IRS announces 2024 HSA, HDHP limits

[LostDollar]

That's great. The downside is that you have to spend that amount prior to the insurance to cover 100%

And your point is????

The answer is in other posts.

You seem to be ducking something here.

Are you saying that the only proper type of health insurance coverage that carriers should sell is coverage with no deductibles?

 

[Yagents]

HSA plans do not have "copays", so they require client re-education.

Network contract rates are higher then cash rates, that's a problem. MRI, $450 using insurance, $250 if pay cash right then. Choice u choose depends on how much of deductible has been met.

Problem is that ACA OOP's are increasing At a much higher rate the HSA 7k OOP's, causing HSA plans to have higher premiums vs $9100 OOP ACA bronze plans.

Solution, everyone should be able to open HSA accounts. Insured or not. Get everyone off the govt tittie

 

[somarco]

I thought insurance carriers set the repricing structures for plans they offer and networks they create and offer providers membership in.

It's actually more of a negotiation between provider and the MCO. The contract usually runs a 3 year cycle for hospitals . . . often shorter for docs & clinics. As the expiry approaches the carrier offers a new pricing schedule and either they come to an agreement or not.

Sometimes they are at a stalemate when the contract ends . . . most of the time they reach an agreement within a few days . . . sometimes it goes longer.

Medicare & Medicaid likewise have contracts but it is more like "take it or leave it". M & M have a lot of "juice" to use as leverage.

 

[Deborah Armstrong]

Those are fluff pieces from two left wing organizations written by folks who have no real knowledge of how insurance works.

Insurers adjudicate every claim and reprice according to the MCO agreement signed and agreed to by the providers. Medicare has their own reimbursement schedule which is always lower than commercial insurers.

Many Medicare claims are flat rate or per diem, not based on a schedule.

If carriers did not adjudicate all claims, regardless of the size, their reinsurance carrier would yank their contract.

I am glad you have never experienced that. I do not trust that companies or corporations will never have errors, so I always check. We are insurance agents we are required by law to have E & O and not because we are dishonest but because we are human. and can make mistakes.

 

[Deborah Armstrong]

You seem to be ducking something here.

Are you saying that the only proper type of health insurance coverage that carriers should sell is coverage with no deductibles?

All carriers have deductibles. What you contribute to your HSA is used as a deductible. Once you meet your OOP (out of pocket of copays, deductibles and coinsurance) then the insurance pays 100% of covered benefits You would have to look at your plan to see what is a covered benefit.

 

[LostDollar]

I am glad you have never experienced that. I do not trust that companies or corporations will never have errors, so I always check. We are insurance agents we are required by law to have E & O and not because we are dishonest but because we are human. and can make mistakes.

you seem to be suggesting that people going to doctors (almost everybody) have to become insurance billing experts too.

If you look at an EOB and see a billed price and a network price, how do you propose that the patient knows if there is an error there. I don;t think that is possible.

 

[Deborah Armstrong]

you seem to be suggesting that people going to doctors (almost everybody) have to become insurance billing experts too.

If you look at an EOB and see a billed price and a network price, how do you propose that the patient knows if there is an error there. I don;t think that is possible.

I wouldn't say that it isn't possible. I would say it is highly unlikely they will catch it. With that said, the more you can educate your clients and give them information that others aren't giving them. The less likely they are to jump ship to another insurance agent or broker.

 

[LostDollar]

you seem to be suggesting that people going to doctors (almost everybody) have to become insurance billing experts too.

If you look at an EOB and see a billed price and a network price, how do you propose that the patient knows if there is an error there. I don;t think that is possible.

I wouldn't say that it isn't possible. I would say it is highly unlikely they will catch it. With that said, the more you can educate your clients and give them information that others aren't giving them. The less likely they are to jump ship to another insurance agent or broker.

I asked you this question:

If you look at an EOB and see a billed price and a network price, how do you propose that the patient knows if there is an error there.

to which you did not respond.

and made this statement:

I don;t think that is possible.

To which you responded:

I wouldn't say that it isn't possible. I would say it is highly unlikely they will catch it

So we need to back up.

In 2022 I received EOB's from my primary insurance carrier that accounted for around 60 billings (give or take) from Medical providers.

I think most of those bills included services that were repriced, some of them also included services that were not repriced.

Let's take one of those bills.

It totaled over $142K. It contained 44 service line items. Some of the services were repriced. Some were not repriced.

What kind of errors do YOU think that bill could contain?
How would YOU expect someone to review the EOB and find them?

 

[somarco]

some of them also included services that were not repriced.

Look at your MSN for those not repriced. Were any coded as "L" or "O"?

If so, those services are not covered by Medicare.

 

[Deborah Armstrong]

I asked you this question:

to which you did not respond.

and made this statement:


To which you responded:


So we need to back up.

In 2022 I received EOB's from my primary insurance carrier that accounted for around 60 billings (give or take) from Medical providers.

I think most of those bills included services that were repriced, some of them also included services that were not repriced.

Let's take one of those bills.

It totaled over $142K. It contained 44 service line items. Some of the services were repriced. Some were not repriced.

What kind of errors do YOU think that bill could contain?
How would YOU expect someone to review the EOB and find them?

Not enough information. I would have to look at it to see all the details. At this point I have lost interest in this discussion. Everyone keeps going in circles around assumptions of what is meant and assuming things. I won't question we have very intelligent agents/brokers on here that understand their business. I also noticed a lot of people grasp on to one or two things that someone is saying and assume what was being said.. I am not speaking about my comments specifically but I notice that this is common practice any anyone's comments. For this reason, you can all debate amongst yourselves.