If you need to stimulate the economy with my cash, you need to convince me that you have something to sell that is worth having. Someone else's house with more than 3,000 square feet does not fit that description.
Just looking at the mental health part of their benefits with which I'm familiar, we can see that Blue Cross-Blue Shield reimburses its network providers - psychologists, psychiatrists, social workers - an average of 25 to 44 percent more (depending on the procedure) than Tufts or Harvard Pilgrim. In addition, the authorization process for continued care at Tufts and Harvard Pilgrim requires much more nonreimbursed time of providers than does Blue Cross-Blue Shield, and imposes a higher administrative burden, thus passing the costs along to their network providers and participants.
Furthermore, Blue Cross-Blue Shield invested a significant amount of money in 2008 in funding an independent blind research study across its membership. It was designed to contribute to our overall knowledge of effective mental health practices and to contain costs in the long haul. The study took into account the administrative costs to providers. In contrast, Harvard Pilgrim's mental health carve-out funded a "first alert" program which inserts the insurer into people's treatment by, for example, calling them at home or notifying their providers to "alert" them to obvious symptoms which they believe the doctor may have missed.
These philosophical differences between insurers can't help but lead the most well-established providers to resign from the Tufts and Harvard Pilgrim networks. Once again, this leads to Harvard Pilgrim and Tufts passing the cost along to their members, as members sometimes choose to pay out of pocket to retain a trusted doctor or therapist. But providers stay with Blue Cross-Blue Shield, because it demonstrates concern for both its providers and the families it insures. Note that I can speak with knowledge only of the mental health aspects of each insurer's benefits. But one can extrapolate that these business practices may extend beyond their mental health benefits.
In this economic crisis, employers choosing health plans may gravitate toward lower cost plans. However, as employees encounter the artificial obstacles to access to healthcare that are called "cost containment," and as our economy improves, no doubt this trend will reverse itself. From my perspective, Cleve Killingsworth appears to be doing a good job.
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