The Money Mustache Community
General Discussion => Welcome and General Discussion => Topic started by: RetirementDreaming on June 09, 2016, 04:41:51 PM
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Today I went to see a dermatologist. When I was completing the paperwork I read in capital letters – WE DO NOT ACCEPT COVERED CALIFORNIA OR ANY HEALTH PLANS ON THE EXCHANGE. My children’s pediatrician also as a sign in his office that says he doesn't accept exchange plans.
My husband and I plan to FIRE in as little as 3 years (and I’m trying to pull that in). The ACA is a big part of making that happen. I looked online at the closest dermatologist I could find that would take ACA. It was 50 miles away. I’m starting to second guess voluntarily giving up employer sponsored health care. We seem to be creating “have” and “have nots” related to healthcare at least where I live.
Has anyone else experienced this? Does it affect your FIRE plans?
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Did you ask them why their policy is the way it is? Was it a political thing? I have a hard time believing that every single plan on the exchange pays doctors less than the average employer-based plan, given that the same companies run both types of plans, and there's a wide variety of cost levels for the exchange plans. Surely there's a platinum plan or something that will pay out comparably, right?
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Keep in mind Covered California is essentially CA's branding for medicaid isn't it and California's medicaid pays doctors extremely low rates (on average only 52% of what they'd get paid to perform the same services for a patient with medicare).
Nope, I was thinking of Medical, not Covered California. Sorry for the mixup.
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After a Google search of "doctor doesn't accept covered California" I realize this is an issue. Glad I found out now. I need to go back into planning. If I FIRE at 48 as planned that's a long time to risk not having healthcare available and I won't have the funds to pay out of pocket for all health care.
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I'm in Texas, FIREd as of last year and on our second year of ACA coverage with BCBS - HMO (used to have the PPO and would have paid more to still have that option, but oh well). My doctor that I'd been seeing for the last decade or so took the ACA coverage. Same with the hospital that is less than a mile from my house and most all of our other regular/specialist docs we've seen over the years. Only had one doctor not in this specific provider network but he was in network for a different group through the ACA (but it's a super specialist that is only seen maybe once every other year, and we decided to cover his cost out of pocket to keep in network with all the rest of the docs we regularly see).
So I guess it really depends on where you live? Which is kinda odd when you consider that Texas blocked everyone from the Medicaid (or is it care?) extension, and also refused to set up a state exchange and were in general huge douche canoes about the whole thing, but I guess the doctors in general were okay with it?
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In most states there's a pretty big range in the size of the network. And, as you would expect, the cheaper plans generally have smaller networks (but not always). Plans are required to have some level of network adequacy. They need to have some minimum amount of key providers in their network in geographic areas. I know California had some issues where the lists of providers the plans provided to Covered California was not accurate for awhile. I think that situation has been improved, but am not recalling for certain.
How did you conduct your search? I am very skeptical that there are no dermatologists within 50 miles on any individual market plans (the plans on and off the marketplace are largely the same). I would expect that many do not take those plans. But certainly not all. That's against the requirements for a plan to even be offered in any state. And Dave Jones is pretty on top of things.
I would go look at plans on the marketplace and look at their networks and find a doctor that way. Or call one of the plans up and say you are shopping for a CC plan and want a list of dermatologists in your area.
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Did you search on your insurance website? Back when I was on an a catastrophic exchange plan with a limited network, I naively thought BCBS would have a tool for me to find primary care doctors. Their website told me there were a total of 2 doctors who would want to see me, in a metro area of about 2.5 million.
It turns out that nobody at BCBS thought that looking for doctors directly on a website provided by a company to which customers pay hundreds of dollars per month was a valid use case. Their online search was completely broken for the ACA plans. It has since been fixed, and from what I can tell almost everybody takes ACA plans in this area. I just checked and I could find all types of specialists even in the limited network.
So to answer your question, no I am not worried one bit. Healthcare is a stupid commodity that currently happens to cost an arm. I couldn't care less who my doctor is so long as 1) they do a reasonably good job for a reasonable price, and 2) they are not too far away from me. It boggles my mind to see how the average consumer focuses on getting "the best care there is" with little regard to price, all the while eating crap food and leading terribly unhealthy lifestyles.
There are millions of families on ACA plans, and that number is growing. If some doctors decide for one reason or another not to take these plans, I have full confidence in the market forces to usher in another market participant to fill the void.
