Colleague and FoIB Darth Billius has a credible, if cynical, take on the recent Premier Health/United Healthcare (UHC) kerfluffle:
Housecleaning.
How's that, Henry?
Well, last Spring the network provider contract between Premier Health and UHC expired, and renewal negotiations hit a quagmire (which, by the by, is not all that unusual: see here, for example). The two parties remained on the outs for some time, and finally resolved the impasse at the beginning of this year.
In the meantime, there appeared to be a mass exodus of groups from UHC as a result of so many facilities being out-of-network due to the absence of a contract.
This morning, I mentioned to Darth B that it didn't seem likely to me that all parties had had a sudden change of heart when the ball dropped the night before; surely they had known this for weeks (at least). So why take the hit?
Darth B replied "why, to get rid of unhealthy groups, natch."
Hunh?
Continued the Dark Lord of Insurance, "well, think about it: someone that sees their doc maybe once or twice a year, with no chronic or major health issues, probably figures it's easier to change providers than insurers.
Unhealthy folks, though, who have an on-going relationship with their docs and need to see them often, well, they're going to jump ship at the earliest opportunity to get those providers back to in-network benefits levels."
Hunh.
Makes sense to me.
Housecleaning.
How's that, Henry?
Well, last Spring the network provider contract between Premier Health and UHC expired, and renewal negotiations hit a quagmire (which, by the by, is not all that unusual: see here, for example). The two parties remained on the outs for some time, and finally resolved the impasse at the beginning of this year.
In the meantime, there appeared to be a mass exodus of groups from UHC as a result of so many facilities being out-of-network due to the absence of a contract.
This morning, I mentioned to Darth B that it didn't seem likely to me that all parties had had a sudden change of heart when the ball dropped the night before; surely they had known this for weeks (at least). So why take the hit?
Darth B replied "why, to get rid of unhealthy groups, natch."
Hunh?
Continued the Dark Lord of Insurance, "well, think about it: someone that sees their doc maybe once or twice a year, with no chronic or major health issues, probably figures it's easier to change providers than insurers.
Unhealthy folks, though, who have an on-going relationship with their docs and need to see them often, well, they're going to jump ship at the earliest opportunity to get those providers back to in-network benefits levels."
Hunh.
Makes sense to me.
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