Marie--neither of theses comments have anything to do with BCBSNC. It is a NON-profit insurer. What is your point?

To NNNN C.,

I thought this was a forum to discuss insurer facts and opinions. Does everything here have to be about BCBSNC or somehow relate to it?

Our only goal for this campaign is to foster a rational, productive discussion about rising medical costs and it certainly does not have to be related to Blue Cross and Blue Shield of North Carolina. Too much of the public debate on health care is a blame game. Everyone who participates in the health care system plays a role in rising costs — so all of us must play a role in reining in costs.

Please feel free to continue sharing all thoughts and opinions.

To NNN C

It is precisely because there are such large profits and annual salaries by a nonprofit company that it SHOULD elicit such sharp criticism. It should also make the public and consumers wonder about why BCBSNC is spending a great deal of time, money and resources recently to make sure "we don't play the blame game." This media blitz is disturbing and highly insulting for BCBS NC members who have had real, everyday issues with this insurance company getting directly involved in the doctor/patient relationship. This media campaign (and that is all it is - a media campaign to sway public attention away from the issue that the largest insurer in the state of NC is raising premiums while cutting care options) is repulsive to patients that are being denied medically necessary care. And that is THE "rational, prodcutive discussion" that is not being addressed at all.

It is not a "blame game" to put this right back on their doorstep. Everyone was very upset when the government was accused of getting involved directly in patient care and in the middle of the doctor/patient relationship. It is extremely distasteful that BCBS NC is now launching an "informative and funny" effort as they do this very thing. And this media campaign is nothing more than at attempt to divert attention from the fact that they are continuing to roll out policy after policy that denies medically necessary care. I will continue to play the "blame game" when a monopoly acts in an unethical fashion.

To NNN C

>>Marie--neither of theses comments have anything to do with BCBSNC. It is a NON-profit insurer. What is your point?

The original statement was:

"In 2008, the combined profits among the top 10 U.S. health insurers would have only covered about two days of medical spending."

As far as I can tell that statement had nothing to do with BCBSNC either. It really means nothing unless you provide more context to the statement.

What we need is Insurance Company reform! They are making BILLIONS --- do you really think a "for profit" company is going to provide healthcare in an ethical and with the patients best interest in mind? NO WAY! They only care about the bottom dollar and the billions of dollars they rake in --- it's all about GREED!

Michelle,

How about you provide the salaries of all of the employees (particularly CEO and upper management) of BC/BS - including that with your profit of $167.7 million profit --- come on --- you really want us to buy into your belief that insurance companies are hurting? Please, don't insult our intelligence!

Leslie P., We are very open about our goal of earning a profit margin of 3.5 to 4.5 percent. We believe that's a modest and very reasonable profit -- and also appropriate for a company that pays $4 billion in medical claims for customers each year. Health insurance is expensive because health care is expensive. Last year just over 86 cents of every premium dollar our customers paid went right back out to pay medical claims. We are doing everything we can to operate our company more efficiently, but if we want to make health insurance more affordable, don't we have to also look at the 86 cents of the dollar that's going to pay medical expenses?

Michelle,

You can make numbers look any way you want them to. The reality is - the rest of the country is suffering and paying outrageous premiums that continue to rise, a decrease in coverage, and a decrease in approved covered services. As a mental health provider myself - sometimes I have to spend HOURS on the phone trying to take care of claims that were processed incorrectly, denials, and trying to get authorizations and verify benefits. Frequently I am given incorrect benefit information - and all of your "disclaimers" don't hold you accountable when the incorrect information is provided. On more then one occasion, I have called to verify benefits for a client hung up, called back and spoke with another person and told something COMPLETELY different. Sometimes, mental health is managed by Magellan. EVERY time I have sent claims in for a plan managed by them - it gets denied. Then I am told they probably haven't "uploaded" the information showing the coverage, so it is denied. I'm told to resubmit the claim, denied again. Call back - spend 20 minutes on hold - go through the whole scenario again - get nowhere - told to resubmit again and the cycle goes on and on and on. I have had more then one instance in which it took a YEAR for Magellan & Blue Cross to get it figured out and the claims processed correctly. Ultimately, I probably made about $2/hour on this client because of the ridiculous amount of hours I had to spend on getting the claims processed correctly. This is why good providers are starting to go off insurance panels.

