Aetna, big NYC hospital group in fight over rates

notadmin, thanks for posting this. our health care coverage options are changing as I type, and aetna is one of our new choices. i can tell you that the aetna option seemed like a tremendously good deal to me. it IS almost 40% cheaper than the other two options being presented, and the coverage seems better.

now i'll have to do more research. most of our doctors have privileges at beth israel (and just this week i checked aetna's provider list and beth israel was most certainly included), which is the hospital we have always used. now i'll have to make sure that all of the doctors have access to NYU.

Aetna has been great with us, their customer service is very good too. There's a very smooth dispute process, that ended up being educational to me as Aetna was right and I was wrong. They taught me how the specifics work and how to find out myself online when it comes to coverage, although that really needs improvement.

They provide a detailed bill and items charged (unlike Cigna) so it's the most price transparent we've had so far. Several times both doctors and hospitals had overcharged and I was able to correct it, to the benefit of both Aetna and us. With Cigna I would have no idea about how much are they charging and for which procedures.

We have yet to receive a detailed booklet regarding coverage, HR at Columbia Univ blames Aetna and Aetna blames HR at Columbia Univ... the stuff is online and I can find it though.

i had aetna previously and liked it. now i have a bs/bc plan administered in a different state and it has been beyond horrible (i've had at least six of the major carriers by now and this was the worst). i think i'll go with aetna and if the coverage becomes too limited i can always switch at the end of the year.

But Continuum is a non-profit - I thought that rising health care costs were the result of the greedy profit-seeking insurance companies.

btw, Oxford/UHC just fought this out with Continuum as well, though they recently settled. These "non-profit" hospitals, with CEOs getting multi-million dollar compensation packages and other egregiously paid administration are at the center of the skyrocketing health care costs. But instead of challenging them, Obama got bought off with some measly promises to reduce costs.

But Continuum is a non-profit - I thought that rising health care costs were the result of the greedy profit-seeking insurance companies.

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non-profit hospitals engage in upcoding at the same rate as for-profit ones. it's one of the most common corrupt ways of getting more $ from the privately insured people. you go with a flu and they claim it was bronchitis type of "mistake". that's why getting detailed bills from the insurance companies is a great way to put a stop to this.

> measly promises to reduce costs.

giving total price transparency to the consumer through the internet will be a great way to allow us to put a stop to shifting costs. it's also key for those with high co-pays, that way they will be able to shop around and hospitals/doctors will become competitive and more efficient. my gut feeling is that there are tons of consumers like me that would be happy to help out containing costs that way.

do you have an HSA/high-deductible plan?

"giving total price transparency to the consumer through the internet will be a great way to allow us to put a stop to shifting costs"

Its not just the transparency.... consumers need an incentive to check the costs. If they don't pay for 'em, they're not going to bother.

Thats why I like the HSA/high deductible options (but cover all checkup / preventative).

> do you have an HSA/high-deductible plan?

Nope, but I did look into it. There's no real catastrophic HSA plan (most cover preventive) in NY given all the mandates. My gut feeling is that the HSA are used by the higher risk pool instead of the healthiest. Here in NY the super healthy that take care of themselves and want to save have dropping out of the pool as only option.

> Its not just the transparency.... consumers need an incentive to check the costs. If they don't pay for 'em, they're not going to bother.

Yep, I would though. But you are right, the ones that care about cost containment for its own sake might be only a few. I joke with my husband that I saved thousands of dollars to the insurance company thanks to insisting on a vaginal birth instead of a C-section. But didn't get a thank you note from them, and I should have! I also saved them a night of stay in the hospital/hotel. Not too shabby, why using more resources than needed? Somebody somewhere is paying for that.

The real problem is that people aren't bartering with their doctors:

http://tpmdc.talkingpointsmemo.com/2010/04/dems-fricassee-lowden-for-chicken-bartering-health-care-plan.php
On Monday, Lowden doubled down on the barter idea. "Let's change the system and talk about what the possibilities are. I'm telling you that this works," Lowden said. "You know, before we all started having health care, in the olden days, our grandparents, they would bring a chicken to the doctor. They would say I'll paint your house."

> The real problem is that people aren't bartering with their doctors:

agreed, and, again, part of the problem is a system where folks doesn't care what it costs.

so what it costs should relate to what it costs THEM.

Full Disclosure: I used to work for Continuum several years ago. I actually side with the hospitals because they have to raise rates to mek up for the losses they take when uninsured peopel come to them for care.

http://www.dscc.org/chickens

"But Continuum is a non-profit - "

So what? Do doctors and nurses at non profit hospitals work for free? Do they get free medical supplies? Do they pay less malpractice insurance?

> agreed, and, again, part of the problem is a system where folks doesn't care what it costs.
> so what it costs should relate to what it costs THEM.

higher co-pays including medicare will work only if we can see what the cost will be before the fact. it should be illegal for hospitals/doctors not to show the costs for typical procedures from the consumer. if we eventually end up footing the bill through higher premiums within a few years, why are they allowed so much lack of transparency?

> Full Disclosure: I used to work for Continuum several years ago. I actually side with the hospitals because they have to raise rates to mek up for the losses they take when uninsured peopel come to them for care.

don't agree Presi, if the solution to the uninsured problem is to overcharge the insured, you only get more uninsured people. fix the reasons why people are uninsured instead.

for example, stop free riding on the young and healthy, provide catastrophic insurance (without expensive mandates) if that's what they want. 3 out of 4 of those young and healthy just opt out, so charging the same regardless of age and health (community rating) just doesn't work and the system expose those that are young to too much risk. it's so expensive for those that use it very little that penalties for not having insurance are not going to prevent opting out either. simply solve the reason why people opt out: give a bare bones cheap option!

"Full Disclosure: I used to work for Continuum several years ago. I actually side with the hospitals because they have to raise rates to mek up for the losses they take when uninsured peopel come to them for care"

Then explain why in Massachusetts where everyone is covered, hospital costs have been going up so sharply as well?

"So what? Do doctors and nurses at non profit hospitals work for free? Do they get free medical supplies? Do they pay less malpractice insurance?"

Exactly my point - I was ripping on the people who claim that the driving force behind the increases has been the profit-seeking of insurance companies, when in fact those premiums by and large are just a reflection of them passing along the costs of care. If it were the profit motive, then non profit hospitals would be increasing costs less than for-profit hospitals, but that's not the case.

I have a fundamental problem with non-profit hospitals acting just like for-profit hospitals do, but then claiming the tax break. I shouldn't be subsidizing the $2mm salaries and egregious perks of these CEOs.

The main motive behind insurance increaases are the expense of care for uninsured people. Any why do you think people are uninsured to begin with? You think that insurance companies have absolutely no blame?

> The main motive behind insurance increaases are the expense of care for uninsured people

Once again, alpo, you have NO FING IDEA WHAT YOU ARE TALKING ABOUT.

Hell, did you not read printer's post RIGHT BEFORE YOURS.

No, sorry, the increases are NOT from the uninsured care... not only does printer note the evidence... but the uninsured issue is NOT a new one, so it wouldn't represent an increase.

jeez, dude, why do you even bother posting?