Author Topic: A good experience with the ACA?  (Read 2437 times)

Tom Bri

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A good experience with the ACA?
« on: February 15, 2017, 08:37:54 PM »
Has anyone had a really good experience with 'Obamacare'? I understand that previously uninsurable people would be happy to get anything at all, but that's not my question here.

I recently had my yearly checkup, and, as usual, have to pay out of pocket for supposedly covered services, like the cholesterol check. This has happened every year since my first compliant plan. The problem is NOT the insurance companies. The doctors do NOT understand that in order to get payment, they have to choose codes from the approved list. Invariably, they code with whatever likely code they see, probably whatever they had always used in the past, and the insurance company rightly applies it to deductible.

I worked in medical insurance claims during the transition to the ACA, so I know what codes work and which don't, and I can, eventually, get the doctor to re-code the claims and the insurance company to pay. I just do not like the hours I spend on the phone getting this done. Happened to both my daughters and my wife too, from multiple doctors over several years.

So my question. Is my experience normal? Do you get your claims paid easily for your yearly physicals? From my years working insurance claims, a huge portion of my time was advising our clients on how to get their doctors to properly code claims so that my company would pay them.

I suspect a lot of people just pay the claims, not knowing that the services should be 100% covered.

misshathaway

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Re: A good experience with the ACA?
« Reply #1 on: February 16, 2017, 07:22:07 AM »
Good experience on cost after I figured out that I was eligible for the subsidy. My cost per month went from $400 something to $90 something. But, the cost is now time on the phone disputing non-payment. I've had ACA for about 18 months and I would guesstimate that I have spent 6 hours on the phone and on getting together paperwork to fix non-payment claims. I'm retired so it's worth it to me.
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Daisy

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Re: A good experience with the ACA?
« Reply #2 on: February 16, 2017, 08:43:29 AM »
After a recent medical incident, I have noticed when I call to make a doctor's appointment, one of the first things they ask is if I am on a public exchange plan. I am covered under an employer's plan so I say no. In my limited experience, I have found that many doctors I call do not accept public exchange health plans. This is one thing that worries me about FIRE ing and going on an ACA plan.

jim555

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Re: A good experience with the ACA?
« Reply #3 on: February 16, 2017, 10:24:41 AM »
I am on a Medicaid Managed Care plan and no complaints.  Same doctors as was on my Megacorp plan when I worked.  Had annual physicals, heart test, blood work, urine work, colonoscopy.  Been to a few specialists.  No surprise bills.

Cranberries

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Re: A good experience with the ACA?
« Reply #4 on: February 16, 2017, 11:06:31 AM »
I've been happy with it. With the subsidy I am eligible for my ACA plan is pretty similar in price to the insurance I had before but has a lower deductible, no risk of being dumped for pre-existing conditions, and no lifetime caps.

Gin1984

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Re: A good experience with the ACA?
« Reply #5 on: February 16, 2017, 02:25:41 PM »
My mom is happy with hers.  She got to retire 4 years earlier than she had planned at 58 because she could still get care. 
Just a side note, I've had to do multiple hours of phone calls between doctor's offices and insurance companies prior to ACA.  The issues with coding etc, is not a ACA caused issue.

Financial.Velociraptor

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Re: A good experience with the ACA?
« Reply #6 on: February 16, 2017, 08:55:25 PM »
I was uninsurable before ACA (pre-existing).  Now I have market rate insurance.  Very happy.
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SilveradoBojangles

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Re: A good experience with the ACA?
« Reply #7 on: February 16, 2017, 10:01:09 PM »
I have an ACA plan through Kaiser, it has been no problem. Preventative care was 100% covered, and I've never had any billing problems (my sister has Kaiser as well on an ACA plan - she seems to like it). Maybe HMOs are easier?