The CEO of NC BC/BS made a ridiculous salary in 2010 and a bonus to boot, while the rest of the country is lucky to pay their bills. The "usual and customary" fees you pay mental health are far from usual and customary for the most part and the amount of time required to correct claims processed incorrectly, hardly makes it worth it.

Hospitals charge hundreds of dollars for a motrin and tissues given in the hospital and those of us who are committed to our clients/patients end up getting screwed.

Insurance companies are what need to be reformed. Making a profit of any kind off of peoples health, is criminal, in my opinion. If one of your family members was denied a cancer treatment that could save their life because the insurance companies didn't approve it for whatever other reason is conjured up - I think you would agree that this is not a system that works. The fact that Americans have tolerated how we have been robbed by insurance companies is beyond my comprehension. The focus of reformation needs to be on the insurance companies!

I just have to add here that your comment:

"Our only goal for this campaign is to foster a rational, productive discussion about rising medical costs and it certainly does not have to be related to Blue Cross and Blue Shield of North Carolina. Too much of the public debate on health care is a blame game. Everyone who participates in the health care system plays a role in rising costs — so all of us must play a role in reining in costs."

is a great diplomatic response - but doesn't deal with the reality of the situation. You are only feeding the blame game rather then taking responsibility for the racket YOU, as an insurance company have created. The real issues are pointless to address and discuss when YOU are not being real and dealing with your part of the problem. As others have stated, it's insulting to me as a provider as well as a consumer that you are now spending exorbitant amounts of money in advertising campaigns that could be used to pay for all those medical services/treatments that you are denying, outrageous salaries for upper management/executives, and suggesting that doctors make too much money - without looking at your own payroll.

Until insurance companies are REALLY ready to disclose ALL of the information, then this discussion is pointless and a facade of playing pretend to seek a solution, while in reality, not being transparent and forthcoming with the WHOLE picture and turning the blame on everyone else but yourselves. Again, an insult to our intelligence and simply not honest on your part.

Sure. BCBSNC is a not-for-profit. However, that doesn't mean they don't make a profit. They make millions. "Not-for-profit" just means that they keep the money instead of giving it to shareholders.

http://www.bizjournals.com/triad/stories/2010/03/01/daily17.html

The company recorded net income of $107.3 million for a profit margin of 2.1 percent, down from 3.6 percent in 2008 and below the company’s 3.5 percent to 4.5 percent target.

These comments have EVERYTHING to do with BCBSNC. They reported MILLIONS in profits last year. The ignorance of Americans is incredible...wake up people...we are being scammed by this company. They increase the premiums, find more and more loopholes for covering medical costs, increase their profits, make healthcare decisions based on the bottom line (their profits and greed). Notice that in these "rational and productive discussions" they "wish to foster" that any time a question regarding salaries of executives, bonuses or disclosing the REAL numbers and information have been posed, those questions have been ignored completely. So, please, give me a break, and stop with the insult to those of us who do have some intelligence ~ you have no desire to do anything but divert the attention from yourselves and how you are scamming the American public. Shame on you!

You have some good questions here. Let's add a few more.

Was that $186 million revenue or "profit"? How many days of medical spending for BCBSNC does that $186 million represent? How much do other executives at other sizable not-for-profits and, conversely, for-profit companies make? For example, what do the top executives at the Red Cross make? Or Cigna or Aetna? I would assume that getting qualified individuals to run large corporations would be extremely difficult if the compensation was totally out of line with others in similar positions, but without the numbers, it is hard to make any rational argument. I, too, would be interested in knowing the numbers.

I believe you are missing my point (or my sarcasm).

Actually, I am not questioning the right of anyone (insurance executives included) to their salaries, even if I find them higher than industry average. To answer just one of your questions though, according to the Chronicle of Philanthropy, the CEO of the American Red Cross earned $446, 867 in compensation for the year 2009. I will again compare that with the almost $4 million figure from the same year for the CEO of BCBS NC. You can do the math in figuring out the difference - if we are talking about cutting costs, and all.

But back to my original point in that I find it highly disingenuous that a website that is stressing cost does so under false pretenses. This site lists the average general physician salary and asks the public if they think that is too high or too low. Let's post the executive salaries at BCBS of NC and ask the public if they think this is too high or too low. If we are having a "rational discussion", I think that is a fair question.