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When I changed jobs and changed insurance providers, I tried to use my insurance providers' website to check if my current doctors accepted my new insurance. None of my doctors were on their website. However, they all actually took my insurance.
TL;DR don't trust website results, make some phone calls to the actual offices.
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Although ACA provides insurance to millions of people, that subsidized insurance has very high deductibles that many who require subsidies can't afford anyways. Therefor seeing a patient with such insurance has a high likelihood you will not get paid for the service provided especially if it is early on in the year and deductibles have been unlikely met yet.
I'm not saying this is the only reason those doctors don't take Exchange issued insurance, but it may be part of the reason.
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Many of the plans offered on the exchanges have lower reimbursement rates than commercial group insurance. The reimbursement rates for many of the exchange plans fall somewhere between Medicaid and Medicare. That being the case, many doctors have chosen not to deal with them.
An additional gotcha for doctors is that subsidized plans offer a 90 day grace period from the point the insured stops paying and when they're not liable for payments. The problem is that insurers often will not reimburse doctors during this grace period if the insured doesn't pay either.
Due to these issues a lot of doctors have decided it doesn't pay to take any ACA patients, or to limit them to a certain percentage of their total patients.
Mike
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With my high deductible policy, I'm paying anyway for office visits, so the doctor being in or out of network is less of a concern. I load up my HSA, and invest it agressively, in anticipation of needing to pay for care post FIRE,
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I think as time goes on, you're going to see less of this. There are huge changes happening to reimbursement across the board, and fewer and fewer doctors are going to be solo private practice. You're also probably going to see a return of more limited insurance networks, and higher costs for "out of network" providers. Do your research before you sign up for a plan, and make sure you're getting the providers and health care system you really want.
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With my high deductible policy, I'm paying anyway for office visits, so the doctor being in or out of network is less of a concern. I load up my HSA, and invest it agressively, in anticipation of needing to pay for care post FIRE,
You might want to review your policy documents.... All the plans I've ever been in have had separate deductibles for in-network vs out-of-network doctors (and the out-of-network deductible is usually 2x or 3x higher than the in-network-deductible). So if you have an in-network deductible of 6,000, you might have an out-of-network deductible of 12,000... you could end up paying 18,000 before anything is covered.
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I think a lot depends on what state you are in as far as doctor networks. My plan has the same doctors as my Megacorp plan did, except for the Ophthalmologist. The only difference is I pay less now since it is Medicaid managed care.
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I'm curious where in Ca you are because I just helped someone in Palm Springs go through covered Cal (COBRA expired) who had no problem finding a dermatologist under multiple plans as we compared. No idea on pediatrician though.
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It would be useful if we could crowdsource some feedback from our doctors. Next time you go ask what type of private insurance they would accept and what types they reject. From my reading some insurance carriers have better reimbursement rates than others. The limitation of the insurance exchanges is that they only talk about monthly premiums and deductibles: there's no mention as to whether or not the insurance company's reimbursement policy is so unattractive to doctors to make the policy effectively useless. :)
I'd rather pay $400 a month for insurance I can use than $300 a month for a policy that is not accepted anywhere.
Medicare has similar problems. Medicare establishes set fees for any procedure and those fees tend to average roughly 80% of what private group insurance pays. Due to that some doctors have refused to accept patients who are on Medicare or limit the total number of patients who are on Medicare. It's every doctor's choice as to what insurance he/she chooses to accept.
Mike
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There are a number of physicians on the boards here as well. It would be great if they could chime in to get their perspective.
Mike
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Insurance and medical care in this country are kind of a mess. Honestly though I have not heard of physicians not taking ACA plans. Maybe this is a regional thing. There are plenty of docs who do not take medicare because of poor reimbursement.
The biggest problem is when dealing with specialists, as often times there is just not enough supply in an area and if they don't take your insurance, well, too bad.
The work around is to treat insurance like insurance. It is used to hedge against catastrophic events where you can not manage the risk (A car crash, complex surgery, heart attack, etc.). For routine visits just suck it up and pay the couple hundred dollars out of pocket. The ER will take your insurance.
I know this is not great news, but unfortunately it is reality. The best way to avoid medical costs is to try and interact with the medical industrial complex as little as possible (I sound so doom and gloom, sheesh).
