Thread: What do you think will happen when...

Originally Posted by ChrisL

It's a long established game between health insurance companies and their contracted providers; providers increase their R&C charges (Reasonable and Customary) on services and insurance companies set a lower contracted rate. The contracted rate increases each time the R&C increases. If the R&C for a doctor visit in a certain area is $150 today the insurance company may pay $100. Next year the R&C may be $300. The insurance company may then pay $200, etc.

Chris L

Maybe the problem is that the patient/ consumer is not the one participating in deciding the Usual and Customary (that's what it was called when I was in practice) rate.

Originally Posted by honedright

Maybe the problem is that the patient/ consumer is not the one participating in deciding the Usual and Customary (that's what it was called when I was in practice) rate.

In the Midwest, "R&C" was and I assume is the term used interchangeably with "U&C". I worked for several health plans in Minnesota in the early and mid nineties much of that time as a claims processor than as a data analyst.

Chris L

I just found out that under the bill that is expected to be voted on in the next few weeks will mandate that everyone buy U.S. Government approved insurance or be fined up to $25,000 and up to a year in jail. This is on page 49 of the bill that was written in the House.

Also, states with more than 12% unemployment will be excused from paying for the cost of increases in Medicaid caused by the Universal Health Care. Originally, there were three states that qualified: Oregon, Michigan, and New Hampshire (IIRC). Harry Reed got Nevada added (his state). The cost of the free passes by these four states will be covered by Florida, California, and Illinois. Florida does not have personal income taxes, yet, and California is in terrible financial mess. I don't know about Illinois, but you can bet these three states will have to increase personal income taxes or enact personal income taxes.

Per the Congressional Budget Office, 21% of the cost of the Obama Health Care will be covered by families with family incomes less than $40,000 and 80% will be borne by families with family incomes less than $100,000.