Join the conversation to learn more about what’s going on in North Carolina when it comes to the health care issues we all face.
Blue Cross and Blue Shield of North Carolina invites you to learn how we’re fighting to rein in medical costs, and how you can too.
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Let's Talk Cost
from Let's Talk Cost 2011
April 13, 2011
Third parties — the government, employers and insurance companies —
fund about 86% of all health care, giving consumers little incentive to
manage their own medical costs.
Chuck E. commented on April 13, 2011
This has been, in my opinion, the biggest overall factor. Beginning with the concept of 'employer provided' and further exacerbated by the brilliant invention of the co-pay in the 80's. The consumer has little to no skin in the game. I am not aware of anyone even discussing this in the debates.
Herman N. commented on April 19, 2011
I paid real close to $5,000 in copays last year. (not including my portion of the premium that was deducted from my paychecks) Apparently you either don't have a family, or they never get sick. Good for you. Close to 10k is a hefty chunk of skin in the game.
Juan P. commented on May 18, 2011
I agree Chuck, 100 years ago we learned that paying employees in tokens, and tokens are only good a the Company Store, was a bad idea. Any non-cash benefit is unethical if you really think about it.
Alison K. commented on April 13, 2011
I know I don't make enough money to cover health care costs for my family of four. So if it doesn't come from my employer or the government where would we get care? Just do without?
Jonesy T. commented on May 13, 2011
The Government can't afford to pay for peoples health care either. Even it's own employees. One of the reasons why it's broke.
But the problem doesn't start with who will provide it. It starts with the costs.
Why does an emergency room visit for 20 minutes where you see a doctor for 2 and nurses for the rest end up costing you $10,000? Oh you have insurance? Then it's $20,000!
It's all a scam.
The governement provides a piece by giving you a tax break on money you spent on HC. If you remployer didn't provide it, you would just get paid more in cash. The good news about Obamacare, if you are a family of 4 and make less than 88,000 a year, you will have some kind of tax credit to help pay for this. I don't know your salary, but if of the 4, 2 are children, they both may qualify for Medicaid or NC Child Insurance. Just google NC Medicaid, and look at the thresholds for your family size.
Richard B. commented on May 30, 2011
Do you have enough to buy food, housing, clothing? When you say your employer or the government you are really saying me through higher prices for goods/services or taxes. I have for the last 10 plus years paid 100% of my HCI premium and all deductibles and copays. Why is it that you think I need to pay yours too?
Janice W. commented on April 14, 2011
When I purchase something I expect to know up front what my costs will be. That never happens when I go to a physician or try to make a decision about in-patient treatment. How can I keep costs down when I have no way to compare options. Further, I have no way to compare quality of providers (the new centers of excellence excepted). When I look for a physician, I don't even get his/her resume. Where did they get their training? Are there any metrics that can identify how effective they are? This could be something that a health insurer can give us. You, Blue Cross, have the data.
Michelle Douglas commented on April 14, 2011
Public Relations Manager
Stay tuned, Janice. We are working on more tools to help customers make informed decisions w/r/t cost and quality as we speak.
I agree Janice and hope Michelle is right. I just had a foot operation and the hospital would not even give me an estimate of the cost although they did want me to pay a some unspecified amount in advance. I did not call BCBS but when I have called in the past they were not forthcoming with cost estimates or even coverage confirmation. I have a contract with BCBS and pay my premium every month. More info from BCBS about what they will pay and what that amount is would be great. BCBS and network providers such as this hospital have a contract. They probably do dozens of foot operations per month and both the provider and BCBS have a very good idea of the actual cost and certainly the contracted cost yet the customer (insured/patient) have no ability to get this information.
Michelle Douglas commented on June 2, 2011
Richard, we hear this frustration from many of our customers. In the coming months, we expect to have tools available that will tell you what your out-of-pocket costs will be for various health care services. We have a great team dedicated to working on this, so hang in there!
It's difficult for our Customer Service Professionals to provide detailed cost information before a claim has been filed. We don't know what codes the doctor/hospital might file, what other claims might be floating out there that would impact deductible/out-of-pocket max thresholds, etc. We have aired on the side of caution in not making promises relative to cost that might not hold up once the claim is filed and processed. But we recognize that this is frustrating for our customers, and we are working to make this information available. Thanks for sharing your feedback!
Richard B. commented on June 2, 2011
Michelle, thank you for your response. I understand that no one can predict what might happen during a procedure but I expect both the provider and BCBS have a very good idea of the nominal/expected codes from a procedure. Certainly BCBS must have criteria to evaluate against the codes submitted and assuming an in network provider both BCBS and the provider know what the reimbursement for the code will be. I just received an EOB for my emergency room visit for my broken foot and there are 13 separate items listed that all have exactly the same generic text description with charges that range from less than $100 to more than $2000. I would really like to help with the fraud and abuse checking but cannot with that information. Could we at least list the medical codes and provide the key for the codes on the BCBS website?
Michelle Douglas commented on June 3, 2011
I think that's a great idea, Richard. We have a group currently working on making EOB's more usable, so I will contact them and see if that's something we can work on. Kudos to you for taking an interest in the health care charges that are accumulated under your name! We'll try to do a better job of giving you tools to support those efforts.
Richard B. commented on June 3, 2011
Michelle, that would be great. Having a HDHCP/HSA tends to focus the mind.
Richard B. commented on June 28, 2011
The new BCBSNC website is a first good step but only a first step. While there is more billing detail than before you still cannot get a digital EOB that often provides more detail than even the updated site. For instance I have a billing for $27K for surgery. The EOB has several line items for that billing ranging from $100s to $1000s. Online there is just a single line for $27K. Neither online or EOB contains any specific info on the line items, just a generic phrase like "Surgery". Why not include the codes that were actually used in the billing and then provide a code table on the website to see what is actually being billed for each line item?
