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ObamaCare Discuss Report: Medicaid enrollment, costs swell under ObamaCare expansion at the General Forum; Originally Posted by AZRWinger Medicare dictates reimbursement rates to healthcare providers whereas private insurance providers don't have the power to ...

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Old 12-27-2017, 12:01 PM
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Default Re: Report: Medicaid enrollment, costs swell under ObamaCare expansion

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Originally Posted by AZRWinger View Post
Medicare dictates reimbursement rates to healthcare providers whereas private insurance providers don't have the power to dictate cut rate reimbursement. It is likely part of the cost of private care offsets the loss from low Medicare rates.
Mmmmm.... private insurance negotiates payment rates (reimbursement) with medical providers based on groupings called Reasonable & Customary, sometimes based on zip codes, because not all areas have the same cost factors for procedures. Networks also have negotiations for doctors and hospitals.

Ever read your EOB?
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Old 12-28-2017, 04:00 PM
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Default Re: Report: Medicaid enrollment, costs swell under ObamaCare expansion

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Mmmmm.... private insurance negotiates payment rates (reimbursement) with medical providers based on groupings called Reasonable & Customary, sometimes based on zip codes, because not all areas have the same cost factors for procedures. Networks also have negotiations for doctors and hospitals.

Ever read your EOB?
Private insurance negotiates, Medicare dictates, see the difference? The former is voluntary, the latter mandatory.

Yes, I have reviewed my EOB, everyone should so they can reconcile them with the bills from medical providers.
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Old 12-28-2017, 04:35 PM
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Default Re: Report: Medicaid enrollment, costs swell under ObamaCare expansion

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Originally Posted by AZRWinger View Post
Private insurance negotiates, Medicare dictates, see the difference? The former is voluntary, the latter mandatory.

Yes, I have reviewed my EOB, everyone should so they can reconcile them with the bills from medical providers.
I agree on the negotiates/dictates, but I won't stretch so far as to use the words voluntary/mandatory. A doctor or facility can decline to accept either one.
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Old 12-29-2017, 05:28 AM
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Default Re: Report: Medicaid enrollment, costs swell under ObamaCare expansion

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Originally Posted by AZRWinger View Post
Medicare dictates reimbursement rates to healthcare providers whereas private insurance providers don't have the power to dictate cut rate reimbursement. It is likely part of the cost of private care offsets the loss from low Medicare rates.
oh bullowney. all insurance pays what they pay. none pay everything unless you have a cadillac plan and even then they do dictate which drugs they will pay for and sometimes not the drug needed and generic but a whole different drug. I know this because I had that situation when my son was sick as a teenager.
And the doctors around here are quite happy with my husband's medicare. though he has almost entirely switched to the VA now. But when he did use medicare they rolled the carpet out for him. Also he gets his vaccines w/o co pay through medicare.
but I think the thread is about medicaid, which is also good. handled by states it is better some places than others. For a low populated state and rater poor, Idaho has excellent service and cost.
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Old 01-02-2018, 09:01 AM
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Default Re: Report: Medicaid enrollment, costs swell under ObamaCare expansion

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oh bullowney. all insurance pays what they pay. none pay everything unless you have a cadillac plan and even then they do dictate which drugs they will pay for and sometimes not the drug needed and generic but a whole different drug. I know this because I had that situation when my son was sick as a teenager.
And the doctors around here are quite happy with my husband's medicare. though he has almost entirely switched to the VA now. But when he did use medicare they rolled the carpet out for him. Also he gets his vaccines w/o co pay through medicare.
but I think the thread is about medicaid, which is also good. handled by states it is better some places than others. For a low populated state and rater poor, Idaho has excellent service and cost.
That is true, but the difference between private insurance and a one size fits all government coverage is that one has the ability to shop around for different providers of private insurance. With a government plan, you are stuck with what you get while unelected bureaucrats decide what you do and do not need.
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Old 01-02-2018, 12:01 PM
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Default Re: Report: Medicaid enrollment, costs swell under ObamaCare expansion

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Originally Posted by GottaGo View Post
I agree on the negotiates/dictates, but I won't stretch so far as to use the words voluntary/mandatory. A doctor or facility can decline to accept either one.
Negotiated prices with private insurance companies are voluntary. There is no negotiating with government reimbursement rates. Healthcare providers can elect to accept or reject either.
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