For the record, I am totally against the entire concept of class envy that this web site and media campaign is going out of its way to emphasize. I realize that some jobs are extremely stressful and require a great deal of leadership and skill. If successful at that post, then the people responsible for good stewardship should be rewarded accordingly. But a web site and media blitz that actively promotes a discussion (for example) of physician salaries and has people quoting that "specialists make too much money" without posting their own incomes is simply a diversionary tactic to get the public attention away from the policies that BCBS NC is currently implementing - daily. And for the record, if the cardiologist that put in a successful implant of a pacemaker in a family member gets compensated for his level of skill and success, then I have no problem with it.

I do have a problem with a company telling me - members that pay rising premium costs every year in good faith - if they think our medical well being is worth it, when these type of salary figures of their executives are flying around. I have a serious problem with that. So I will call it out again and again: one executive salary at $4 million for one year.

So given this, the only question I am really interested in is how they can have the audacity to deny procedures (please see their web site for the latest procedures that are not being covered any longer - you may want to bookmark it, they add to it daily) with the rational that they only want to foster "rational" discussion about rising medical costs.

Stop the diversionary tactics please. Come back to the point that executives that are not in the exam room with me and my doctor are making decisions about my medical care - no matter what they make in annual income, this is simply wrong.

K.D./Nath, in 2010 (the most current numbers available) BCBSNC earned $5.2 billion in total revenue (premiums paid by customers). Of that we paid out $4 billion in medical claims for customers and $159.9 million in state, federal and local taxes. That left us with $167.7 million in profit for 2010, which would cover 4.5 months of claims and medical expenses for our customers. This is within the range that we are required by law to maintain.

This information is publicly available in our online media center and is filed each year (along with the compensation of our executive team) with the Department of Insurance.

Last year we spent 86 cents of every dollar we took in on medical care for our customers. Those are the expenses we all need to work to control if we want health insurance to be affordable.

K.D./Nath, my colleagues have let me know that my math was wrong – our profit margin of $167 million would only pay for about 15 days of claims. Not 4.5 months. However, we keep enough in our reserves to cover roughly 4.5 months of claims. We do this because it’s prudent and fiscally responsible, and is required by state law. I hope this adds clarity, and I apologize for any confusion.

Nath - notice you don't get a response. Hmmmm....what happened to that "open and honest discussion" they are looking for?! A testament to the joke of a campaign this is and the absurdity of it all --- and we have allowed this to go on. Shame on us!!!! Now WHAT are WE, as Americans going to do about this criminal activity????

That's a good question, Steve, and I believe Fortune's comparison was total US health care spending. I'm not aware of a comparison that has been done on total profits of all US health insurers against total US health care spending -- but that would also be interesting.

Michelle,

Okay, if it is total US spending then honestly I'm afraid your infographic is a bit misleading in its implication, even if it is not inaccurate. The graphic representation shows that the profits of the 10 top companies are but a tiny piece of the pie. The implication (and presumed motive for creating the infographic) is to represent the profits as insignificant. However the pie in truth includes far more than the reach of the 10 companies.

Let's say we took the sum of salaries of the top 10 movie stars and represented it as a percentage of total spending for all entertainment in any form. I'm not sure that would be a useful statistic.

More details here would be helpful. Thanks.

Another words Steve, Michelle's response can be translated as: I'm a diplomatic spokes person for BCBS and have no intention of giving detailed information that would reveal the true picture. This is just a marketing campaign to divert the attention from us taking any responsibility for the problem which we, as a profit making company who pays outrageous bonuses and salaries don't want to lose any money - we want to keep raking it in, and so far we have been able to get away with it - we don't want anything to effect that! In fact, we're trying to figure out how to increase our profits, salaries and bonuses at the expense of the american publics health. Why should we change anything....we've got you all fooled!

Yes Steve & Michelle, we could in principle do the analysis and understand the actual 'number of days'. The statistic would be very complex, and not all that enlightening. Leslie's point is more relevant: to present a graphic like that, with such grotesquely simplistic numbers and terms, reveals much about the mindset of the one who posted it: it's all about propaganda, not discussion. If we're going to participate in this blog, let's at least talk about real stuff (and actually, I am quite pleased at the level of the discussion I'm seeing here!)

Stephen, look for my comment on this thread. I estimate that the real number of days in 2008 was 19 and not 2 days.

I don't think they did their due diligence.

Not sure I understand why you think the Medicare model is the way to go. On average, there is plent of data that supports the notion that hospitals lose money treating Medicare patients. Medpac says 87% of all Medicare hospital stays are money-losers for the facility. 13% turn a profit, the average is only 3%.