Also the expected cost section is still very generic and not particularly accurate.
Krysia L. commented on May 13, 2011
In the True North strong and free where they have single payer health care, co-pays of as little as $4 per visit are seen as a significant barrier to accessing care for the poor. Having worked a few summers answering the phone in a medical office to cover for vacations, appointments are cancelled because the patient lacks the bus fare to get to the office.
Knowing that the cost of a family health insurance policy is around $12K per year for a family with no significant health risks, that is about $5.77/hour for someone working full time.
I think that the current US system causes people who need on-going care to manage a chronic condition to avoid doing so and causes higher long-term costs because of the disincentive of co-pays. This also results in high costs because when people are evenually forced to seek care, they are no longer in a position to attempt to mitigate costs - their choice is between bankruptcy and dying, so they just don't care. You don't even bother to check if the hospital is in network if you are having a heart attack or stroke or are in a diabetic coma.
14% is too big a slice of the pie. You need to be a comfortably middle class family to be able to afford to use the coverage your employer provides. And you need to be a wealthy family to be able to afford to buy individual insurance.
As a poprosal, what if hospitals, drug companies, doctors, government and insurance got together and negotiated a uniform set fee schedule for what they would pay medical providers for a service and then they can allow providers to extra-bill patients directly for amounts above that fee level. That would incent medical providers to keep their overhead and operating costs lower, would incent patients to seek lower cost providers and would return some market discipline to the industry. The catch is setting the fees high enough that there are some providers who are willing to not extra bill. But it only works if you don't allow private insurers to cover the extra billings. And it leaves you with the perception of a two-tiered health system.
In health care, more and more expensive and not necessarily better. But they might be ...
This research looks at cost sharing for those with commercial (ie not government) insurance. The portion of costs paid by employees vs. employers is more like 40%. $8K/$20K when employee premiums, co-pays and deductibles are considered.
I think employers have absolutely no business buying health insurance for their emplyees. Any compensation that is not cash, is a slippery slope to slavery.
That being said, as an employer, I would have to give some health benefit in order to compete for good employees, so I would just pay my employees the maximum allowed into an HSA account and tell them to use the $5,000 however they wish, whether it be on insurance or actual costs or both.
Rick R. commented on June 1, 2011
Hmmm, generally the lower costs path through the healthcare system are the most pleasant, so I guess that has no effect. So the big costs like say pancreatic or breast cancer, you should spend a month or so looking around... A car accident, not your fault, what's the logic here?
Number of deaths for leading causes of death
•Heart disease: 616,067
•Stroke (cerebrovascular diseases): 135,952
•Chronic lower respiratory diseases: 127,924
•Accidents (unintentional injuries): 123,706
•Alzheimer's disease: 74,632
•Influenza and Pneumonia: 52,717
•Nephritis, nephrotic syndrome, and nephrosis: 46,448
So which ones would we be able to manage our costs. Diabetes with regular medication and DOCTOR'S VISITS. Alzheimer's? If people stopped smoking or breathing polluted air or ate less... but really managing their costs? I don't see it. In fact, if people had to think less there would be earlier cheaper intervention in most cases.
The fact is we are living longer, heathcare really can add good years to our lives, this has happened in less that 1.5 generations, and frankly it costs more than 80% of households can afford. We are going to have some problems, especially since we are slow learners about costs. Again, look at every single payer system and you see people living even longer and spending less to do it. Oh, that's it, we are putting people in office who can't understand numbers because it is okay to say you hate math.
Richard B. commented on June 1, 2011
... and the single payer system is a government run and taxpayer financed system where there is even less of a correlation between use/overuse/abuse of the system and the cost of doing so. These systems run at lower cost by limiting treatment. Government bureaucrats decide the allowable treatments and if you do not like what is on their list, that is just too bad. See the limits VA drug formulary for what that means in the real world.
Richard B. commented on July 2, 2011
This is an interesting development...
"Managed care enters the exam room as insurers buy doctors groups"
Richard B. commented on July 21, 2011
"I don't see it. In fact, if people had to think less there would be earlier cheaper intervention in most cases."
scott h. commented on August 10, 2011
After a first visit with an eye doctor, he wanted to schedule surgery. I said I wanted to visit another doctor first. He asked why. I told him I wanted to "shop around"
The doc smirked and said ok. The woman who took my payment sneered it wouldn't matter. This is what Blue Cross will pay. It won't matter who you go to, your cost will be the same.
How do I participate in cost control when Blue Cross does that?
Len P. commented on October 18, 2011
There is a " consumer driven healthcare " aspect to many of these comments, informing and engaging the consumer to help make value-driven decisions...better outcomes and lower cost. But we've evolved a business model so complex that hardly anyone can understand the data. This objective would be far more feasible if medical codes were standardized and simplified, universally across all payors. We could better understand what is covered and not, what various alternatives cost in advance of care, and what we were charged after care. One cannot manage what one cannot measure, and one cannot measure what one cannot understand. Are there initiatives throughout the system to simplify and standardize information, so consumers have some opportunity to engage in more value-driven decision making?
Bruce Allen commented on October 21, 2011
Great point, Len. Many users share your thoughts about the complexities of our health care system.. One thing we’re doing here at BCBSNC to increase transparency is including features on our website and app where members can look up the cost of prescription drugs and procedures. This is just one example, but a step in the right direction. As part of health reform, all health insurers will be required to explain basic plan information through a template. For example, they will have to list deductibles for specific categories as well as an explanation of three common medical scenarios and what the out-of-pocket cost would be for each scenario. Do you think providing this information will be helpful? If you have any suggestions on how we can work together to simplify health care we’d like to hear them.