2013
Many of you are too young to appreciate this, but before 1970 health plans reimbursed exactly this way, a set payment for a given procedure … it was called a fee schedule … duh! Then someone got the idea that costs for workers were too much of a burden so we began using “reasonable and customary charges” in lieu of set fees. Thereafter, the allowed R&C fee merely increased each time the providers raised their charges … brilliant, right? Good thing someone came up with this “new way.”
Employers Test Plan to Cap Medical Spending
By REED ABELSON
Published: June 23, 2013
Hoping to cut medical costs, employers are experimenting with a new way to pay for health care, telling workers that their company health plan will pay only a fixed amount for a given test or procedure, like a CT scan or knee replacement. Employees who choose a doctor or hospital that charges more are responsible for paying the additional amount themselves.
via Employers Test Plan to Cap Medical Spending – NYTimes.com.
QUINNSCOMMENTARY 
I recall these scheduled plans in the late 60’s when I started the Pru.i believe the excess liability typically rolled over into the integrated major medical coverage subject to deductible and coinsurance? Blue Shield offered a nuMber of standard schedules and riderJ. I believe that union bargaining and corporate benefit plans expanding benefits drove the change to R&C.? Correct me if I am wrong on that trend.No one would have anticipated the incredible health care cost increases.I recall quoting integrated major medical plan rates at $1.50/ee/mo and $2.50dep/mo.How times have changed!
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Before there was major medical it was just the basic coverage and of course once the major medical was added, the purpose of even the fee schedule was circumvented. Employers and unions kept improving benefits and then began asking why health care costs skyrocketed.
Dick
Blog http://www.quinnscommentary.com Twitter @quinnscomments
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Local medical practices now are operated through local Hospitals. If an emergency occurs they immediately refer you to the emergency room or to a quick care facility. Appointments with the local medical practice will be over a week and up to several weeks. An appointment made last week for a foot surgeon was turned down by a group and when she did go to one she had surgery with, the appointment is scheduled for 8/5/13. We live in a county with 41000 registered voters.
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Problems we are seeing already are doctors are limiting how many medicare patients they will see in a day and many “specialists” are not seeing new medicare patients. Appointments are now extending outward of two to three months for even “routine” illnesses. Getting interesting.
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Is that what you are experiencing in Ohio in actual practice?
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Yes. Local medical practices were merged/purchased by local hospitals. If you need immediate medical attention you get referred to the ER or a quick-care facility. Appointments routinely take a week or two. Wife tried to go to a podiatrist and was told they are not taking new medicare patients. She learned she needed to see the orthopedic surgeon who operated on her foot. Her earliest appointment is set for 8/5/13. We live in a county the size of Middlesex Co but only have 41,000 registered voters. We also can go to Parkersburg WV for services.
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Not in Florida. We are in a large Medical group with all the physicians for every type of issue. Probably will occur later on when OBC kicks in. Hope not.
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