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The Massachusetts Attorney General’s Preliminary Report, Investigation of Health Care Cost Trends and Cost Drivers issued on January 29, 2010 faulted the leveraged based disparities among health providers in pricing as the principal driver in health care cost increases in Massachusetts over the past five years. In particular the study noted that providers with leverage due to size, geographic location and branding had a substantial leg up in negotiations with insurance companies driving their prices in some cases at levels that doubled those of their competitors for comparable services. Interestingly, the study note a number of health insurance contract provisions that had a substantial negative impact on cost containment. On of the principal contract provisions that tended to chill competition was the “payment parity provision” that tend to lock in payment levels and prevent innovation and competition based on pricing. If an insurance company gives a rate increase to providers it uses payment parity provisions to insure that the provider will insist on similar rate provisions from the insurance company’s competitors, so that all premiums will rise together and the initial insurer will not be at competitive disadvantage in giving a rate increase. Product Participation Provisions are contract clauses that high market leverage providers insert in health insurance provider agreements that prohibit insurers from created limited network products and tiered products that might steer patients away from them. Examples of these provisions are called “anti-steering”, “guaranteed inclusion” and “product participation parity” clauses. “Anti-steering clauses stop insurers from creating new products that might steer patients away from certain providers. “Guaranteed inclusion” clauses guarantee the participation of certain providers in certain products. On the insurance company side, “Product participation parity” provisions...
Principal Health Insurance- News
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Immigration Reform is Necessary for America's Economic Recovery Immigration Reform is Necessary for America's Economic Recovery massive drumbeat of negative ads, or a well-heeled corps of entrenched lobbyists that have been such factors in the battle for health insurance reform. and more » |
This Merger Changes the Playing Field in Employee Benefits
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