed the report you linked which estimates 30 percentage points.

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