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Pinkflamingo

(177 posts)
Fri Dec 5, 2014, 02:44 PM Dec 2014

Let's talk about why healthcare premiums are so high in Florida

I'm a doctor in Melbourne who's spent my entire career dealing with health insurance companies so I know a thing or two about healthcare insurance. I could write a book but I'll stick to a big reason why rates are so high here.

In May of 2013, our state legislature passed a law that disallows our Florida Insurance Commissioner from refusing or negotiating ANY health insurance rate hikes. From Politifacts:

http://www.politifact.com/truth-o-meter/statements/2013/aug/08/ted-deutch/florida-democrats-say-gov-rick-scott-and-legislatu/

Health insurance first came into being after WWII. Congress wrestled with how to regulate the new industry and ultimately decided to allow insurance companies to raise their rates at their sole discretion. When this proved to be a mistake, they tried to rectify the situation by having state insurance commissioners (in our case currently Mr. McCarty) to evaluate whether proposed increases are justified. Unfortunately, this is no longer happening so is it any wonder that rates have taken a huge increase? Of course this was done to make the ACA Marketplace look bad.

Florida Blue is the largest insurer in the state. The CEO contributed $5M to Scott's first campaign, and recently had the pleasure of announcing this 17.6% rate increase:

http://kaiserhealthnews.org/news/floridas-largest-health-insurer-is-raising-exchange-rates-an-average-of-176-percent/

So now we know why rates are up. Please spread the word.

7 replies = new reply since forum marked as read
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Let's talk about why healthcare premiums are so high in Florida (Original Post) Pinkflamingo Dec 2014 OP
k and r! nashville_brook Dec 2014 #1
Thanks So Much For Posting This! ChiciB1 Dec 2014 #2
Hi ChiciB1 Pinkflamingo Dec 2014 #4
K&R hay rick Dec 2014 #3
My premium with FL BCBS went up 24.6% steve2470 Dec 2014 #5
Sure! Pinkflamingo Dec 2014 #6
thanks for a great answer, much appreciated nt steve2470 Dec 2014 #7

ChiciB1

(15,435 posts)
2. Thanks So Much For Posting This!
Fri Dec 5, 2014, 08:12 PM
Dec 2014

Will come back a little later, very busy right now. Both my daughter & son-in-law are in the medical field. My daughter got her Masters Degree and is an ARNP in cardiology and her husband is finishing up on his Masters in the same field and will graduate in about a year!

I hear more than most, but passing the information along to uninformed and apathetic citizens is quite an ordeal! Drives me crazy too! Very, very sad!

Pinkflamingo

(177 posts)
4. Hi ChiciB1
Sat Dec 6, 2014, 12:05 PM
Dec 2014

Thanks for your show of appreciation and I hope your daughter and son-in-law enjoy long and happy careers. The work is hard but also rewarding.

steve2470

(37,455 posts)
5. My premium with FL BCBS went up 24.6%
Sat Dec 6, 2014, 12:08 PM
Dec 2014

As a result, I had to severely downgrade my coverage. Can you talk more about what is driving health care cost inflation and insurance prices, please ? Thanks.

Pinkflamingo

(177 posts)
6. Sure!
Sat Dec 6, 2014, 02:25 PM
Dec 2014

The reason why inflation in healthcare is so much higher than regular inflation is due to several things. In no particular order:

There's 3 factions that aren't concerned enough about rising prices. The patient does care about the doctors prices, the patient is only concerned about the premium. The insurance company doesn't care about rising prices because they use this info to justify raising rates. The doctor is always playing catch up on their charges to patients because the insurance companies' formula for determining payments to the doctor are based on 90%. The insurance determines the average cost of a procedure and pays the doctor 90%, so doctors will raise their fees to catch up. Plus, in my practice, the insurance companies lost or paid incorrectly about 20% of all the claims we submitted. Of course they always told the patient that we had not submitted a claim. And they hired only minimum wage workers to process the claims which made for many errors, always in their favor.....I'm digressing, aren't I?

A vicious cycle indeed. Meanwhile Aetna has a million different policies. So do all the other insurers. It doesn't even depend on where you work because one level of worker often has worse coverage than higher level employees with the same carrier.

Insurance companies are always looking to reduce coverages. Something that they use to pay 80% on is now covered at 60% but they don't tell the policyholders, or the doctors, or the employers. I've even had an insurance company that moved their offices and didn't tell my office. They don't care, their goal is to make everything so difficult that people just give up and accept 'oh well, the insurance didn't pay' much or at all. They never use to give the patient an Explanation of Benefits, that's how old I am.

My point is everything is just too confusing and always changing as to what's covered and how much. This creates extra expense. The goal of the ACA is to be able to compare policies with similar coverage and although we're not quite there yet, hopefully one day we will be. Sadly there's been much sabotage from the right.

This is why some of us here believe we should have a one payer system. My dad was in the Air Force so I experienced a one payer system there that worked just fine. Yes, there would be waste in the system but look at how much time and money we're wasting with the current system! At least a one payer system wouldn't have a bunch of mega rich CEOs at the top.

You can see I have no love for insurance companies but at least I'm honest about it.

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