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Curmudgeon's Corner

cur-mud-geon: anyone who hates hypocrisy and pretense and has the temerity to say so; anyone with the habit of pointing out unpleasant facts in an engaging and humorous manner

Health Plan Reference Pricing

U.S., Quality of Life, Politics, Healthcare

Health plan ‘reference pricing’ has been around for some time.  It involves the process of the plan sponsor locating two or three preferred providers for various costly health care procedures and then requiring that employees and dependents use one of those or that they bear the cost overrun when going elsewhere.

The Obama Administration has made its public position clear that reference pricing is permissible but only so long as the health plans use a “reasonable method” that assures “adequate access” to quality providers.

The employers that have been using this approach are using such methods since they typically research the quality outcomes information alongside pricing information to find the best quality providers within certain pricing parameters.  Forms of reference pricing have been around for several years.  This has most often been employed in self-funded health plans where the employer is directly responsible for making the decisions supported by data gathered by the employers’ advisors.

This most recent discussion apparently involves insured health plans using similar reference pricing points on costly procedures. 

I have relatively little concern when an employer institutes this kind of policy for its health plan(s).  I believe that employers have the best interests of their employees at heart and that they do not arbitrarily make decisions that could prove harmful.  An employer that did so would be open to law suits if cause could be found by attorneys, and it most likely could be found.

I expect reference pricing will rapidly become part of the ObamaCare health plans.  I do not have that same good feeling about its use in this world since I do not believe that government necessarily has those same feelings about the citizenry and since it is difficult if not entirely impossible to bring legal action against the government.

The Associated Press article discussing this latest decision taken by the White House includes the statement made by Karen Pollitz of the Kaiser Family Foundation who was quoted as saying, “The problem…from the patient’s perspective is that at the end of the day, that is who gets left holding the bag.”

Finding those same “good feelings” about how reference pricing might be handled and/or abused in ObamaCare is much more difficult for me.  The VA appointment charade in the West gives me chills and this tool in the hands of those running ObamaCare gives me chills as well.

We have definitely gone down the rabbit hole with the government now controlling a significant part of the health care decision-making.

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