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Re: A good experience with the ACA?
« Reply #8 on: February 17, 2017, 08:21:02 AM »
Not a direct comparison to OP, but we are happy with ACA. We never go to the doctor (gasp!) but we carry health ins in case somebody got really sick. Prior to ACA our premium had been creeping upward every year, was up to $300/mo for a very basic $5K deductible. After ACA the monthly (subsidized) premium is $110.
Bonus: the exchange website works great for shopping, compared to calling several agents and getting quotes.

jrhampt

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Re: A good experience with the ACA?
« Reply #9 on: February 18, 2017, 12:25:07 PM »
I have very much appreciated the ACA rules requiring insurance to cover birth control 100%, although I am on an employer plan.

waltworks

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Re: A good experience with the ACA?
« Reply #10 on: February 18, 2017, 02:09:59 PM »
After a recent medical incident, I have noticed when I call to make a doctor's appointment, one of the first things they ask is if I am on a public exchange plan. I am covered under an employer's plan so I say no. In my limited experience, I have found that many doctors I call do not accept public exchange health plans. This is one thing that worries me about FIRE ing and going on an ACA plan.

The "public exchange" plans are just private health insurance through a regular health insurance company. If your doctor accepts BCBS or Aetna or whatever company you bought your plan from, whether that was done through the exchange or not, you're good.

Maybe you are referring to Medicaid? Many doctors don't do that.

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waltworks

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Re: A good experience with the ACA?
« Reply #11 on: February 18, 2017, 02:30:57 PM »
For us personally, it allowed my wife to become a SAHM and do a ton of volunteering (reading tutoring, running a school science fair, helping out other moms in various ways, etc) as we could more easily get a market rate plan without having to depend on an employer (I'm self employed).

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slackmax

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Re: A good experience with the ACA?
« Reply #12 on: February 18, 2017, 04:34:34 PM »
I have Obamacare and I like it since I am one of the hugely subsidized folks! I still have to call around a lot to verify what's covered and how much stuff costs.  And I still get different answers from different agents at the same insurance co, but at least it's cheap as heck!         

waltworks

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Re: A good experience with the ACA?
« Reply #13 on: February 18, 2017, 04:51:55 PM »
I have Obamacare and I like it since I am one of the hugely subsidized folks! I still have to call around a lot to verify what's covered and how much stuff costs.  And I still get different answers from different agents at the same insurance co, but at least it's cheap as heck!       

Your insurance company should have sent you a fairly comprehensive binder/set of paperwork when you enrolled (or at the very least it should be available online) that specifies exactly what is covered and the copays/deductible/etc.

In fact you cannot even sign up for a plan without reading most of this basic what's covered/cost information. Did you not pay attention then?

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zinethstache

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Re: A good experience with the ACA?
« Reply #14 on: February 18, 2017, 05:04:21 PM »
VERY recent ACA user. I spent alot of time researching the plans. My broker did fail me and I had to scramble to find one to get signed up on time.

The healthcare so far is good, I bought one that has my clinic as part of the healthcare name so I KNOW Im good to go with any Dr.s in that clinic's system.

I've filled one 90 day script and it was half of what I paid with my employer insurance. specialist copay is $15 more than my employer's.

I purposefully bought a plan with co pays for all dr. visits, all labs/xrays in the clinic and for Tier 1 and 2 drugs.

I am subsidized, feel it is a little steep for our income, we are in a HCOL region.

We are leaving for fulltime travel and will have no access to regular Dr. care outside our home location. We will have to rely on email/phone calls to keep scripts going using 90 day mail order. That could be an adventure. I will need labs done at some point while traveling, that should be interesting as I will have to pay 100% and am not sure that they will be accepted.

geekette

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Re: A good experience with the ACA?
« Reply #15 on: February 18, 2017, 07:37:47 PM »
We're in our 4th year of an ACA plan. No problems except having to change networks. Things that are supposed to be covered have been, so far.

The plans available through the ACA are not always the same as through local employers. We have  BCBS "Blue Local". Other plans not available to us are BCBS "Blue Select" (larger network), and a couple others. Our previous doctor doesn't participate is the local plan, but does participate in the select plan (which was available to us the first two years).

So just saying you have BCBS means nothing. One insurer can have many plans.

Daisy

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Re: A good experience with the ACA?
« Reply #16 on: February 18, 2017, 10:05:58 PM »
After a recent medical incident, I have noticed when I call to make a doctor's appointment, one of the first things they ask is if I am on a public exchange plan. I am covered under an employer's plan so I say no. In my limited experience, I have found that many doctors I call do not accept public exchange health plans. This is one thing that worries me about FIRE ing and going on an ACA plan.

