Health Insurance cluster

Let'sgoflying!

Let'sgoflying!

Touchdown! Greaser!
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west Texas
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Dave Taylor
I suppose we expected ongoing problems with the new health care system but it's getting a bit silly.
I lost my coverage when the ACA came into play so I got a new policy last year. Now my insurer says my new policy is disappearing and I need to re-apply for a third policy.
Have a look at the wording of the release:

"Have you been notified that your medical policy is ending Dec 31?
If YES, you qualify for a special enrollment period that allows you to enroll in an individual plan. Be sure to enroll in a new plan by the last day of your current plan and coverage. The coverage can begin on the 1st of the month following your loss of coverage. Also, open enrollment will be open between November 15, 2014 – February 15, 2015. Coverage start dates would be from January 1 – March 1, 2015. You cannot obtain coverage outside this special enrollment period or the open enrollment period, unless you qualify for an additional special enrollment event. Otherwise, you may not enroll until the open enrollment period starts in 2015."

So there is
a) a special enrollment period
b) regular open enrollment
c) an unnamed enrollment, in a period outside a) or b) that exists only for those qualifying.

I sure hope this is brief growing pains, because it is really effed up in my opinion.
 
PS, pleadings not to make this thread political. I'd like to hear opinions and don't visit SZ much. Thanks.
 
Every state seems to have different rules.

I'm still on a pre-ACA plan... I'm actually unsure as to whether or not I will be able to keep it at the end of the year.
 
Oh, we got a significant rate hike and our deductible went from $2500 to $5500 thanks to the ACA.

We can't have small businesses doing, well, business, now can we?
 
Waiting for the shoe to drop. I changed to a high deductible plan for this year, but haven't heard yet about what's going to change for next year.
 
Yeah cheapest post ACA plans I can find are about 33% higher premiums than what I have now with higher deductibles. :mad:

All politics aside, I hope they do something to fix this. I don't care which side does it but this is just ridiculous.
 
cowman said:
Yeah cheapest post ACA plans I can find are about 33% higher premiums than what I have now with higher deductibles. :mad:

All politics aside, I hope they do something to fix this. I don't care which side does it but this is just ridiculous.
Click to expand...

Well, there is an election next month...
 
What we really need is the option to buy a low-cost plan that covers nothing up to the deductible then covers everything- like just about every other kind of insurance out there.

They also need to crack down on the health care providers for their pricing. Why is it one price for something out of pocket and another lower price when they run it through insurance even when the insurance co isn't paying anything?
 
Can't wait to see how much my insurance will be for next year.
 
cowman said:
What we really need is the option to buy a low-cost plan that covers nothing up to the deductible then covers everything- like just about every other kind of insurance out there.

They also need to crack down on the health care providers for their pricing. Why is it one price for something out of pocket and another lower price when they run it through insurance even when the insurance co isn't paying anything?
Click to expand...

Another issue is ridiculous pricing at the billing stage - which is then knocked way down when insurance gets in the act. I have seen the actual payout reduced to one tenth of the amount billed. This nonsense needs to be outlawed.
A start would be an across-the-board requirement that medical pricing schedules be made public. As with mandatory health insurance for all, once again Massachusetts leads the way in this matter: http://www.fiercehealthfinance.com/...akes-price-transparency-next-level/2014-10-12

Dave
 
cessna182b said:
Another issue is ridiculous pricing at the billing stage - which is then knocked way down when insurance gets in the act. I have seen the actual payout reduced to one tenth of the amount billed. This nonsense needs to be outlawed.

A start would be an across-the-board requirement that medical pricing schedules be made public. As with mandatory health insurance for all, once again Massachusetts leads the way in this matter: http://www.fiercehealthfinance.com/...akes-price-transparency-next-level/2014-10-12



Dave
Click to expand...


I agree with the ridiculous pricing at the billing stage. The negotiated payment is always way less. But I was surprised at the last bill I saw for a hospital stay (not my own this time). Everything was itemized.
 
Everskyward said:
I agree with the ridiculous pricing at the billing stage. The negotiated payment is always way less. But I was surprised at the last bill I saw for a hospital stay (not my own this time). Everything was itemized.
Click to expand...

This practice is called cost shifting. The hospital needs to make a certain amount of revenue to cover costs and make a profit (or margin for a non-pro). With many payors in the mix (medicare/caid, private insurance, self pay, indigent/charity) you have to shift the cost to those that can pay more to cover the "lost" revenue from those that pay less.

