I’m prepping for my transition to the feasibility team and away from the plumbing department. One of my major tasks is the creation of formal, documented knowledge instead of tacit knowledge that I just happen to know because I’ve been doing X for so long that I know why we made that decision in 2008 and how it is still echoing today and will still echo in three years.
One of the documents I’ve been working on is the network bible. Part of that process has been documenting all the networks and their membership. Below is a chart of our biggest selling networks on the commercial side of the business and the percentage of hospitals and providers included in the network. The baseline for the percentages is the number of hospitals and total docs in the broadest commercial network that we sell.
Network | % Broad Hospitals | % Broad Docs | President during year of 1st introduction |
A | 37% | 98% | Bush |
B | 42% | 100% | Bush |
C | 15% | 35% | Bush |
Broad | 100% | 100% | when dinosaurs roamed the Earth |
D | 25% | 100% | Bush |
E | 64% | 90% | Bush |
F | 28% | 100% | Obama (before PPACA passed) |
Mayhew Narrow | 82% | 85% | Obama (PPACA Exchange) |
Mayhew Super Narrow | 21% | 44% | Obama (PPACA Exchange) |
Note that the three commercial networks which are the top sellers by membership are narrow to very narrow networks and they were all fundamentally built when President Obama was either a state senator or a junior Senator in D.C.
Narrow networks have been around for a while and have been popular with some large employer groups as a means of controlling costs without shifting too much first dollar burden onto individuals.
BGinCHI
“Narrow Networks” would be a good name if the GOP decides to re-brand.
GHayduke (formerly lojasmo)
Currently in the process of appealing a ROYAL FUCKING by my health insurance because they have no in-network detox centers, and I was in no mind to FUCKING GET PRE-APPROVAL for detox while I was withdrawing from alcohol dependency
Grumble grumble.
Richard Mayhew
@GHayduke (formerly lojasmo): Bring this up with your state insurance regulator… network inadequacy problems are easy wins for them most of the time.
GHayduke (formerly lojasmo)
@Richard Mayhew:
“Bubba” the fellow I just talked to, seemed to not care very much. I’ll just keep doing battle with my insurer until my options run out.
Happily, it’s not a terrible hardship for me personally, but it’s sort of a shit situation to require pre-authorization of somebody who is in the throes of withdrawal…and a grand isn’t chump change, either.
Mnemosyne
@GHayduke (formerly lojasmo):
Is it possible for you to get your primary care doctor (or whoever referred you to that center) to write a letter for the appeal? Sometimes it helps to have the backing of your doctor with stuff like that — they can say it was an emergency, couldn’t wait for pre-authorization, etc.
GHayduke (formerly lojasmo)
@Mnemosyne:
I have a request in to the chemical dependency councellor who referred me. Thanks!
MomSense
@GHayduke (formerly lojasmo):
Sorry this is so frustrating for you. Even though you are dealing with the payment aspect of it now, I’m really glad you went to detox and send you lots of good wishes.
GHayduke (formerly lojasmo)
@MomSense:
Thanks! Feeling blessed.
Tommy
@GHayduke (formerly lojasmo): Good luck my friend.
mclaren
Richard Mayhew is once again lying to you — this time by distracting you from the real crisis in American health care to focus on wonkish minutia like “narrow networks.”
The real crisis destroying American health care is rising prices. Not costs, prices.
Ordinary people are now getting priced out of vaccinations. That’s insane. If the vaccination rate drops below 95%, herd immunity collapses, and we get pandemics.
Source: Doctors Stop Offering Vaccines as Costs Skyrocket”
Naturally, Mayhew’s dishonest deceptive posts utterly ignore the gigantic role of skyrocketing health care prices in the ongoing collapse of our broken health care system. And let there be no doubt whatsoever that health care costs are skyrocketing:
Source: “Why Doctors Are Reluctant to Take Responsibility for Rising Medical Costs — If doctors feel health cost reform will just worsen the workload of practicing medicine, it will be hard to get them on board,” The Atlantic, 14 August 2013.
American doctors have systematically dismantled medical schools so that today, in 2014, there are fewer medical schools than in 1965 — all in order to keep American doctors’ salaries double what doctors get paid in Europe.
But American doctors refuse to take responsibility for this.
American doctors take bribes from big pharma companies to prescribe insanely overpriced medications, but American doctors refuse to take responsibility for this either.
American doctors have colluded with hospitals to form obscenely overpriced imaging and bloodwork and tissue testing clinics which sign sweetheart contracts with the hospitals to lock in sky-high prices and prevent potential competitors from seeing pricing information. Once again, American doctors refuse to take responsibility for this.
Richard Mayhew is lying to you by yammering on about narrow networks and suchlike bureaucratic trivia, instead of talking about the real problems with American health care.
Email John Cole. Demand that he throw this liar Richard Mayhew off Balloon-Juice.
Kylroy
@mclaren: Yes, throw off the guy who works for an insurance company (the player in the market who has a *reason* to lower costs) for not demonizing doctors enough. Have you *noticed* what happens when insurance companies fight doctors in the public eye?
Fred Fnord
@mclaren: Who is paying you for your sterling work here? High-quality frontier gibberish like that doesn’t come free.
docg
@Fred Fnord: Gibberish? Did you read the post? Grade A, extra virgin bullsh*t.