The "public exchange" plans are just private health insurance through a regular health insurance company. If your doctor accepts BCBS or Aetna or whatever company you bought your plan from, whether that was done through the exchange or not, you're good.

Maybe you are referring to Medicaid? Many doctors don't do that.

-W

I have Cigna through work and they have various plans. Even my employers "local plus" plan doesn't have the same providers as some of Cigna's other plans. The doctor's office specifically asks which plan I am on and specifically asked if it was a Cigna public exchange plan, which they were not on. It wasn't until I gave my specific plan's name and policy number that they could verify if they were in my plan.

I got the questions enough times with different doctors that it has me worried about ACA plans.

I have another friend with a different employer and plan and she just had a baby and she commented that she got the same questions from doctor's offices when making appointments.

Maybe this only happens in Florida?
« Last Edit: February 18, 2017, 10:09:06 PM by Daisy »

waltworks

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Re: A good experience with the ACA?
« Reply #17 on: February 19, 2017, 08:56:44 AM »
It sounds like an issue specific to your location or to Cigna, perhaps they are selling plans that only allow a very small network of providers. You can buy that kind of plan (ie Kaiser) off the exchange as well, the ACA itself has nothing to do with whether or not a doctor will accept your insurance.

When you sign up, you can search for providers names and see if the plan you want will cover them, so this should not have been a surprise, really.

-W

Car Jack

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Re: A good experience with the ACA?
« Reply #18 on: February 20, 2017, 11:56:28 AM »
One of the benefits of ACA is that pre-existing conditions cannot be used to deny a claim.  My story is this:  I've been working full time for 40 years.  Like plenty of people, I've had many jobs.  I have NEVER taken a single day off between jobs because of a medical condition that could have disqualified my treatments.  A concrete example occurred when I changed jobs 5 years ago (pre ACA).  After my first doctor visit with the new company, I received a letter from the health insurance company requiring proof that I have had uninterrupted insurance coverage during the job change.  If not, the condition would be considered disqualified from then forward.  Of course, I had been covered, so was fine.  Fast forward to a year ago with ACA requiring companies to cover me even with this pre-existing condition.  For the first time ever, I took a week off between leaving the old job and starting the new job.  As it turned out, the old company covered me for the remainder of the month so I would have been ok, but this was the first time I ever dared to take time off between jobs.

little_brown_dog

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Re: A good experience with the ACA?
« Reply #19 on: February 20, 2017, 12:33:56 PM »
I have employer based insurance but they have to comply with ACA. In my experience, prenatal and well baby care is awesome under Obamacare. All those prenatal appointments had no copays, and my GD and strep B screens had no charge. My postnatal checkup after birth - no charge. All of my daughter's pediatrician appointments from birth through 2 years, and the numerous vaccines and screenings that go with them? No charge. I have seen estimates that before ACA only 10-20% of insurance plans had comprehensive maternity care coverage, so this stuff is a BFD.

Low risk women can go from conception through baby's toddler years without paying for anything but maybe an ultrasound (can't remember if it was fully covered or not) and the birth. That's awesome.

I also have never had a copay or charge for a standard wellness visit and corresponding screen (cholesterol, glucose, etc). I just have my insurance information on file with my doctors' practices and if it is a standard wellness visit I just walk in and out without any questions or bills.
« Last Edit: February 20, 2017, 12:37:25 PM by little_brown_dog »

merula

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Re: A good experience with the ACA?
« Reply #20 on: February 20, 2017, 01:55:31 PM »
I have an employer plan, but I've seen some great changes as a result of the ACA.

One issue that I ran into was a procedure that was supposed to be 100% covered with no out-of-pocket costs. This procedure required an initial appointment (which I rolled into a physical), the actual procedure appointment and a follow-up appointment. Everything went great, except I got a bill for an office visit for the follow-up, and I COULD NOT get anyone to look into it. I ended up giving up and deciding that $25 wasn't worth any further headache.

Daisy

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Re: A good experience with the ACA?
« Reply #21 on: February 20, 2017, 02:39:04 PM »
It sounds like an issue specific to your location or to Cigna, perhaps they are selling plans that only allow a very small network of providers. You can buy that kind of plan (ie Kaiser) off the exchange as well, the ACA itself has nothing to do with whether or not a doctor will accept your insurance.

