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There will be longer waits for hospital visits, doctors' appointments and specialist treatment, as more people crowd fewer providers...More IT failures are likely...Be prepared for eligibility, coverage gap, billing, claims, insurer payment and patient information-protection debacles". Michael J. Boskin in The Wall Street Journal.
Some programs impose per-episode out-of-pocket payments caps, promising to cover any costs in excess of that cap, while others impose insurer payment caps, requiring participants to cover any cost over the cap.
"The insurer payment cuts, which would total [cuts of] $12.5 billion over five years, include fees paid to private insurers".
The Deyo implementation of the Charlson comorbidity index score was calculated based on medical claims adjudicated (insurer payment determined) during the pre-index observation period [ 37, 38].
A threshold analysis also was performed to estimate the MIS index stay commercial insurer payment that results in cost neutrality for the overall group by year following the MIS index stay.
24 The opioid dose strength and quantity of fill for each adjudicated (ie, insurer payment determined) opioid prescription claim was converted to MEq and summed for the respective observation period.
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In actuarial studies, the insurer might ignore the losses below the deductible t>0 since they do not result in insurance payment (insurer might not be aware of the losses below t).
Insurer payments in exchange for variable annuity endorsements were the subject of a Forbes story (see: Costly Lesson) that prompted an investigation by New York Attorney General Spitzer.
The OMB spokesman did not deny Mulvaney's prior comments to Pelosi about the possibility of stopping insurer payments after May.
Many carriers raised their rates preemptively for 2018, in case Trump cut off the insurer payments, while others are scrambling to do so now.
Either on their own or at the behest of their regulators, those insurers filed rates for 2018 assuming the insurer payments might stop.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com