Health insurance that restricts employees from receiving care outside of employer owned ho

JKL33 · Oct 24, 2018

Indeed. Employer-sponsored health insurance originally only covered hospital charges and was offered at a single hospital (first to teachers, then to hospital employees). Considering employers are offering a benefit which you are under no obligation to accept, it would be pretty difficult to conceive of a reason why the employer owes you a benefit somewhere else.

In the case being discussed, the employees actually accepted different terms which could be said to be of greater value. The reason an employer would owe them this "benefit" would be no other reason than because that is what was offered and accepted. Just like the actual cash portion of the compensation.

If you worked in retail and the store offered you an employee discount at that store would that be antitrust? No, because you don't have to use your employee discount. The store has a vested interest in not giving you a discount at their competitor (both from a financial and PR standpoint). Health systems have the same interests. It would look bad it the nurses from X hospital won't even go their themselves/see the doctors in that system.

An employee discount known to be valid only for the purchase of the employer's own goods that is part of an employee's compensation is not analogous to this situation. This situation is more like working for, say, a large grocer who decides to sweeten their employment offers by making generic food vouchers part of the offered compensation. Eventually, after choking out smaller grocers, the company decides they can make even more money by seeking to develop more companies that address every angle of food being produced, bought, and sold. And, after a time, they realize that, although their sheer size has managed to choke out most other food-related competition, they can literally commandeer most of the rest of the market by simply telling their tens of thousands of employees that things are changing and as it turns out, with those food vouchers you earned as part of your compensation, you can only buy our food where we are selling it.

In regard to your last sentence, aside from the fact that people may have their own personal reasons for seeking care wherever it is that they will seek care, if the nurses are potential customers/patients, then why is it that their business can be commandeered rather than earned? I mean, if they don't want to go there because they don't like the kind of care that is being delivered (as you imply would be the appearance they are giving by not seeking care there), then why is this something that should be able to be negated by reneging on an employment agreement rather than striving to be a place where this large segment of the market would choose to do personal business?

RNrhythm, BSN, RN · Oct 24, 2018

Sometimes I have this weird thought: Why does my healthcare come from my employer?

pro-student · Oct 24, 2018

In the case being discussed, the employees actually accepted different terms which could be said to be of greater value. The reason an employer would owe them this "benefit" would be no other reason than because that is what was offered and accepted. Just like the actual cash portion of the compensation.
An employee discount known to be valid only for the purchase of the employer's own goods that is part of an employee's compensation is not analogous to this situation. This situation is more like working for, say, a large grocer who decides to sweeten their employment offers by making generic food vouchers part of the offered compensation. Eventually, after choking out smaller grocers, the company decides they can make even more money by seeking to develop more companies that address every angle of food being produced, bought, and sold. And, after a time, they realize that, although their sheer size has managed to choke out most other food-related competition, they can literally commandeer most of the rest of the market by simply telling their tens of thousands of employees that things are changing and as it turns out, with those food vouchers you earned as part of your compensation, you can only buy our food where we are selling it.
In regard to your last sentence, aside from the fact that people may have their own personal reasons for seeking care wherever it is that they will seek care, if the nurses are potential customers/patients, then why is it that their business can be commandeered rather than earned? I mean, if they don't want to go there because they don't like the kind of care that is being delivered (as you imply would be the appearance they are giving by not seeking care there), then why is this something that should be able to be negated by reneging on an employment agreement rather than striving to be a place where this large segment of the market would choose to do personal business?

So the key error in your reasoning is the idea that an employment benefits are static. If you read yours and any common employment contract, I highly doubt it locked in your benefits unchanged in perpetuity. Chances are the contract allows the employer to change benefits at their discretion possibly with some notice and/or specific time period (i.e. - health benefits might be modified annually). No employer would box themselves in like that if, for no other reason, than it forces them to guarantee things they never could (such as an insurer no longer offering a plan or going out of business). As an employee, your option is to accept the change in benefit or find new employment.

You're also misunderstanding health insurance as a benefit similarly to the OP. Insurance is no coercion or dictating how and from who you can receive healthcare. Insurance only pertains to how healthcare is paid for. You always have the option of picking up the tab for getting care anywhere and from anyone who will provide it to you.

Your grocer example belies a fundamental misunderstanding of health insurance. Like I mentioned, health insurance originally include only hospital stay (not doctors fees, procedures, anything else we now expect) at one hospital. This is just like an employee discount - you don't have to use it, but they also don't have to offer to pay for things a competitor sells. Just because the health insurance industry is much more complicated doesn't negate this basic logic. As a nation, we've decided healthcare is not a right and one's ability to pay for it is a reasonable limiting factor. This makes healthcare a commodity just like the t-shirt someone might get an employee discount on. You can buy from whoever will sell to you but your employer is not obligated to pick up the tab. Maybe you'd like a different analogy. Lets say a teacher works for a private school which, as a benefit of employment, offers reduced tuition to the teacher's children. Now this teacher could send his or her kids to any school including a different private school. The employer wouldn't be obligated to pick up any portion of the tab and would have the same PR and financial incentives to only offer a tuition benefit at their own school and not a competitor. The employer is, at best, incentivizing enrolling their kids (or getting healthcare within the network) since there is no requirement that the employer be used. Rather there is a financial incentive to accessing services through the employer.

pro-student · Oct 24, 2018

Sometimes I have this weird thought: Why does my healthcare come from my employer?

And this is the real issue.

elkpark · Oct 25, 2018

Sometimes I have this weird thought: Why does my healthcare come from my employer?