When you sign up, you can search for providers names and see if the plan you want will cover them, so this should not have been a surprise, really.

-W

I don't  think you understand what I wrote. I am not on an ACA plan. I am on an employer plan. I ran into a new health issue so was looking for providers outside of my regular providers. Of course I only called providers on my plan. One of their first comments when trying to make an appointment was "we're not on the public exchange plan". My plan is on a private exchange provided by my employer.  I had to clarify it for them.

I just found it odd that I got that comment so much. So as someone close to FIRE it does have me a little concerned about which providers are on ACA plans in my state. I hope it won't  be an issue. I was hoping some doctors in this forum can shed light on why I was getting these comments. Hopefully it won't be an issue when I go on an ACA plan.

I should probably ask a family member who is a doctor and see what her experience is.
« Last Edit: February 20, 2017, 02:40:38 PM by Daisy »

waltworks

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Re: A good experience with the ACA?
« Reply #22 on: February 20, 2017, 03:05:22 PM »
I don't  think you understand what I wrote. I am not on an ACA plan. I am on an employer plan. I ran into a new health issue so was looking for providers outside of my regular providers. Of course I only called providers on my plan. One of their first comments when trying to make an appointment was "we're not on the public exchange plan". My plan is on a private exchange provided by my employer.  I had to clarify it for them.

I just found it odd that I got that comment so much. So as someone close to FIRE it does have me a little concerned about which providers are on ACA plans in my state. I hope it won't  be an issue. I was hoping some doctors in this forum can shed light on why I was getting these comments. Hopefully it won't be an issue when I go on an ACA plan.

I should probably ask a family member who is a doctor and see what her experience is.

Ah, gotcha. Cigna is presumably selling some very inexpensive/limited network plan via exchanges that many people who otherwise accept Cigna don't take. That is not something I've heard before.

-W

matchewed

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Re: A good experience with the ACA?
« Reply #23 on: February 20, 2017, 03:39:33 PM »
Was on ACA while finishing up a degree. Just fine experience, no different from any other insurance I've had except I had to pay the premium knowingly instead of it being taken out of my paycheck.

slackmax

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Re: A good experience with the ACA?
« Reply #24 on: February 23, 2017, 07:45:32 AM »
I have Obamacare and I like it since I am one of the hugely subsidized folks! I still have to call around a lot to verify what's covered and how much stuff costs.  And I still get different answers from different agents at the same insurance co, but at least it's cheap as heck!       

Your insurance company should have sent you a fairly comprehensive binder/set of paperwork when you enrolled (or at the very least it should be available online) that specifies exactly what is covered and the copays/deductible/etc.

In fact you cannot even sign up for a plan without reading most of this basic what's covered/cost information. Did you not pay attention then?

-W

Of course I read the coverage before signing up. But unfortunately some of it is inaccurate or just too vague. When I call up a customer rep to get a definitive answer, sometimes I get a clear answer, but often I get a "well, it depends on, blah, blah" and they end up telling me they won't know if it is covered until AFTER I use it and file a claim. Not kidding. It was this way before Obamacare, just a lot cheaper now, for me.

llorona

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Re: A good experience with the ACA?
« Reply #25 on: February 23, 2017, 12:22:44 PM »
My experience with ACA has been very positive. Because our income fluctuates, DH and I purchased market-rate insurance from Kaiser Permanente from the California exchange. We're on the bronze plan. If we qualify for the subsidy in any given year, our premiums are about $250-$400 per month. 

Preventive services, like an annual physical and OBGYN visits, have been free. After breaking a finger last year, I received excellent care from the ER and a specialist. If I remember correctly, the total cost was about $500. Last week, I saw my doctor after being for sick for five weeks. She diagnosed me with pneumonia. The cost was roughly $70 for the visit, $70 for a chest x-ray, and $10 for antibiotics, all of which I paid for with an HSA.
« Last Edit: February 23, 2017, 12:24:26 PM by llorona »

letired

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Re: A good experience with the ACA?
« Reply #26 on: February 23, 2017, 12:32:18 PM »
ACA has been great for me! I'm on my employers plan, but they comply with all the ACA stuff, so when I had some lady issues a few years ago, getting it all checked out was very painless, and the birth control since then has been free, which is sort of magical.

