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  #61  
Old 11-04-2019, 07:45 PM
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Or.. herpes...
Ladies and gentlemen, I think we’re on to something.
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  #62  
Old 11-05-2019, 09:59 AM
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It says ‘flat fees’ for things like procedures. So it could be $4k OOP for a surgery or whatever, right? I don’t think there is enough detail to really tease out what the benefit design looks like.

But in general I agree with what I think you’re getting at: if it’s a really great deal for employees, it’s likely not a great deal for plan sponsors.
This is where my mind went. Seems like first two years they price aggressively with low copays. Then as experience starts to hit, the copays go way up and add deductible to satisfy all the healthy members on cost.
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  #63  
Old 11-05-2019, 10:52 AM
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A great deal of "upkeep" is significant costs for ongoing chronic conditions (due to a rare disorder that is unrelated to any "stay healthy" exercise/diet options).
This is something that is not very well suited for insurance but is very well suited for a social insurance.
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  #64  
Old 11-05-2019, 11:34 AM
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It says ‘flat fees’ for things like procedures. So it could be $4k OOP for a surgery or whatever, right? I don’t think there is enough detail to really tease out what the benefit design looks like.

But in general I agree with what I think you’re getting at: if it’s a really great deal for employees, it’s likely not a great deal for plan sponsors.
I remember a certain ACA plan that was copay only. It had a $6,350 inpatient hospital copay. That also happened to be the regulated maximum OOP that year. That's one way to avoid inpatient usage.

For other reasons, they were liquidated a year later.
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  #65  
Old 11-05-2019, 11:37 AM
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Copay is a per-service "you pay up to this amount" charge. So, anywhere from $5 to $50.
Deductible is a per-year "you pay up to this amount" charge that accumulates until you reach it. So, anywhere from about $250 to $7000.
I've seen copays of like $125-$175 for Emergency Department visits. Though it was a very generous plan that I guarantee lost money.
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  #66  
Old 11-05-2019, 01:05 PM
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I remember a certain ACA plan that was copay only. It had a $6,350 inpatient hospital copay. That also happened to be the regulated maximum OOP that year. That's one way to avoid inpatient usage.

For other reasons, they were liquidated a year later.
Exactly. I’d like to see some more details, but best I can tell this really doesn’t look like innovation.
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  #67  
Old 11-05-2019, 01:29 PM
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I've seen copays of like $125-$175 for Emergency Department visits. Though it was a very generous plan that I guarantee lost money.
I thought there would be questions about my ranges. But, meh.
Just trying to healthactuarysplain it to Westley.
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  #68  
Old 11-05-2019, 01:33 PM
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A great deal of "upkeep" is significant costs for ongoing chronic conditions. For example, the $5,000 per year drug I take, which I will be on for life (assuming no developments that change things) so that I don't die (and is due to a rare disorder that is unrelated to any "stay healthy" exercise/diet options). Ideally, I could have obtained long term coverage when I was younger for the possible of being diagnosed with a future chronic condition. That option has been and continues to be non-existent. Since this kind of situation affects many people, and it is literally impossible for them to buy an insurance product to mitigate their future risk, it's necessary that we have a system which covers ongoing costs.
It is the one glaring issue that no one seems to recognize nor wants to discuss, and thus don't bother to solve: people are starting out with different health statuses (stati??), and there is a wide variance of the expected costs of people. One simple solution doesn't fix it for everyone. And guess who will yell the loudest about "unfairness" (and with good reason)? The ones most adversely affected.
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"45 es un titere" -- Seal of The President of The United States of America protest art

“That is reminiscent of Harry Truman’s famous saying, ‘The buck stops, uh, somewhere over there, maybe?' That is a level of dodging responsibility that Trump has been perfecting ever since he was very much not in Vietnam.” -- LWTwJO
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  #69  
Old 11-05-2019, 02:22 PM
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It is the one glaring issue that no one seems to recognize nor wants to discuss, and thus don't bother to solve: people are starting out with different health statuses (stati??), and there is a wide variance of the expected costs of people. One simple solution doesn't fix it for everyone. And guess who will yell the loudest about "unfairness" (and with good reason)? The ones most adversely affected.
What you could do, and hear me out on this, is force insurers to accept members who have pre-existing conditions. And perhaps, just perhaps, put a cap on how much you can charge for coverage. Say, put a limit on the ratio of highest charged premium / lowest charged premium.

I need to see if this new health company is hiring, brb.
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  #70  
Old 11-05-2019, 02:33 PM
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It is the one glaring issue that no one seems to recognize nor wants to discuss, and thus don't bother to solve: people are starting out with different health statuses (stati??), and there is a wide variance of the expected costs of people. One simple solution doesn't fix it for everyone. And guess who will yell the loudest about "unfairness" (and with good reason)? The ones most adversely affected.
Hold on. You mean people are different. Maybe we can risk adjust the population. Everyone can pay the same rate and we shift funds from those who don't need care to those who do.

Groundbreaking stuff here. Anyone have the direct line for the Nobel application line?
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