My work around is this: Fund an HSA. This is available to only a minority and if you have one it usually means your primary insurance sucks. Pay for medical care out of pocked and let the HSA grow. When I retire I will draw from the HSA as needed and pray I make it to 62 without having a medical disaster, cancer or expensive chronic disease which will bleed my savings.
Had our first trip to the ER ever this year for a relatively minor (but emergent) thing. I will write about it when all the bills come in. Hopefully I will be pleasantly surprised, but I'm preparing for a pretty large bill. In any event it should be educational :)
Bottom line: Early retirement is probably not in the cards for anyone with serious medical issues unless they have an unusually high income, or they are fine living below the poverty line and living on medicaid and other subsidies. Stay healthy!
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The ER bills are a scam. They literally make up prices out of thin air. That is why aspirin is $5 a pill. These guys are scammers and get away with it and no one says anything.
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Mid 50's retiree with an expensive chronic condition here. We retired before HSA plans were widespread (we had one his last year partial of working and spent it down on COBRA premiums)
Plans on the exchange change every year, so I spend a month or so looking over the 30+ plans from at least 3 companies with an eye to keeping our costs down, and our options open. BCBS was our choice for a couple years, but last year, BCBS decided to offer only "Blue Local" plans in our area, and our GP of 20+ years doesn't accept that, so we switched to United Health Care, which has been great. Now they're leaving the state, so next year we switch again.
I don't understand why BCBS no longer offers the Blue Select and Blue Value plans they did before, but if you live in one of the larger metro areas in our state, the only ACA plans available are the smaller network Blue Local plans. If we moved one county south, we could still get a Blue Select plan and go to our regular GP. Not really worth it though!
Oddly, specialists are not a problem here, they all seem to take every plan, but I would prefer to stick with my GP if at all possible.
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Yeah I'm not really looking forward to switching next year since BCBS is leaving NC in regards to the ACA. I like my plan but I guess I'll have to review my options pretty carefully come November.
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I didn't hear the BCBS was leaving! Just UHC. There's still Aetna, but getting info on their plans has been difficult (as in their own customer service reps couldn't answer questions).
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I wish we could actually look at plans on the company's website. Some of them I go on and I can't look at anything since its outside of the enrollment period. It would be nice to be able to get an estimate a few months in advance so I could make plans.
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The ER bills are a scam. They literally make up prices out of thin air. That is why aspirin is $5 a pill. These guys are scammers and get away with it and no one says anything.
Aspirin costs $5 because for every 5 people billed for it, only 3ish pay for it. My mom worked to bill out ER procedures in a rural hospital for many years and said they had about a 40% charge-off rate. ERs must treat first, then check for coverage. MANY people never pay. That's why its always better to go to urgent care or your regular doctor's office unless it really is an emergency.
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I wish we could actually look at plans on the company's website. Some of them I go on and I can't look at anything since its outside of the enrollment period. It would be nice to be able to get an estimate a few months in advance so I could make plans.
You can get details on current year plans at healthcare.gov, but that won't help for next year. See plans (https://www.healthcare.gov/see-plans/) (no need to create an account, but you have to give some info on ages/sex/tobacco use. For subsidies, estimate your income).
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Ok, this is general. But.
1. Doctors are free to join or not join an insurer's network. Either side may not like the arrangements and decide to not enter into a contract. Yes, it's a contract.
2. Overall, insurance companies are losing money on ACA/exchanges. That's why some of them (United for example) are pulling out of the exchanges. Their choice. Personally, I think it's a symptom that ACA overall isn't working and needs adjustments.
3. The broader networks, etc that we as consumers like so much (think PPOs) - those cost the insurance companies more. Because they're already losing money (see #2), a lot of them have dropped those plans from the exchange. You can still get them off-exchange, but you don't get subsidies.
4. The online provider searches - they can be helpful, but ALWAYS call the doctor to confirm. The insurance company will make updates they receive, but it's up to the doctor to send in the updates. And they often don't. If the tool is wrong, ask the doctor if they submitted the updates to the insurance company. They probably didn't.
5. Billing - yeah, that's messy. I'm staying out of it. Good luck, and always check the bill.
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I didn't hear the BCBS was leaving! Just UHC. There's still Aetna, but getting info on their plans has been difficult (as in their own customer service reps couldn't answer questions).
BCBS is separate by state. It's possible that the NC BCBS is leaving that local market. I know they aren't leaving many other markets.