ACA has also been great for many of my friends. One friend in particular was on a super el-crapo grad student plan through their university and was constantly having issues with their coverage and treatment. With ACA, the university had to actually pony up and provide actual insurance for grad students, and my friend was able to finally get help with their health issues. I'm in tech, and many of my friends work freelance, so with ACA, they can actually afford health insurance, which they were all really excited about when the whole thing got started. More recently, I had a few friends who were laid off, and ACA was a huge help for them to be able to continue stuff like therapy and whatnot while job hunting.

BlueHouse

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Re: A good experience with the ACA?
« Reply #27 on: February 23, 2017, 01:39:17 PM »
It's been a positive experience for me overall.  I've had independent insurance for years, because self-employed.  I see the ACA as a way for all Americans to be eligible for group insurance and group rates.  Still not subsidized by employers, but at least now I get the same benefits that my peers who work at companies can get. 

1.  No longer fear telling my doctors the truth, because I no longer fear they will drop me if I become "expensive".
2.  Prices are comparable to independent (non-employer subsidized) insurance.
3.  Choosing and changing plans is SO MUCH EASIER.  Because all the plans provide the same information and you can truly compare plans, in the same format, and identify the differences and choose what is the best plan to you.  I don't know if this is the same in all states, or if my exchange just happened to require it, but in DC, every plan had to have a summary plan of information in the same format so that comparisons were EASY instead of difficult.  It just seemed like they wanted the information to be useful for the first time ever.  Previously, switching insurance was a MAJOR ordeal -- so much so, that I've made comments before like "I'm never switching jobs" or "I'm never changing insurance because it's too hard to get the paperwork right". 
4.  I look back to the pre-ACA days and think that these asshole companies want any excuse to deny you coverage, rather than just trying to make people healthy.  And I guess it really does take a government mandate to make insurance companies act responsibly to their customers and not just to their shareholders. 
Sometimes nothing can be a real cool hand

RangerOne

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Re: A good experience with the ACA?
« Reply #28 on: February 23, 2017, 03:16:48 PM »
They covered my wife's $600 IUD placement after she gave birth. Typically she would have had to go to plan parent hood for that. Before the ACA most plans didn't cover basic contraception like this so it was out of pocket or pay for by the government through planned parent hood.

We have blue cross through my work, but the ACA had ramifications for everyone since it change the rules on what all plans must include. Mostly sensible stuff but its pretty clear why costs went up, coverage got more inclusive.

Tom Bri

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Re: A good experience with the ACA?
« Reply #29 on: February 23, 2017, 11:27:39 PM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

misshathaway

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Re: A good experience with the ACA?
« Reply #30 on: February 24, 2017, 06:17:20 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Nope, not unique.  I am very grateful for the ACA, and therefore fine with the hassle, but in the 18 months I've had it, doing nothing but annual physicals and mammograms, it has been one billing problem after another - and I have an HMO. The billing issues started when I switched under ACA from a non-subsidized plan to the comparable subsidized plan.
Passed ER first year anniversary - settling in

Gin1984

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Re: A good experience with the ACA?
« Reply #31 on: February 24, 2017, 06:29:52 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Nope, not unique.  I am very grateful for the ACA, and therefore fine with the hassle, but in the 18 months I've had it, doing nothing but annual physicals and mammograms, it has been one billing problem after another - and I have an HMO. The billing issues started when I switched under ACA from a non-subsidized plan to the comparable subsidized plan.
I don't understand this.  My mom's plan is the same regardless of her getting subsidy or not.  No matter the income you put in, in california, the plans are all the same.  Is that not the same everywhere?

geekette

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Re: A good experience with the ACA?
« Reply #32 on: February 24, 2017, 09:04:11 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Nope, not unique.  I am very grateful for the ACA, and therefore fine with the hassle, but in the 18 months I've had it, doing nothing but annual physicals and mammograms, it has been one billing problem after another - and I have an HMO. The billing issues started when I switched under ACA from a non-subsidized plan to the comparable subsidized plan.
I don't understand this.  My mom's plan is the same regardless of her getting subsidy or not.  No matter the income you put in, in california, the plans are all the same.  Is that not the same everywhere?
Not here.  BCBS offers probably a half dozen plans, only 2 of which are available as ACA plans.  Last year we were on a United Health Care plan, and any ACA plan (there were several) was labeled a "compass plan", and they required referrals for everything, which was annoying.  Still, everything has been covered as expected.

waltworks

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Re: A good experience with the ACA?
« Reply #33 on: February 24, 2017, 09:04:57 AM »
I'm also baffled by these reports, since here (Utah) we also are just buying the same plans you could buy without a subsidy. You can get better or worse plans, or plans from different insurance companies, but the actual plans are the same whether you are getting a subsidy or not.

