Does Insurance Company Transparency Help You?


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By Scott W. Dowling. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.

#016 Insurance company transparency is required by both the Affordable Care Act and the new Hospital Price Transparency rule that took effect on January 1, 2021. Learn how insurance companies are complying and how (if) that helps you.
The Patient Protection Affordable Care Act, aka Obamacare, requires insurance companies to publish the prices they negotiate and amounts they pay to doctors, hospitals, pharma and other providers.
Learn about the PPACA here
Insurance company transparency required by Obamacare includes publishing Medical Loss Ratios (MLR). An MLR is the percentage of paid claims plus reserves (IBNR) relative to the total premium an insurance company receives. Obamacare requires that the percentage representing claims be at least 80% of total premium.
While apparently meeting the federal government requirements, insurance companies do not present any of the information in a consumer friendly way, which is truly unfortunate. Accessing the data is cumbersome. The insurance jargon used is worthless to the average consumer.
While the politicians can claim they did something for their constituents and the insurance companies can claim that they are dutiful and compliant in meeting the needs of consumers, the information is worthless. Further, the time and money spent producing the data is part of the administrative expense added to the premium you your insurance costs more with nothing to show for it.
See how insurance companies meet Obamacare requirements here
CMS, the Center for Medicare and Medicaid Services, requires insurance company transparency, at least from what the former Secretary of Health and Human Services says.
From the HHS site: The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rates they actually pay healthcare providers for specific services.
Still, what insurance companies really need to disclose and publish is what their rates are, what their loss ratios are, what their expenses are and what their profit is.....and don't be fooled....not-for-profits make lots of money......
See the statement including Insurance Company Transparency here
Bottom line is that you need to take control. Stick with me and we'll get it done!
Next episode, we'll look at the healthcare exchanges and see what might be usable and useful to you, a friend or a family member.
Thanks, as always, for listening. I appreciate you and the time and support you afford me. Tell your family, friends and colleagues.....we're all in this together!

19 episodes