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I'm in Texas, FIREd as of last year and on our second year of ACA coverage with BCBS - HMO (used to have the PPO and would have paid more to still have that option, but oh well). My doctor that I'd been seeing for the last decade or so took the ACA coverage. Same with the hospital that is less than a mile from my house and most all of our other regular/specialist docs we've seen over the years. Only had one doctor not in this specific provider network but he was in network for a different group through the ACA (but it's a super specialist that is only seen maybe once every other year, and we decided to cover his cost out of pocket to keep in network with all the rest of the docs we regularly see).
So I guess it really depends on where you live? Which is kinda odd when you consider that Texas blocked everyone from the Medicaid (or is it care?) extension, and also refused to set up a state exchange and were in general huge douche canoes about the whole thing, but I guess the doctors in general were okay with it?
I am also in Texas... and there is a very large number of docs in my town that don't take BCBS HMO. I suspect it has nothing to do with political objection... that the whole HMO referral/approval chain is just a huge pain in the ass. It slows them down, creates paperwork and requires more staff to handle everything.
I know my area was one of the first areas in Texas to experiment with HMOs. The doctors themselves grouped together to start an HMO. About 5 years into it, they were all complaining about the monster they created. One doctor stood up and quoted Pogo: "I've met the enemy and he is us." I think because of that, a lot of the docs that have been around a while are a bit afraid of the HMO pyramid.
I am hoping it will loosen up and more will take it... but it sort of sucks around here right now.
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I didn't hear the BCBS was leaving! Just UHC. There's still Aetna, but getting info on their plans has been difficult (as in their own customer service reps couldn't answer questions).
BCBS is separate by state. It's possible that the NC BCBS is leaving that local market. I know they aren't leaving many other markets.
BCBSNC threatened to leave back in February. The latest news from them is that they are seeking large increases:
http://www.newsobserver.com/news/business/article80879447.html
If they leave, it will be a major blow to the ACA and the rural counties of the state.
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I didn't hear the BCBS was leaving! Just UHC. There's still Aetna, but getting info on their plans has been difficult (as in their own customer service reps couldn't answer questions).
BCBS is separate by state. It's possible that the NC BCBS is leaving that local market. I know they aren't leaving many other markets.
I did some research and found that they considered leaving NC, but as of last week, have "announced their intent" to stay. Interesting Op-Ed article by the BCBSNC CEO here (http://www.newsobserver.com/opinion/op-ed/article82837787.html).
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Thanks geekette. Also, just wow! From the editorial you linked to.
Last year, the sickest 5 percent of our ACA population paid $108 million in premiums, including their government subsidies. We paid out a staggering $1.29 billion in claims for the same customers.
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My assumption is that you'd be able to buy a nice individual plan that's fairly widely accepted if you're willing to pay for it. What I'm unsure of is how to locate those plans. The exchange is convenient but likely has the least usable plans. It seems the best way is to call individual doctors once you have a plan in mind and ask if they accept that particular one.
Cost is less of a factor as long as it's useful: I'd rather pay $500 a month for something I can use than $300 a month for insurance that is only rarely accepted.
Mike
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There was an article in the NY Times last month about this: "Sorry, We Don't Take Obamacare" (http://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html)
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One solution to this is to go to an academic center. In general, they will take all insurance, or work with you on a payment plan. Yes, they usually charge for parking, have long waits, subject you to students and residents, but they provide adequate (and often superior) care.
Living in a place with few medical providers and crappy insurance options is kind of like living in a place with high housing costs. There is nothing wrong with doing it, but a bit of flexibility can allow you to save a tremendous amount of money and hassle. Don't like the California options? Move someplace with better options.
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My work around is this: Fund an HSA. This is available to only a minority and if you have one it usually means your primary insurance sucks has a high deductible.
FTFY. That's my employer's tradeoff. We load our HSAs every year--it came in very handy last year when I got very sick.
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Thanks geekette. Also, just wow! From the editorial you linked to.
Last year, the sickest 5 percent of our ACA population paid $108 million in premiums, including their government subsidies. We paid out a staggering $1.29 billion in claims for the same customers.
That's the way it is with all insurance. It's a power law. The sickest people cost the most. Usually it's the sickest 5% cost over 50% of total expenditures. There are similar power law rules in other domains. Like the 10% heaviest drinkers drink 80% of all the alcohol (or something like that). The richest 85 people have more money than the poorest 3.5 billion.