-W

matchewed

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Re: A good experience with the ACA?
« Reply #34 on: February 24, 2017, 09:18:32 AM »
Yeah people forget that the ACA is not some separate entity from regular health insurance companies. Those companies form the insurance portion of the ACA.

Gin1984

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Re: A good experience with the ACA?
« Reply #35 on: February 24, 2017, 09:32:53 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.
I think you self-selected for those who have had no issues because you asked for good experiences with the ACA.  :)

waltworks

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Re: A good experience with the ACA?
« Reply #36 on: February 24, 2017, 10:02:19 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Just curious, what was your experience like, in, say, 2005? I've been buying my own health insurance for 20+ years and billing battles/wrong codes/endless hours on the phone or resubmitting claim paperwork is... pretty much normal. And it has been for a long, long time.

If you worked for a big company where HR handled that stuff, and now you're in the individual market, it might come as a bit of a shock, I suppose. But that's really pretty much normal in the individual market. There is some amount of incompetence/complexity at work, as well as a healthy dose of "well, if we make it a PITA, maybe she'll give up and we won't have to pay".

-W

Moustaches

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Re: A good experience with the ACA?
« Reply #37 on: February 24, 2017, 12:54:43 PM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Just curious, what was your experience like, in, say, 2005? I've been buying my own health insurance for 20+ years and billing battles/wrong codes/endless hours on the phone or resubmitting claim paperwork is... pretty much normal. And it has been for a long, long time.

If you worked for a big company where HR handled that stuff, and now you're in the individual market, it might come as a bit of a shock, I suppose. But that's really pretty much normal in the individual market. There is some amount of incompetence/complexity at work, as well as a healthy dose of "well, if we make it a PITA, maybe she'll give up and we won't have to pay".

-W

No, if you work for a big company you face the same issues of incorrect bills.  Insurance companies have every incentive to be a PITA, and health prices are notoriously opaque.  This is why single payer with government negotiated transparent prices is the only common sense system.
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whitedott

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Re: A good experience with the ACA?
« Reply #38 on: February 24, 2017, 01:17:19 PM »
My observation is that its less to do with the ACA and more to do with individual offices or hospitals having poor administration. I've worked in financial services for the last ten years and have had a great deal of contact with medical points of service both advising doctors directly or needing to be in contact with offices for insurance related needs. From my experience, doctors are not good managers of people and typically have extremely incompetent staff operating their billing and such, at least relative to office staff in other industries.

Now, you could argue that it wouldn't be a problem without the increased regulation of the ACA. Sure, that's true. But, other industries are subject to heavy regulation and manage to put together a functioning office just fine. The problem is medical services have never been about the price tag. The price, from the consumer's perspective has always been 'it costs whatever it's going to cost. Just fix me'. Because of that, the doctor's offices themselves have never invested in accurate, transparent billing.

Tom Bri

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Re: A good experience with the ACA?
« Reply #39 on: February 25, 2017, 12:26:14 AM »

[/quote]
I think you self-selected for those who have had no issues because you asked for good experiences with the ACA.  :)
[/quote]

!!!!
Darn. You are right!

Tom Bri

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Re: A good experience with the ACA?
« Reply #40 on: February 25, 2017, 12:38:06 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Just curious, what was your experience like, in, say, 2005? I've been buying my own health insurance for 20+ years and billing battles/wrong codes/endless hours on the phone or resubmitting claim paperwork is... pretty much normal. And it has been for a long, long time.

If you worked for a big company where HR handled that stuff, and now you're in the individual market, it might come as a bit of a shock, I suppose. But that's really pretty much normal in the individual market. There is some amount of incompetence/complexity at work, as well as a healthy dose of "well, if we make it a PITA, maybe she'll give up and we won't have to pay".