Milliman studies show over 14% of the premiums you pay today are a direct result of hospitals and physicians shifting costs to cover this shortfall from the government patient to the private system.

In other words, if the private system didn't exist, and didn't allow for negotiation between docs and hospitals, the government would have no hospitals to send their patients to at the below cost numbers they are getting today.

In effect, insurance companies negotiating with providers does cause health INSURANCE costs to rise because network relationships are voluntary and no hospital or doc has to enroll or join, unless he gets the price he wants.

Not so with Medicare or even worse, Medicaid.

The medical system we have today, with all it's advancements, which we essentially provide to the entire world at marginal costs, while we eat all the R & D here in the U.S., would have been impossible with the financial pooling of the private insurance carriers.

Something to think about...

WR29

Well R.: It is not about Medicare per se, it is about getting all people insurance. We no longer live in a world where we can just let people die in the streets, so like it or not, yes, we ALL have to pay to make sure we are ALL covered. Welcome to the 21st century.

So the question is , "What is the best way to do that? "

In other places where there are two-tiered (or multi tiered) systems, they have put into place safety nets to make sure insurance co's do not make $8 mil. a year. In Germany, you can have private or public and there are many insurance companies, BUT your premiums are capped according to your income and there are no co pays and silly things like that. No one in Germany wants or even understands how we have let our health care system operate in a democratic society and almost 100% of their people are covered.

The UK has several systems based on the idea that health care is a right. Where the private sector has been allowed to compete too heavily, there is a weakening of the public sector (England) while places like Scotland have limited private sector involvement and thus, less contention between doctors and higher satisfaction. . However, in the UK, all people are covered and they certainly prefer it to ours.

In Canada, there is Medicare for all and private clinics are prohibited from offering services under the Health Canada Act. There are no copays, no deductibles, and only those making more than $200,000 have a premium in certain provinces. Again, almost 100% of Canadians are covered and they enjoy a longer lifespan and greater happiness. PLUS, they have a great economy, banks are #1 in the world, and they are more satisfied with their health care than we are with ours.

I could go on and on about other countries and you can do your own research. NO country has a system as silly and stupid and unsustainable as ours. They jettisoned their own For Profit models long ago as they saw it was a detriment to their economies and human rights.

A system such as ours- unlimited premiums (try explaining an $800 monthly premium to a European), outrageous co-pays and insane deductibles (we call it a "catastrophic" plan with up to $10,000 deductibles) is completely unsustainable.

So in the US, Medicare has already been proven to be the most sustainable that we have. Of course, unlike other countries, it has premiums that we suck out of our seniors and copays and a small deductible.

So no, American Medicare is still not a great plan, but if you are talking about wanting your grandkids to have a better life, is sure as heck is not going to come about with private insurance companies that are allowed to operate in any way they see fit while the rest of the world is light years ahead.

Well R.: If hospitals could eliminate the waste involved in battling with private insurers for payment, and improved clinical processes to avoid costs associated with patient harm, there would likely be plenty of room to make money under Medicare payment schedules. (Of course, if the hospitals get more efficient, that might be another excuse to reduce payments, but that's a separate argument.)

But the % of the pie is not 20% in "Admin Costs". Health insurers make money by assuming risk. The reason commerical health insurers are profitable is because the risk is spread across a healthier patient population than the Medicare population.

Amen, Herman. They will crash. They will outprice themselves and in 2014, people will NOT buy it. They will push their heels in and refuse. A change will have to come because things will not be as they are now. Totally unsustainable system built on greed and racism.

Herman, I agree completely and second that! The good news is - that what goes around comes around - I've lived long enough to know this is true. The insurance companies will get what they deserve in the long run ---- the public just needs to be sure to make sure that we have a voice and that they DON'T get bailed out....only to give their CEO's and managers bonuses! The entitlement is amazing - but it doesn't last forever and as Sam M. said---it will come back to bite them! The presentation of their "profit" is totally deceitful and does NOT tell the whole story!

Correct!

Angela,

That has NOT been my experience as a provider OR a consumer. I have not heard that as being the experience of any of my clients, colleagues, friends or family members either. So, maybe you are an exception to the norm, but I certainly do not believe a positive and caring experience is a typical experience for the "average" consumer.

Leslie P.