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Since it came, up, quick lesson on the Blues plans.
Each BCBS is a separate license. The Blue Cross Blue Shield Association, based in Chicago, administers the licenses, assists with coordination between the different companies, etc. BCBSA is not an insurance company.
There are, I believe, 37 companies currently which hold the licenses and are insurance companies. Obviously, one company may hold multiple licenses. Anthem holds a lot, I think 15+. Health Care Service Corp holds 5. Others are only one, IE BCBS Michigan is one company, one license. These different companies are separately managed, do not cross into other territories, and have various legal structures. That is one reason why you'll find so much variation from state to state - it frequently is different companies.
If you're curious, BCBSA's website has more information.
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Unfortunately the ACA website (which added a filter to only show plans that your doctor and hospital accept) is not accurate. I helped a friend of mine get coverage through the site and found out after the fact that none of her doctors accepted the plan. I cross referenced it with the company website also and it had the wrong information. Many doctors on the company site did not accept the plan.
It is a challenge, but hopefully it will improve. I've found that calling the company and asking them for doctors gives better results than the websites, maybe they don't update often enough, or maybe the doctors only take a certain number of ACA patients and are at their maximum.
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Some of the doctors I know are just not taking any individual plans at all, and it's easier for them to do when individual plans are in different networks than the group networks (different for different states and different insurance carriers) because of the reasons some PPs mentioned.
I'm not relying on individual plans for my FIRE planning at all. I'm going to keep my group plan from my business as long as I can, and my plan uses the largest network in the country and it's cheaper than any individual plans I can find in this market. The largest carrier in my state (BCBS) is requesting a 58% increase for 2017 on their individual plans. Not sure if the state will approve. They requested a 54% increase in another state they did business in for 2016 and got rejected and they pulled out of that state completely for 2016. I'm guessing that may happen here too for 2017, not sure.
I think gradually there will only be 1 carrier available, which is already happening in some areas. Or maybe the federal government will take over. Regardless of how much money you have, you will not be able to buy a decent individual plan, that's a fact in my area.
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It seems like this would be more evidence to buy a bronze plan, i.e. the cheapest plan available, if likely it won't be useful for much other than catastrophic hospital visits.
Mike
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Few relatives have covered can plans in can and the most Dr that accept were community clincs that accept medical patients. This year they switched to kaiser for about $15 month extra and receive much better care. AFAIK kaiser doesn't have member tiers between plans.
Sent from my Nexus 6 using Tapatalk
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Yes, Bronze is mainly the way to go.... I like that Obamacare has standardized the way that health plans are presented. Prior to Obamacare is was difficult to compare plans. Now, you can easily compare the plans apples-to-apples. The nomenclature however is unfortunate in that it gives a false sense that Silver is better than Bronze; Gold better than Silver, and Platinum better than Gold. There is no difference in the actual coverage or the care that you are receiving. The difference essentially is do you want to pay now or pay later. If you believe with a high degree of likelihood that you will have considerable medical expenses, the more expense plans might make sense, but for most people I think Bronze is the way to go.
I quickly became disenchanted with Obamacare because of the available practitioners that most people have covered in this thread already. I experienced this with an individual plan OUTSIDE the exchange. It was a comparable BC plan, but it was directly from BC, not through the exchange.
Right from the start I saw the problems; medical practitioners refusing to cover my wife and me; we had been a group plan through BC previously, but when we switched to an individual plan, our providers informed us that we wouldn't be covered any more. If you are in a large group plan, most providers will happily take on the business, otherwise, it can be a real problem. As someone mentioned earlier in the thread, the closest providers under ACA-like plans can be 50+ miles away.
We quickly elected to change plans and get back into a large group plan. Now we get to see all our providers like we could before.
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We quickly elected to change plans and get back into a large group plan. Now we get to see all our providers like we could before.
So how did you get back into a group plan?
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How the hell would they know you are using an ACA plan? It's just a healthplan. Unless it's Medicaid, it's a plan from a major insurer. Unless they don't accept the major insurer, then it's none of their business.
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"Last year, the sickest 5 percent of our ACA population paid $108 million in premiums, including their government subsidies. We paid out a staggering $1.29 billion in claims for the same customers."
