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WSJ Editorial: Health Insurance Providers Deliver Real Benefits To Consumers

posted by Alicia Caramenico

on September 18, 2019

Every American deserves affordable, comprehensive coverage and care. Health insurance providers are committed to delivering that. A recent piece in the Wall Street Journal underscores the value delivered by health insurance providers to millions of Americans – managing costs and claims to offer better benefits and better care.

The writer, a senior fellow at the Manhattan Institute, uses Medicare Advantage (MA) versus traditional Medicare as a case study. The comparison illustrates insurance providers’ role in expanding benefits, ensuring patients have access to high-quality care, and delivering that care in the most efficient and cost-effective way.

The clearest apples-to-apples comparison of public versus private management of American health care is within Medicare. And Medicare Advantage suggests private insurance oversight allows patients to get health care that has a meaningfully better value.

Here’s how:

Savings generated by Medicare Advantage help private insurance providers offer extra benefits.

  • MA provides the same benefits as traditional Medicare – and so much more. These extras can include vision, hearing, and dental benefits, as well as wellness programs.
  • Many MA plans give seniors access to affordable prescription drug plans, often at no additional cost.
  • All MA plans deliver affordable coverage by capping out-of- pocket costs.

Private insurance providers use networks of doctors and hospitals with a track record of providing high-quality, efficient care.

High-value networks can save lives. Studies show provider network arrangements – that meet certain safety, quality, performance standards – help reduce premiums and promote more affordable coverage options for consumers.

In developing their networks, health insurance providers make sure they have the variety of primary care doctors, specialists, hospitals, and other providers that consumers need and can access in a variety of locations. And health plans periodically reevaluate the qualifications of the providers and their performance within their networks to make sure the consumers’ needs are met.

Private insurance providers regulate reimbursement claims to prevent fraud, waste, and abuse.

Using data-driven strategies and strong internal and external partnerships, fraud prevention efforts ensure the optimal, most appropriate care for patients and tremendous value for the health care system. Insurance providers work together with government and law enforcement to fight health care fraud. Every provider delivering unnecessary or inappropriate services uncovered keeps patients safer.