About Anthem Blue Cross Private Health Insurance Payments to Doctors....Reader comment on: Anthem Blue Cross Premium Increase Irks Sebelius Submitted by xzr56 (United States), Feb 26, 2010 14:43 Upset that your monthly Anthem Blue Cross Health Insurance Premium charges will increase by 39% in 2010 after 2009's 20% increase (in this time of "no inflation")? Just remember that Private Health Care Payments = Government Health Care Payments + 20%. The "Maximum Benefit Allowance" for over 8000 procedures codes with private health care supplied by Anthem Blue Cross Blue Shield is the Medicare rate (ie: government single payer rate) plus 20%. That is Anthem's "Maximum Benefit Allowance" even if your private health insurance premiums are double or triple what you would pay into a government option. You pay so much up front as a private investor owned health insurance policy holder, while medical providers who actually do the work on you get paid so little out the back door. Why should Anthem pay any more than 20% higher than government reimbursements? Doctors cannot negotiate with large health insurance companies. They simply take what the health plan offers as reimbursement, or they leave the health plan. Private health insurance companies only need to pay out a little bit more than government reimbursement rates to claim the high ground of the "socialized medicine" hot button "debate". But then private health insurance companies work tirelessly to avoid payment, deny treatments, create unending confusion and complexity, increase paperwork for policyholders and providers, etc etc etc.. The great thing about this setup is that private health insurance companies can always shout out how they pay doctors MORE than government health insurance, but they never say exactly HOW MUCH MORE, even if you are paying monthly premiums that are double or triple than what you'd end up paying to the government to buy into medicare… A very large protion of the huge pile of money Americans pay to the health insurance industry is skimmed off as profit for wall street investors, and high salaries / bonuses for executives. Here it is, straight from the horse's mouth. (exact copy of text from my recent Anthem BCBS rejection of appeal letter requesting payment to a health care provider... < <<<<<<<<<<<< "Anthem's maximum benefit allowance (MBA) is based on a calculation. The calculation is determined The Medicare "Physician Fee Schedule" establishes the payment policies and payment rates for over To determine the payment rate for a particular service, Medicare applies a conversion factor expressed in Anthem applies its own conversion factor to determine the payment rate for a particular service. Note: Comments are moderated by the editor and are subject to editing. Other reader comments on this item
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