So, assuming that the sickest 5% are similar in age to the rest of the ACA population, they took in over 2.1 billion in premiums overall and paid out most of it on the expensive cases. That's pretty much par for the course with health insurance. It would be more interesting if they just said whether their loss ratio was too high. They're supposed to be paying at least 80% of their income in claims, but I can see how they might start having trouble if the number was pushing 90% (it was around 87%) because of all their overhead. They can either cut overhead or increase premiums. They don't seem to publish an annual report, though, just a few summary numbers, so it's hard to evaluate their statements.
Of course, if NC accepted the medicaid expansion, then BCBS wouldn't have to worry about a lot of the subsidized people who are within 100-133% of the FPL. There are also a lot of people who wouldn't work a lot of extra hours just to stay in the ACA system because they would be eligible for medicaid.
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Right from the start I saw the problems; medical practitioners refusing to cover my wife and me; we had been a group plan through BC previously, but when we switched to an individual plan, our providers informed us that we wouldn't be covered any more. If you are in a large group plan, most providers will happily take on the business, otherwise, it can be a real problem. As someone mentioned earlier in the thread, the closest providers under ACA-like plans can be 50+ miles away.
We quickly elected to change plans and get back into a large group plan. Now we get to see all our providers like we could before.
This seems to be the case in CA. I don't personally know anyone with an exchange plan but I called a few doctors listed as in-network for an exchange plan and most said they do not take exchange plans or not accepting new patients. This means I need to work longer just for the health benefits. I'm researching where I want to work in the future with as few hours necessary to receive health benefits. Not the FIRE plan I envisioned but better to find out now.
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I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
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This thread just proves what I have been saying for years. Health insurance does not equal health care.
This country has been confusing the two for way too long.
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I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
Sounds like you work in a crappy office. Seriously, complaining about "too much paperwork"? Sounds lazy and more interested in ripping off patients to me. I haven't had any problems finding excellent doctors that take my BCBS insurance plan. When I needed surgery last year, it was no problem at all having excellent care at a nearby hospital that was covered by insurance (with a relatively tiny deductible).
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We quickly elected to change plans and get back into a large group plan. Now we get to see all our providers like we could before.
So how did you get back into a group plan?
It does mean continuing to work in some capacity
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Right from the start I saw the problems; medical practitioners refusing to cover my wife and me; we had been a group plan through BC previously, but when we switched to an individual plan, our providers informed us that we wouldn't be covered any more. If you are in a large group plan, most providers will happily take on the business, otherwise, it can be a real problem. As someone mentioned earlier in the thread, the closest providers under ACA-like plans can be 50+ miles away.
We quickly elected to change plans and get back into a large group plan. Now we get to see all our providers like we could before.
This seems to be the case in CA. I don't personally know anyone with an exchange plan but I called a few doctors listed as in-network for an exchange plan and most said they do not take exchange plans or not accepting new patients. This means I need to work longer just for the health benefits. I'm researching where I want to work in the future with as few hours necessary to receive health benefits. Not the FIRE plan I envisioned but better to find out now.
That might be the case
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How the hell would they know you are using an ACA plan? It's just a healthplan. Unless it's Medicaid, it's a plan from a major insurer. Unless they don't accept the major insurer, then it's none of their business.
Insurers offer many different plans. United might have 25 different plans in a states. Some of them have a higher reimbursement rate than other plans. So some providers will be in network for some plans and not for others.
The nomenclature however is unfortunate in that it gives a false sense that Silver is better than Bronze; Gold better than Silver, and Platinum better than Gold. There is no difference in the actual coverage or the care that you are receiving. The difference essentially is do you want to pay now or pay later.
There's no consistent correlation between paying more for healthcare and getting higher quality outcomes. Sometimes the more expensive providers do a worse job.
I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
Are you in the mental health area? That's one of the only kinds of medical care where I can imagine people getting enough business without taking insurance. There are concierge docs that serve the wealthy. And alternative medicine or therapy places that insurers frequently don't cover.
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I'm not really stressed about it. Folks on medicare and medicaid have just as good risk-adjusted outcomes as those on private health insurance plans. That must mean that some doctors are seeing them.
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I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
Are you in the mental health area? That's one of the only kinds of medical care where I can imagine people getting enough business without taking insurance. There are concierge docs that serve the wealthy. And alternative medicine or therapy places that insurers frequently don't cover.
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Yes, I am in the mental health field. And yes, we are currently closed to new patients and have a waiting list.