The guy with private insurance who's insurer doesn't have a contract with the hospital? That's where you get the $50 tylenol pills, $10,000 visits to the ER for an ankle sprain, etc.

It's not political, it's plain math.

Same thing with the no more pre-exisiting condition exclusions. To make that work you need to get everyone in the pool/market, hence the mandate.

I could propose a solution to all of this and my belief is we are headed there eventually, but I don't want to send this to Spin Zone.. :lol:
 
Keep in mind that many States are still allowing non-compliant plans be sold illegally until after the election cycle. It'll get worse.
 
at my work we just lost one plan that was deemed too 'rich', and they said in the next couple of years we'll probably lose the PPO plan, leaving us with an HRA or HSA with high deductibles.
 
cessna182b said:
Another issue is ridiculous pricing at the billing stage - which is then knocked way down when insurance gets in the act.
Click to expand...

Recent example:

15106090330_dfdd235ea7.jpg


A recent routine colonoscopy - no polyps or complications.

BTW, "Sunshine" is actually the doctor's name!
 
For a colonoscopy I would have figured his name to be Moonbeam.
 
jjflys said:
This practice is called cost shifting. The hospital needs to make a certain amount of revenue to cover costs and make a profit (or margin for a non-pro). With many payors in the mix (medicare/caid, private insurance, self pay, indigent/charity) you have to shift the cost to those that can pay more to cover the "lost" revenue from those that pay less.

The guy with private insurance who's insurer doesn't have a contract with the hospital? That's where you get the $50 tylenol pills, $10,000 visits to the ER for an ankle sprain, etc.

It's not political, it's plain math.

Same thing with the no more pre-exisiting condition exclusions. To make that work you need to get everyone in the pool/market, hence the mandate.

I could propose a solution to all of this and my belief is we are headed there eventually, but I don't want to send this to Spin Zone.. :lol:
Click to expand...

It's exactly the same reason the many jurisdictions now charge for ambulance calls.... the "selling point" to the residents is "so we can bill the insurance companies and it will never cost you anything". In the end, though, the more costs billed to insurance, the higher the insurance cost will be. Any savings to the jurisdiction's budget don't result in any tax reductions. It's all cost shifting.

Oh, and for folks that don't have insurance, the fee is often discounted or waived.
 
wsuffa said:
It's exactly the same reason the many jurisdictions now charge for ambulance calls.... the "selling point" to the residents is "so we can bill the insurance companies and it will never cost you anything". In the end, though, the more costs billed to insurance, the higher the insurance cost will be. Any savings to the jurisdiction's budget don't result in any tax reductions. It's all cost shifting.
Click to expand...
But the insurance company always negotiates down, way down. So they are paying what actually might be a reasonable fee for ambulance service, and hospital stays for that matter.
 
Everskyward said:
But the insurance company always negotiates down, way down. So they are paying what actually might be a reasonable fee for ambulance service, and hospital stays for that matter.
Click to expand...

May very well be. But in the jurisdictions I am thinking of, the ambulances (paramedics) are part of the fire department and traditionally funded with tax money or volunteer donations.
 
FastEddieB said:
A recent routine colonoscopy - no polyps or complications.

BTW, "Sunshine" is actually the doctor's name!
Click to expand...

You mean to say you paid to have sunshine up your <ahem>... nevermind. :rofl:
 
wsuffa said:
May very well be. But in the jurisdictions I am thinking of, the ambulances (paramedics) are part of the fire department and traditionally funded with tax money or volunteer donations.
Click to expand...
I don't know about small towns but the San Francisco Fire Department definitely bills a lot for their ambulance service! Of course they don't end up getting what they bill, at least not from insurance. I also know someone who got a large bill for an ambulance ride in Denver. He had no insurance and he said they would not negotiate.
 
cowman said:
What we really need is the option to buy a low-cost plan that covers nothing up to the deductible then covers everything- like just about every other kind of insurance out there.

They also need to crack down on the health care providers for their pricing. Why is it one price for something out of pocket and another lower price when they run it through insurance even when the insurance co isn't paying anything?
Click to expand...


From a medical provider, fees are established based on a percentage of what medicare sets in the outpatient primary care setting. Those same fees are less then what it costs to practice!

