Extreme profit health insurance company thugs -- in this case, evil Aetna -- often claim that one reason that their premiums are, well, so extreme, is because they get charged more by hospitals and doctors due to Medicare and Medicaid -- highly-popular government insurance programs -- paying so little.
Well, insurance companies have never been ones to shy away from extreme hypocrisy if it means they can pad the pockets of their Wall Street masters with more profits. Enter Aetna's new love affair with single-payer Medicare. The Wall Street Journal reports:
Health Care Service, the nonprofit parent of Blue Cross and Blue Shield plans in Illinois and Texas among other states, began phasing in Medicare-based fees last year. Cigna says employers are increasingly opting for plans that pay a set percentage above Medicare.
Insurers say Medicare is a reasonable basis for reimbursement. An Aetna spokeswoman says the Medicare-based payments are a "more consistent way of paying and keeping the premium down." Health Care Service says the Medicare method helps "increase transparency for providers and members."
What does this mean? Extreme-profit insurers realized that they can't squeeze any more blood out of patients -- they have to start hitting the doctors. (This is fine by me, of course, since when doctors turn on the insurers in mass they'll be really screwed!)
Aetna says some of its plans began basing out-of-network payments on Medicare rates in late 2009, and typically they pay a percentage above the government program's fees.
This is really working out swell for the big-profit insurers. According to the Journal, Blue Cross and Blue Shield of Illinois is one of those companies parroting single-payer Medicare, and look how swell they're doing:
The parent of Blue Cross & Blue Shield of Illinois raked in $1.1 billion in profit last year, a doubling of 2009's results that is likely to stoke the controversy over skyrocketing health insurance costs.
Chicago-based Health Care Service Corp. has kept up the torrid pace in 2011, with net income leaping by nearly two-thirds to $437 million in the first quarter from $275 million a year earlier.
Of course, some Aetna patients (errr...consumers) aren't enjoying this new profiteering scheme that much:
New York entertainment attorney Mark D. Sendroff says he knew he'd get a bill when he went to an out-of-network surgeon for a shoulder operation last summer. But he was shocked when his Aetna health-insurance plan paid only around $1,000 of the surgeon's approximately $30,000 charge -- and part of the payment was his deductible. "It was absolutely crazy," he says.
Mr. Sendroff thought the plan was going to pay his doctor based on a "usual and customary" rate that's supposed to represent a typical charge for his area. Instead, the insurer pegged the doctor's reimbursement to 110% of the fee paid by Medicare. Mr. Sendroff appealed the decision, and after he contacted the New York attorney general's office, Aetna agreed to pay more, he says.
Aetna says some of its plans began basing out-of-network payments on Medicare rates in late 2009, and typically they pay a percentage above the government program's fees. In New York, the company says it warned insurance brokers the new system might generate bigger out-of-pockets, and mentioned the issue in a summary for potential customers.
So, you know, if Aetna and fellow industry thugs were really doing this to just help "control costs," which is entirely necessary by the way, this new system might be all well and good for everyone. But, do you really think Aetna will cut premiums now that it's saving thousands and thousands of dollars on out-of-network care? Probably not! Given that Aetna backed down in the above case when the policyholder contacted his Attorney General's office, Aetna knew it would not win this case in the court of public opinion -- or probably even the court of law.
What's the take-away point from all this?
Extreme-profit insurers are proving once again that they are entirely unnecessary and a worthless parasite sucking the blood out of our health care system.
No, that's not hyperbole...not by a long shot.
If extreme-profit insurers are just copying the reimbursement rates of Medicare, which has been going on for a long time even before this story broke, why the heck do they even exist?
You know, if the overpaid CEOs of Aetna and CIGNA love Medicare so much, perhaps they should join the Physicians for a National Health Program in advocating for an improved Medicare for all. Or join California in fighting for California One Care.
If this latest news is any indication, some so-called "free-market," extreme-profit health insurers just seem to be proving that opposites attract.