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I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
Sounds like you work in a crappy office. Seriously, complaining about "too much paperwork"? Sounds lazy and more interested in ripping off patients to me. I haven't had any problems finding excellent doctors that take my BCBS insurance plan. When I needed surgery last year, it was no problem at all having excellent care at a nearby hospital that was covered by insurance (with a relatively tiny deductible).
No, it is not a crappy office filled with lazy doctors. Lol. Do you know how much paperwork is required by many insurance companies? We would have to hire people just to do the paperwork. And to file claims. Instead, we keep our overhead low and pass the savings on to our patients. As I mentioned above, we have a waiting list. We also see a percentage of patients on a sliding scale or for free - not something doctors can do if they are being controlled by contracts with insurance companies. In my area, there are very few psychs that take insurance.
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The whole process of dealing with Medicare/Medicaid and private insurance is a massive expense and a huge hassle. Just about every physician I talk to would love to remove themselves from dealing with those organizations.
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Does it factor into your FIRE Plans?
No, I don't think it should unless somebody is already FIRE'd or within a couple years of it
The ACA is very new. It obviously needs improvement and probably will change. Don't plan your life around today's market conditions and today's implementations of the law, or even the law itself. It is all too likely to change.
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Does it factor into your FIRE Plans?
No, I don't think it should unless somebody is already FIRE'd or within a couple years of it
The ACA is very new. It obviously needs improvement and probably will change. Don't plan your life around today's market conditions and today's implementations of the law, or even the law itself. It is all too likely to change.
Yes, healthcare law is almost certain to change in 5, 10 20 years. The best thing about the ACA in my opinion is that anyone can get insurance - not great or cheap insurance always, but basically anyone that can pay the premiums gets a catastrophic policy no matter their health status. This is a great benefit to those that are in poor health. Before the ACA some people just couldn't get health insurance.
That being said, there are structural problems with medicine today and it is hard to imagine a system in 10 years that is less expensive or one that provides better access to care. I think it will play out like social security, in order to pay for expanding benefits someone has to pay for it. This is already happening: Higher copays, narrow networks that make finding a provider more difficult, higher deductibles, more restrictive drug plans, etc. Plan for higher medical costs in the future unless there is something disruptive on the horizon that no one sees coming.
An interesting idea is to lower eligibility for medicare to 50 or 55 shifting people from private insurance to CMS, although this would probably have the unintended side effect of making doctors that take medicare much more scarce and tough to see (unless reimbursement in increased, which is can't because then the program would be impossible to fund). This would be great for FIRE because it would significantly shorten the gap between private insurance and medicare.
When you retire at 35 nobody thinks of health care, because most 35 year olds are pretty healthy, even the ones that abuse their bodies (within reason). It is that 50-to-medicare time frame that can be an absolute nightmare. This is when things can really go wrong with health, even in people that have lived a very health life.
Also I don't know many docs that restrict insurance because they are lazy or greedy. Many can not afford to sign a certain contract with an insurance company because they would lose money on it. The overhead to run a clinic or hospital is pretty huge. Insurance contracts are usually pretty terrible, hundreds of pages written by lawyers for insurance companies that are designed to shift at much liability and cost to physicians as possible. Don't underestimate the amount of friction that has been introduced into the system in terms of paperwork, per-authorization and compliance over the past decade or so.
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I did some research and found that they considered leaving NC, but as of last week, have "announced their intent" to stay. Interesting Op-Ed article by the BCBSNC CEO here.
Heh, I work there. And it's funny this was quoted because when I started reading the thread I was thinking about how different our situation is. When the ACA first started, I heard of doctors not accepting ACA patients initially because of their own political reasons and because of some initial things that weren't 100% worked out at that point but since have been (people could sign up, not pay their premium, and then it wasn't clear who was on the hook for the bill). But I haven't heard of anything like that since. Any employer group can buy an ACA product (not on the exchange, just get the same type of product), and many do. From the doctor's perspective, it shouldn't be different than any other member.
And as for member's not paying their deductibles... for the poorest folk, there are not only subsidies, there are cost share reduction reimbursements from the government- which essentially means they pay next to nothing in cost share and the government reimburses the insurance company. This still could be somewhat of a problem for doctors, but I do not believe it is a large problem. In fact, several of the largest hospital systems here have had record breaking profits since the ACA was implemented.
I can only guess that in other states, some plans do have truly different reimbursement levels for ACA versus non ACA products. This is not something I was aware of before, so it's my guess that this currently is not the norm. If it's effective at reducing costs though, it's possible it could spread.
