disclosure Insurance agent here...I explain the basics of a policy like this: There are 3 stages...1. the Deductible (the You Pay Stage) 2. The Co-Insurance, this is the percentage...like 80/20 or 60/40. (the you both pay stage). 3. The out-of-pocket maximum (the "they pay" stage). I only work with individuals and families...does simple pay work with individuals and families?
Thanks, I do billing for doctors, I am learning so much from you! If we remove coinsurance from plan design and use copay only; how are copays calculated, how do the patients know ahead of time what their copay is? Thanks!
Great question. On their benefits materials/website from their employer who provides the insurance. Also, doctor does not collect copays. They are billed monthly like a credit card statement.
It’s difficult for me to not think cynically on this topic. It’s much easier to overcharge someone when they’re confused. Are there any good arguments for the complexity of the current designs? Who benefits other than the insurers?
what a mess we are in. thank you for your insights and help in navigating and understanding our broken system. Almost makes me hopeful enough not to leave the country.
You really should do a problem/solution series that focuses on solutions. You can then request viewers to share the vids to create awareness, especially among our representatives.
Great insights! The most important feature of a health plan is the out of pocket maximum for the calendar year. “American Healthcare 101” in all schools is a way out.
These numbers are so interesting. Amazing that most people in America don’t understand the basic terms in their health plans yet we have so many options. You wonder how these selections are fitting people’s needs
I keep asking the same question about "quality" providers that plans use. They offer lower co-pays for "quality" providers. How do they determine "quality"? Is that like a trade secret algorithm designed by Facebook or Twitter? Who determines this "quality"? Never had anyone tell me the answer, specifically for a primary care physician.
Great point. Whole can of worms… published research in residency on failure-to-intensify treatment/clinical inertia. Good = Doc Did something about BP, DM in face of elevated values (e.g. added med, increased dose, some other intervention). Bad = Did nothing and did not document why did nothing. Thoughts?
@@ahealthcarez So doing something or anything signifies a "good" doc. not really quantifiable like math though. very hard to figure that out using codes and data.
Good idea in many cases. Unfortunately, the law states that you MUST have a coinsurance plan (including Rx drugs in the coinsurance) in order to qualify for an HSA. The HSA is the best way for people to use their own pre-tax money, along with employer money in many cases, to fund health needs. And with no "use it or lose it" provision, the HSA is a way to save for retiree health care, without the delayed income taxation of a 401(k). But under current law, no coinsurance = no HSA.
disclosure Insurance agent here...I explain the basics of a policy like this: There are 3 stages...1. the Deductible (the You Pay Stage) 2. The Co-Insurance, this is the percentage...like 80/20 or 60/40. (the you both pay stage). 3. The out-of-pocket maximum (the "they pay" stage). I only work with individuals and families...does simple pay work with individuals and families?
Good question. No. Only self-funded groups. Thank you for watching and for your comment.
As someone who deals with patients on a daily basis who is in that 4%-9% category thank you!! 🙌🙌
Thank you for watching and for your comment.
Thanks, I do billing for doctors, I am learning so much from you! If we remove coinsurance from plan design and use copay only; how are copays calculated, how do the patients know ahead of time what their copay is? Thanks!
Great question. On their benefits materials/website from their employer who provides the insurance. Also, doctor does not collect copays. They are billed monthly like a credit card statement.
It’s difficult for me to not think cynically on this topic. It’s much easier to overcharge someone when they’re confused. Are there any good arguments for the complexity of the current designs? Who benefits other than the insurers?
True. Thank you for watching.
what a mess we are in. thank you for your insights and help in navigating and understanding our broken system. Almost makes me hopeful enough not to leave the country.
Thank you for your comment. Yes, quite a mess.
You really should do a problem/solution series that focuses on solutions. You can then request viewers to share the vids to create awareness, especially among our representatives.
Thank you for watching and for your feedback.
Great insights! The most important feature of a health plan is the out of pocket maximum for the calendar year. “American Healthcare 101” in all schools is a way out.
Thank you for watching and for your comment.
Thank you for attempting to clarify -- still confused despite your explanation --
Thank you for watching and for your comment.
These numbers are so interesting. Amazing that most people in America don’t understand the basic terms in their health plans yet we have so many options. You wonder how these selections are fitting people’s needs
Great point. They are not. Thank you for watching.
I keep asking the same question about "quality" providers that plans use. They offer lower co-pays for "quality" providers. How do they determine "quality"? Is that like a trade secret algorithm designed by Facebook or Twitter? Who determines this "quality"? Never had anyone tell me the answer, specifically for a primary care physician.
Great point. Whole can of worms… published research in residency on failure-to-intensify treatment/clinical inertia.
Good = Doc Did something about BP, DM in face of elevated values (e.g. added med, increased dose, some other intervention).
Bad = Did nothing and did not document why did nothing.
Thoughts?
@@ahealthcarez So doing something or anything signifies a "good" doc. not really quantifiable like math though. very hard to figure that out using codes and data.
Good idea in many cases. Unfortunately, the law states that you MUST have a coinsurance plan (including Rx drugs in the coinsurance) in order to qualify for an HSA. The HSA is the best way for people to use their own pre-tax money, along with employer money in many cases, to fund health needs. And with no "use it or lose it" provision, the HSA is a way to save for retiree health care, without the delayed income taxation of a 401(k). But under current law, no coinsurance = no HSA.
Thank you for watching and sharing your thoughts.
Do you think it is worth keeping the whole bronze human, silver, gold, platinum human grading system?
Not particularly. Obscures the reality of the very high OOP cost in the plans.
Thanks for the video!
Thank you for watching!!
Avoid health insurance and save, Telethink instead.