tag:blogger.com,1999:blog-4241416962008169508.post7311523663797989305..comments2024-03-27T21:03:58.972-04:00Comments on Just A Life Sciences Blog...: This, Courtesy Of A Sweet Commenter -- Interesting, But McCarran–Ferguson Act May Present ObstaclesUnknownnoreply@blogger.comBlogger1125tag:blogger.com,1999:blog-4241416962008169508.post-81251657675309557822013-06-01T17:30:36.576-04:002013-06-01T17:30:36.576-04:00A bit more color on the issue, which was consolida...A bit more color on the issue, which was consolidated to Federal court:<br /><br />http://johnsonandbell.com/alerts-blog/nationwide-antitrust-lawsuits-against-bluecross-blueshield-plans-consolidated-as-multidistrict-litigation/<br /><br />A good read fr history of the Blue model:<br /><br />http://www.charlotteobserver.com/2013/02/08/3842399/lawsuit-blue-cross-stifles-competition.html<br /><br />Although the Blues operate as independent insurance providers, their collective link thrugh the Association allows for subscribers to see doctors in any Blue network. Those claims are paid using an internal program called Blue Exchange. If you are a resident and subscriber of the Blue FL, for example, and are on vacation in MA in need of medical care, you would go to a Blue MA provider who submits your claim to MA who then charges back the FL plan. The MA rates prevail for the provider and FL is charged an additional fee by MA (set by the Association) for claims processing and provider network rental. <br /><br />Those fees are absorbed by the plans - in some cases as expenses (in the example that is FL) and in others as revenue (in the example, MA). For a plan lopsided on the expense end that could translate to higher premiums overall.<br /><br />The provider rates are negotiated by the local plans but the 'power' they can exert is not only the majority of subscribers they enjoy in most states but the potential expansion of subscribers through the Blue Exchange program. Snow bird states, for example, will potentially bring providers more subscribers than the local rolls reflect - as well as revenue to themselves via fees.<br /><br />Unfortunately rate calculations are not very straight forward or it would be interesting to compare premiums between a plan on the revenue end of the Blue Exchange program and one on the expense end. The lawsuit will, no doubt, be very closely watched by a good many.Anonymousnoreply@blogger.com