What a crock! I worked for one too and I know for a fact that everything you said is a lie!!!!!!! You act like 3% is nothing. 3% of billions of dollars is a huge amount. Now what did you say about that poor pitiful 3% your insurance company makes off the backs of it's struggling members you love so much?

You make a profit? After taxes? After paying large salaries? After a couple billion in depreciation (which is not a cash expense) and even after political contributions and lobbying costs (which are disclosed in your m-3 reconciliation but not your financial statements with the SEC)?

3% of 60 billion is a lot.

This is a load of bs! The representation of 3% profit is ridiculous. Insurance companies are making life and death decisions based on MAKING MONEY! That is the bottom line --- this is CRIMINAL. The ONLY time, I as a mental health provider, have EVER experienced an insurance company being "helpful and caring" is when there is a child dying of cancer. Then they almost have carte blanche to services --- but if they needed a medication that was not approved by the insurance companies that compassions would go right down the drain. You have clearly been as brainwashed as most of america on the "profits" of insurance companies --- just like the "profits" (or lack thereof that they claim) of the banks who then use our bailout money to pay million dollar bonuses to Execs. COME ON AMERICA -- WAKE UP AND STOP TOLERATING THIS!!!! IT'S CRIMINAL!

How come my homeowners insurance keeps going up every year but the value of the home goes down? I have never had a claim and I don't see discounts. My grandmother paid auto insurance for 50 years and never had a claim where's her bonuses? All yeah I thank my agents name is Steve maybe I don't know but he's my buddy!

Does this include the 2-3 billion each that the companies spend (does not appear on the income statements) to pay their executives stock dividends? No? Yeah, maybe next time use numbers like "Cash flow from operating activities."

Ok, so you took the 2.5 trillion number and divided it by 309 million (new population number per US cencus) and got $8,086. But of the 2.5 trillion, is that the amount that I pay in premiums, + my out of pocket, plus your costs, plus the moeny the doctor spends, plus what the pharmacy pays employee, plus what drug companies pay to lobbyists? I think the 2.5 trillion number has been inflated by 4-5 times. It does not cost $8,000 per person and it is completely ridiculous to assume that that number is correct.

Wow, $8086 per person. So, If only accounted for $400 to $1000 per year for 18 years are you saying that I am owed one awesome refund from BSBSNC???? Which BTW, most spouses of people that have BSBSNC "provided" cover themselves and their children for alot less, tremendously less, and they are on group plans with their employers. So, why is BCBSNC so expensive?, goat media campaigns?

I have read on here from Directors, Human Relations people, etc... and the purpose of this site is so I can contribute to an "open discussion" to help solve problems TO reign in medical cost? You guys earn awesome salaries to run this company. Sorry, but I should not have to run your company too. I am accountable for my work, and you should be too. I barely have time for my job much less yours. If you have to justify your profits, bonuses, and salaries through media goat campaigns, something is wrong.

Shannon – The $8,086 per person is an average that covers all medical spending; this ranges from insurance premiums to doctor’s fees, public health programs and prescription costs. So while some people may spend significantly less on their medical care, others may spend significantly more. I think we can both agree that it’s hard to get a true snapshot, because all of our situations are so unique.

The harsh reality is that health insurance is expensive because health care is expensive.

I do want to mention that the Let’s Talk Cost campaign does not affect our customer’s premiums, which are determined by the price of medical goods and services and how often those goods and services are used. We believe that the thoughts and discussion started on this website can actually lead to cost savings. And we know that there are North Carolinians who want to share their ideas, and we are listening.

Our job as a health insurer is to pay medical bills, but we feel a greater responsibility to improve the health care system in North Carolina. And we cannot change the system alone – we need everyone from doctors, to pharmaceuticals, to individuals like yourself to share their ideas and perspectives on how we can work together to rein in costs. In turn, we believe this will help create a better health care system for North Carolina.

Thank you for your comment, John. We created Let’s Talk Cost to start a dialogue about solutions to the rising costs of health care. We are pleased with the level of participation and conversations taking place among users. But, it is very important to us that we are part of that dialogue as well. Our Public Relations Manager is one of many BCBSNC employees communicating across the website. There are also comments from our Chief Medical Officer, Director of Provider Relationships, Director of Member Service Operations, and even our CEO, Brad Wilson.

We realize if we’re going to find solutions to lower costs, we must be collaborative. We need all good ideas from everyone involved in health care. I hope you will join us in sharing your ideas to help rein in medical costs.