Insurance comapanies by contract usually agree to pay someone 125-135% x medicare allowable. As medicare ratchets down reimbursement and increases workload for reimbursement, revenue for several aspects of medicine will lose revenue. Independents can no longer survive or will not survive much longer no matter how efficiant they can run their practices. Then place the burden of providing for your businesses and its a sad situation.
 
I had an individual plan, high deductible, HSA, etc. with a $2500 deductible and low premium (~$115/mo). Perfect for me, but got outlawed by ACA. Last year I got a one year reprieve but now it is getting canceled. New plan would be ~$200 mo and a >$5k deductible IIRC. Fortunately I'm moving on to my wife's insurance, but I expect this time next year everyone will be thrown off as the employer mandate waiver expires. It seems their intention is to completely destroy private sector insurance...

We need to put a lot of the responsibility back on the customer so that normal price/value comparisons can be made, just like any other purchase. The current system has completely disconnected the consumer from cost, so there is no incentive to shop around or for providers to compete. Putting more gov't in the way will only make it worse.
 
Jthamilton said:
From a medical provider, fees are established based on a percentage of what medicare sets in the outpatient primary care setting. Those same fees are less then what it costs to practice!

Insurance comapanies by contract usually agree to pay someone 125-135% x medicare allowable. As medicare ratchets down reimbursement and increases workload for reimbursement, revenue for several aspects of medicine will lose revenue. Independents can no longer survive or will not survive much longer no matter how efficiant they can run their practices. Then place the burden of providing for your businesses and its a sad situation.
Click to expand...

Isn't one goal of the ACA to push consolidation of medical providers & make them part of a vertically-integrated health care provider? In the name of cutting costs & increasing accountability? Or am I mistaken?
 
I just attended a CLE program on the ACA and the burdens on business are enormous. Once the exceptions and waivers disappear in a couple of years, I can't see how it survives.
 
LDJones said:
I just attended a CLE program on the ACA and the burdens on business are enormous. Once the exceptions and waivers disappear in a couple of years, I can't see how it survives.
Click to expand...

I have had more than one person tell me that they believe the intent was for the ACA to fail because the alternate solution is government single-payer.

That said, I do agree with you. Given the rise in medical & insurance costs coupled with benefit mandates pretty much every corporate plan will be subject to the "Cadillac tax" in a few years.
 
My ACA-approved plan will be increasing by 15 percent in 2015. I'm seriously considering canceling it.

I can legally cancel my coverage because I've made it a point to get at an annual physical at the V.A. ever since I was first enrolled, which maintains my enrollment, which technically exempts me from ACA requirements. (They also do a heck of an annual physical, let me tell ya.)

But because V.A. care is not free for me, there's also the practical matter of paying the bills. It might be the case that because I'm technically exempt from the ACA requirements, I can buy a catastrophic plan from one of the insurers that V.A. has a contract with, without having to get anyone's permission. Then I could just pay the V.A. out-of-pocket for anything up to that level. It would probably cost considerably less than what my "silver" level ACA plan costs, and the quality of care at the V.A. here seems to be at least as good as any private care I've gotten in the past 10 years.

Rich
 
FastEddieB said:
Recent example:

15106090330_dfdd235ea7.jpg


A recent routine colonoscopy - no polyps or complications.

BTW, "Sunshine" is actually the doctor's name!
Click to expand...

I just had a colonoscopy AND gastroscopy.
The entire bill was $1,073 and my insurance paid all of it. Of course, this is my pre-ACA insurance (HMO) that has been grandfathered for this year. Next year I get to buy an ACA plan.

The good news is they didn't find anything. The bad news is that I don't know how hard they looked considering the Doctor, Nurses, Anesthesiolgist, and all other related items were only paid $1073.
 
Urologist whose real name is Wilbur, has for all his life gone by WOODY.

you'd think he would have the discretion to find another specialty.
 
Once visited an oral surgeon named Dr. Groaner. His office was in an old Victorian mansion right out of the Munsters. Vivid memory of his refelctive flashlight on a headband - spattered with small drops of blood.

Gary
 
I had at one time heard many hospitals actually have no idea how much a given procedure costs and basically just make a good guess when they price things. Sometimes actually loosing money and other times gouging people. Thus explaining the huge differences in costs between hospitals for the same work being done.

I wish I could find the article I saw that in... but this one is similar.
http://www.businessweek.com/article...-do-medical-devices-cost-doctors-have-no-idea
 
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