-W

In 2005 through getting the ACA I had no serious billing problems. I paid my copays and got what I paid for (AFAIK, I may have just been more ignorant!)

From 2011 through 2015 I worked in the medical claims dept of an insurance company, and we were self-insured but ACA compliant (part of that time I was part-time and purchased insurance). That is when the problems started. The doctors simply did not understand that the ACA mandated they use a certain, select list of codes if patients were going to get their routine services covered. It required multiple, lengthy calls to both the insurance companies, and the doctor's billing offices to get claims squared away.

Some claims got paid. Some the clinic eventually forgave after fighting about it long enough. A few I paid just to get it over with.

No one was being obstructive on purpose. The insurance companies, in the main, were professional and helpful (with a few exceptions, not all agents are equally well-trained). The billing offices were often incompetent, but over time could be talked into sending the paperwork that was needed to the insurance companies.

Tom Bri

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Re: A good experience with the ACA?
« Reply #41 on: February 25, 2017, 12:42:21 AM »

-W
[/quote]

No, if you work for a big company you face the same issues of incorrect bills.  Insurance companies have every incentive to be a PITA, and health prices are notoriously opaque.  This is why single payer with government negotiated transparent prices is the only common sense system.
[/quote]

I don't think this is true currently. Insurance companies are now required to return a specified % of their income back to claims. If they pay out less than that %, they have to send their clients checks for the difference. Being a PITA and refusing to pay claims doesn't save them any money.

misshathaway

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Re: A good experience with the ACA?
« Reply #42 on: February 25, 2017, 05:45:59 AM »
Quote
I don't understand this.  My mom's plan is the same regardless of her getting subsidy or not.  No matter the income you put in, in california, the plans are all the same.  Is that not the same everywhere?

I'm in MA. The Silver plan under Minuteman has 2 different names depending on if it's subsidized or not. As far as I could tell the benefits were the same when I picked it. So I had Minuteman Silver before and after subsidy. Before subsidy - AOK. After subsidy - billing problems. Could be specific to Minuteman. They were all resolved in my favor eventually.

As far as a comparison to other setups I've had - I had very expensive private health insurance through a trade group when I was contracting. That was a good 15 years ago. No billing problems but high deductible and high monthly rates. Then working for small companies and a hospital, less expensive insurance, and still no billing problems.


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iris lily

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Re: A good experience with the ACA?
« Reply #43 on: February 25, 2017, 01:26:47 PM »
 In November we moved from a COBRA policy to a policy on the exchange since our COBRa coverage expired.

We don't use health services other than DH's annual physicals with recent exceptin. But just as I expected, the ACA policy seems to be administered by clowns. Even the simple business of signing up henerated errors from them.  We get letters that duplicate something and then get another letter saying later oh never mind. It is a circus.

I can hardly wait until we have actual expenses that need to be covered through them. Not.

Recently DH experienced anxiety and he is seeing a therapist weekly for that, not covered by insurance.  But that is ok, we can afford to pay. And, I am thinking about conceriage physician services so I don't have to deal with the idiot insurance people.
« Last Edit: February 25, 2017, 01:29:27 PM by iris lily »

TheDudeReturns

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Re: A good experience with the ACA?
« Reply #44 on: February 28, 2017, 12:25:39 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Have to agree with this. I routinely get overcharged for "routine" things. Had an annual checkup that resulted in $300 for uncovered blood tests. Took over 6 months of refiling bills to get it down to $150. Really, just more fuel to go with the lowest deductible plan you can as usually there is only about $1k a year difference between that and the worst bronze plan. Also, can't imagine people who work with the healthshare alternatives where they are expected to negotiate EVERYTHING when I've always had issues on even minor health bills with "surprise" costs.

geekette

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Re: A good experience with the ACA?
« Reply #45 on: February 28, 2017, 10:44:55 AM »
I guess I've been lucky, or our local insurance companies follow the rules. 

We've been on an ACA plan from very close to the start, and have yet to have any bad surprises.  I had a very nice surprise a couple years ago when all sorts of lab work and radiology charges were included in a doctor's visit copay, when I was expecting them to go to the deductible.  I also was concerned that my colonoscopy wouldn't be considered "screening" since I'd had a polyp removed before, but it was covered in full, too. 

