I am delighted that our insurers are able to ask for - and receive - increases in their premiums.
How about us?
Who speak for us?
Why is it all too often a "Take it or leave it" for OUR reimbursements?
Our expenses continue to increase, too.
From my observation some insurers pay according to provider market share and the insurers fear loss of coverage if they don't - through their kindness - offer higher rates to those with larger (national chains) practices.
How about paying providers on MERIT?
This would mean that only the best-of-the-best (those providers who provide superior service) determined by a reasonable standard of excellent patient care?
Wouldn't this make it easier for patients (WE AND OUR FAMILIES ARE PATIENTS, TOO) to choose the best care for themselves and their families?
Please...how do we make sense of this aspect of our industry that would most appropriately be of benefit for our patients?
We continually scramble to reduce expenses to adjust for these lowering reimbursements and IMHO it's causing undue frustration for patients and providers alike.
How do we bring method to this madness within the bounds of fairness and decency?
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As the number of Covid-19 cases continues to fall, a debate is just beginning about whether the pandemic will lead to higher insurance costs in 2021.
The state Department of Financial Services released insurers' rate requests for the individual market June 5, showing local plans are looking to increase rates by anywhere from 2.4% to 19.1% on average.
The insurers are all interpreting the effect of Covid-19 differently, with some plans pointing to the higher costs of hospital treatment, testing and a potential vaccine next year as reasons to raise prices.
Oscar, which is asking for the 19.1% average increase, said its higher premiums "reflect the anticipated impact of items such as pent-up demand, the introduction of antibody testing, vaccination costs, and market morbidity associated to membership migration from the employer markets in response to the COVID-19 pandemic on the individual market in New York."
Of course, visits to doctors' offices fell drastically, and nonurgent surgeries, such as joint replacements, have been postponed for months, saving insurers money.
"The Cuomo administration should be really skeptical about these rate requests," said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, which advocates for consumers. "We don't think they should buy this Covid bump."
There's also run-of-the-mill medical inflation which most plans pegged between 4% to 6% in developing their rates for 2021.
Fidelis Care, the insurer with the greatest market share in the individual market, pointed to four factors that made the increase necessary. Higher medical and pharmacy costs, risk-adjustment payments levied by the federal government, the operating costs of developing and maintaining office buildings and computer systems to comply with changing health care requirements and a less healthy population due to the elimination of the individual mandate requirement.
Fidelis attributed 8.4 percentage points of its 18.8% average request to Covid-19. It echoed Oscar in its concerns about Covid, adding that it anticipates higher costs due to complications from people recovering from severe cases of Covid-19.
New York City residents will have seven options to choose from if they're buying coverage in the individual market: EmblemHealth, Empire BlueCross BlueShield Health Plus, Fidelis Care, Healthfirst, MetroPlus, Oscar and UnitedHealthcare.
Healthfirst, which has the second-highest number of members from the ACA marketplace in the metro area, requested a more modest 2.4% average increase. It's increasing prices 3% and New York City and keeping them the same for its Long Island customers.
The state Health Plan Association has noted that insurers have taken on added costs during the pandemic. They waived copays for Covid-19 testing and telehalth visits, and allowed customers to defer their premium payments, starting in April, until June 1. Some also made advance payments to hospitals.
Insurers have participated in a special enrollment period, ordered by the governor, which allowed people another chance to buy coverage from March 16 to June 15. Gov. Andrew Cuomo announced he would extend the period to July 15 on Sunday. New York's regular open-enrollment period ended Feb. 7.
MetroPlus said 2.1 percentage points of its 9.6% average increase were due to Covid-19 but it "does not wish to recoup the added costs associated with complying with NYS DFS COVID-19 requirements in the 2021 rate filing," the insurer wrote.
DFS' decision on how it will adjust rates is expected by August.
Plans shouldn't be asking for increases of this magnitude after benefiting from a drop in medical utilization during the pandemic, Benjamin said. She noted that some of plans in recent years have spent only about 75% of premiums on medical costs and are then forced to give customers rebates. In New York's individual-market, insurers must spend 82% of premiums on medical claims or give rebates to consumers.
"Why should consumers be loaning health plans money interest free?" Benjamin asked. "Essentially consumers are subsidizing insurance companies when it should be the other way around."
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William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com(301) 424-4888
https://www.linkedin.com/in/billkisse/------------------------------