How Do We Get Affordable Health Insurance in Texas? Limit Doctors Pay.

OK, lets hop right into a sticky little subject, limiting your local doctors and hospitals billing amounts. Yep, light me up, call me a socialist. Do whatever you please, I could care less. But the bottom line, doctors, hospitals and pharmaceutical companies are the MAIN reason Texas health insurance premiums are breaking records in regards to yearly increases. Affordable health insurance in Texas could be at every consumers doorstep with a little consistency in billing. Let me explain.

My wife and I were blessed just last month with the arrival of our twins, with that we are now receiving medical bills and explanation of benefit(EOB) forms out the gazoo. I have spent hours combing over the bills and EOB’s with much enjoyment. OK, no enjoyment. I hate it just like you do but did it all the same. Here is what I am finding out, on average the Texas health insurance company, in this case Aetna, is paying right at 60% of what the doctor is actually billing the insurance company.

Billing to date reflects a total cost from conception to release from the hospital of $44,614. The actualy negoiated cost after PPO discounts sliped in at $26,645, right at 60 cents on the dollar of actuall billed amount. This is crazy.

Health insurance companies in Texas receive a discount on services from the health care providers when they are in their network of facilities. This has been going on since I became a health insurance in Texas broker. My problem is why do doctors and hospitals feel the need to charge the higher amount in the first place.

Now, ask yourself this question. Who pays the base rate, in this case the 45 grand? If I get a discount who doesn’t? If no one pays the base rate as some doctors claim why have it there in the first place? Now, here is the answer the all the questions, unsuspecting, naive consumers pay it, that’s who. Doctors are ripping off Texans right and left and the practice must be stopped. Lets just go to a set schedule using the mindset of how Medicare does it, however the amounts should be bumped up due to the low schedule Medicare uses. This system will work.

By instituting a federal law to regulate medical billing as I have discussed here it what you achieve, first you will no longer need PPO plans, all charges will be set with very minor modifications like geographical billing trends. Doctors and other providers like drug companies have been a runaway mine train with medical billing for years steadly ripping off Texans day after day. Simply put, control the spending and you will control Texas health insurance premiums. It is nothing more than common economics.

According to a report released by Wellpoint Health 87 cents of every dollar goes to pay medical expenses. 87 cents! To me that number is astronomicaly high. Also according to their report their profits come in at about 3% of every dollar. Marketing, provider support and consumer support at 4 cents of every dollar. Other addmin cost and goverment payments are at 6 cents. So overall if you think about it the 87% of every dollar being paid to doctors, hospitals and drug companies is more than adaquate. So the problem lies in what your doctors are charging you, bottom line, lower medical claims you will lower premiums and the end result will be affordable health insurance in Texas.