The first was through BCBS, and the second was UHC.

redbirdfan

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Re: A good experience with the ACA?
« Reply #46 on: February 28, 2017, 10:21:02 PM »
I absolutely LOVE the ACA.  I don't receive any subsidies and so far I've only gone to the doctor for "free" wellness/preventative visits.  The ACA allowed me to negotiate an independent contractor relationship with my former employer so now I have an HSA eligible plan.  The independent contractor relationship allows me to invest in a solo 401k plan and max out my HSA to speed up FIRE.  I would never have attempted starting my own business without the ACA.  No complaints so far. 

Full disclosure: I don't currently have any preexisting conditions.  Selfishly, if the Republican proposal covers preexisting conditions with continuous coverage, and it is accompanied by tax credits and expanded HSA accounts, I could get on board with that too.  I just think it would be horrible "solution" for those whose main barrier to health care is affordability.   

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Re: A good experience with the ACA?
« Reply #47 on: March 01, 2017, 10:19:39 AM »
I just do not like the hours I spend on the phone getting this done. Happened to both my daughters and my wife too, from multiple doctors over several years.

So my question. Is my experience normal? Do you get your claims paid easily for your yearly physicals? From my years working insurance claims, a huge portion of my time was advising our clients on how to get their doctors to properly code claims so that my company would pay them.

I suspect a lot of people just pay the claims, not knowing that the services should be 100% covered.

We have employer-provided health insurance and this used to happen all the time until we switched doctors. Not sure if the mixing up of codes was as a result of ACA issues or not. No problems since seeing our new doctors (side note: posh areas have doctors that actually listen and care about proper billing, in my experience. Sucks that that's the case, but true :-/)

I absolutely LOVE the ACA.  I don't receive any subsidies and so far I've only gone to the doctor for "free" wellness/preventative visits.  The ACA allowed me to negotiate an independent contractor relationship with my former employer so now I have an HSA eligible plan.  The independent contractor relationship allows me to invest in a solo 401k plan and max out my HSA to speed up FIRE.  I would never have attempted starting my own business without the ACA.  No complaints so far. 

That's awesome!
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calimom

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Re: A good experience with the ACA?
« Reply #48 on: March 01, 2017, 09:59:25 PM »
No whining from me. No "Obama squished my breasts really hard during the mammogram after the ACA was enacted than before". No "we didn't get to keep the same doctor forever even after she retired. Thanks, Obama".

The ACA helped my family save over $400 per month, and be able to keep my post-college age stepdaughter on our plan. Other than that, everything stayed the same. We're not super high health care users: some basic check ups, the odd swimmers' ear and broken arm. I'm so grateful the ACA came into our world, and will fight for its continued existence.

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Re: A good experience with the ACA?
« Reply #49 on: March 02, 2017, 08:25:39 AM »
Wow. Sounds like me and my family are unique in not being able to get routine services paid! I envy you all.

I had a routine colonoscopy today! It went smoothly and I feel fine, but dread getting a huge bill, even though this is supposed to be covered 100%. I am mentally gearing up for a huge billing fight, just as I have every year for the past 5 after my yearly check-ups.

Just curious, what was your experience like, in, say, 2005? I've been buying my own health insurance for 20+ years and billing battles/wrong codes/endless hours on the phone or resubmitting claim paperwork is... pretty much normal. And it has been for a long, long time.

If you worked for a big company where HR handled that stuff, and now you're in the individual market, it might come as a bit of a shock, I suppose. But that's really pretty much normal in the individual market. There is some amount of incompetence/complexity at work, as well as a healthy dose of "well, if we make it a PITA, maybe she'll give up and we won't have to pay".

-W

No, if you work for a big company you face the same issues of incorrect bills.  Insurance companies have every incentive to be a PITA, and health prices are notoriously opaque.  This is why single payer with government negotiated transparent prices is the only common sense system.

Agree. We've been on a gold-plated UnitedHealthcare plan administered through my husband's employer and we still get reamed quite regularly despite the fact that we're a healthy family that uses few services besides prevention... and strangely, every mistake benefits them! The reason why we don't complain about the yearly increase in rates is because they are automatically deducted from the paycheck before we even see it.  Probably if we had to write checks out, we would get as angry as those folks complaining about ACA rate increases.