Do you mean why does your healthcare insurance come from your employer? That's not a "weird thought," it's a perfectly reasonable question, since it is, AFAIK, unique to the US. Most of the US receiving their healthcare coverage from their employers is a relic of WWII. During the war, there was lots of competition for employees, since so many men were abroad, fighting in the war, and salaries were increasing so fast it was creating serious inflation and problems for the US economy. Congress passed legislation authorizing (temporary) salary/wage freezes; employers couldn't offer more money to attract highly skilled, desirable employees, so they started offering more generous job benefits. Healthcare insurance was one of the enhanced benefits employers started offering to entice employees, and that "stuck," even after the war and salary freezes were over.

Prior to that, not many employers had offered any kind of healthcare coverage to employees, although some big employers had healthcare clinics in their factories or office buildings. WWII lasted long enough that, by the time it was over, people took for granted that they would get health insurance as a job benefit. There are a lot of arguments to be made against our model and, IMO, few arguments to support it.

VioletKaliLPN, LPN · Oct 25, 2018

This is common in my city, the two major hospitals offer much richer benefits such as low/no copay for their physician practices. This does not bother me, nor does it surprise me. It makes financial sense to give an incentive. This is one reason I would not work for the one hospital system..I dislike their care, but some love it.

JKL33 · Oct 25, 2018

So the key error in your reasoning is the idea that an employment benefits are static. If you read yours and any common employment contract, I highly doubt it locked in your benefits unchanged in perpetuity. Chances are the contract allows the employer to change benefits at their discretion possibly with some notice and/or specific time period (i.e. - health benefits might be modified annually). No employer would box themselves in like that if, for no other reason, than it forces them to guarantee things they never could (such as an insurer no longer offering a plan or going out of business). As an employee, your option is to accept the change in benefit or find new employment.

Yes, that is probably true regarding fine print regarding changes they are allowed to make. My healthcare coverage has changed, though it is not through my employer. I've avoided that because personally the part where I work for them to help produce/deliver the product they're selling, and then would need to buy another one of their products in order to pay for the first product which is something I need. I am not trying to argue anything here except that there are several reasons I just don't like it. And yes I know I am "free" to find a new job or else purchase healthcare insurance somewhere else .

Pm'd you.

Tenebrae, BSN, RN · Oct 25, 2018

Exactly. If you don't like your choices now, see what kind of choices you get under a socialist system. The grass is usually not greener...

I get good enough choices under a universal healthcare system with the added benefit, I dont have to worry about selling a vital organ or taking a second mortgage on the house just to pay the medical bills

The problem with obamacare was that the guts of it that would have really benefited all citizens got ripped out to appease the republicans

remotefuse · Oct 25, 2018

This is something that really bothered me during my pregnancy.

I pretty much had to go to a hospital, including doctors and doctors appointments that was 40 min away for my insurance to cover. Also to get there, I had to go over a really long bridge that was frequently backed up with traffic and closed down regularly. I once got stuck on that bridge for over 3 hours due to a fire somewhere on the other side. I was terrified that I would get stuff on the bridge while in labor. To make this even crazier, I had to drive by 3 different hospitals to get there.

**NICU Guy, BSN, RN** · Oct 25, 2018

Starting in 2019, we will only be covered for care if we stay in a new "custom network." This new network consists of only our healthcare system as well as just a few other hospitals. Three very large nearby hospitals and many smaller community hospitals will not be covered except for life threatening emergencies.
I think this is unfair to employees. It also seems very convenient that the uncovered hospitals are our biggest competitors.
Does anyone else's employer do this?

It is called Self-Insured Group Health Plan. It is a way for the hospital to keep their healthcare premiums lower. You only pay a portion of your health insurance premium, the hospital pays a bigger chunk. They assume the financial risk and the National Health Insurance company manages their policy but does not assume any financial risk.

Self-Insured Group Health Plans - Self-Insurance Institute of America, Inc.

KelRN215, BSN, RN · Oct 26, 2018

What did you give up to change jobs? Pension? Amount of PTO? Seniority? Friends? Good schedule? Shorter drive? Culture? Etc.?
Maybe it was a good move all around for you. I hope so. I'm just wondering about the trade-off you might have had to make.

Literally the only thing I can think of that I lost was monthly parking in a convenient part of the city that my company reimbursed me for and that I used when I wanted to attend baseball games because the hospital is within walking distance of our MLB stadium. I found another secret garage not that far away that costs $8.

My PTO now is nearly twice what it was at my last job. My schedule is more flexible and though I was the most senior person in my last department (after only 2 1/2 years), the program I'm working in now changed hands when I started so we all started together and no one has seniority. I was working for a for-profit company that I hated. Places that give better benefits (like health insurance and PTO) are generally better employers in my experience. I will never work for a for-profit company again. In fact, I would not have accepted my last job had I known that they would get rid of our platinum health insurance plan 6 months after I started and that my best option would be a plan with a $2K deductible.

Horseshoe, BSN, RN · Oct 30, 2018

Be glad you have coverage at all. I work PRN and DH is self employed. In my state, there are only 2 options for private insurance for owners of small businesses. We got a letter yesterday that stated that our monthly premium will rise from $2700 per month to $3850 per month.

That's right, people. I said PER MONTH. For a family that didn't meet our deductible, had no surgeries or expensive treatments.

We are lucky that DH can pay this, though I am DISGUSTED by it. But I want to know how in the hell most small business owners can possibly afford health insurance in a country where it is tied to employment. This is a broken system, people.