Disclaimer: any opinions stated above are my own and not that of BCBSNC.
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It's not surprising that hospitals are making big bucks because insurance companies have to accept everybody. BCBS in my state had lost over $1Bil in 2014 and 2015 paying those bills that made record breaking earnings for hospitals. But how many billions of dollars can they lose before they go belly up?! That are just the losses in my state, and the parent company of this BCBS operates in 5 states and they had lost billions already.
The system used to work better here. We had a state health risk pool, EVERYBODY could get insurance, no one would be denied. The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state. Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.
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It's not surprising that hospitals are making big bucks because insurance companies have to accept everybody. BCBS in my state had lost over $1Bil in 2014 and 2015 paying those bills that made record breaking earnings for hospitals. But how many billions of dollars can they lose before they go belly up?! That are just the losses in my state, and the parent company of this BCBS operates in 5 states and they had lost billions already.
The system used to work better here. We had a state health risk pool, EVERYBODY could get insurance, no one would be denied. The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state. Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.
Altons Bobs - so, I work for BCBS, based in Chicago. I'm thinking we work for the same company?
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The system used to work better here. We had a state health risk pool, EVERYBODY could get insurance, no one would be denied. The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state. Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.
Someone has to pay. Before, everyone was paying more through their taxes (that's what the state budget comes from). Now, some people are paying more through premiums, others less (due to tax credits). The ACA is not a perfect system. Your state's old system is also not perfect. I don't know which state it was, but it probably had a double digit uninsured rate for working age adults before the ACA. And I don't know for sure, but I bet the insurance in the state high risk pool was pretty expensive. The state (i.e. taxpayers) could have subsidized that cost a lot though, so hard to say.
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forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here. There is no state income tax. So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody. Since we don't have Medicaid extension here, there are still a lot of uninsureds. The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.
Sibley: I don't work for BCBS, but I do know quite a few people who do work for BCBS of TX.
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forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here. There is no state income tax. So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody. Since we don't have Medicaid extension here, there are still a lot of uninsureds. The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.
Sibley: I don't work for BCBS, but I do know quite a few people who do work for BCBS of TX.
FWIW: I had approximately the same insurance plan in Texas both before and after ACA. My premiums (after subsidy applied) are more than double what my premiums were before ACA when subsidies didn't exist. It was a pretty predictable economics exercise.
I am sure there is a slice of the population that came out cheaper. It's not average Joe Consumer that qualifies for subsidies though.
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FWIW: I had approximately the same insurance plan in Texas both before and after ACA. My premiums (after subsidy applied) are more than double what my premiums were before ACA when subsidies didn't exist.
Was your pre-ACA insurance plan an individual insurance policy that you purchased on the open market, or was it coverage under an employer-sponsored group insurance policy?
It's not average Joe Consumer that qualifies for subsidies though.
Sure it is. Both the median and the mean U.S. household incomes are low enough to qualify for subsidies (despite the fact that the latter is skewed upward by our unequal and top-heavy income distribution).
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FWIW: I had approximately the same insurance plan in Texas both before and after ACA. My premiums (after subsidy applied) are more than double what my premiums were before ACA when subsidies didn't exist.
Was your pre-ACA insurance plan an individual insurance policy that you purchased on the open market, or was it coverage under an employer-sponsored group insurance policy?
Yes, my pre-ACA plan was a BCBS plan purchased on the open market very similar to the current BCBS bronze plans.
It's not average Joe Consumer that qualifies for subsidies though.
Sure it is. Both the median and the mean U.S. household incomes are low enough to qualify for subsidies (despite the fact that the latter is skewed upward by our unequal and top-heavy income distribution).
I wasn't wording that clearly... and quoting it alone there is taking it out of context. Let me try to say it better.
I am sure there is a slice of the population that came out cheaper. It's not average Joe Consumer that qualifies for subsidies that is coming out cheaper.
*edit because I damn well butchered all the quoting.
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In NY, pre-ACA plans were much higher than current non-subsidized ACA plans. This was due to state regulations on how insurance could be created.
With subsidies current plans are MUCH cheaper.
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forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here. There is no state income tax. So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody. Since we don't have Medicaid extension here, there are still a lot of uninsureds. The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.
So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.
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The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.
I think I've benefited from staying on a parents' plan. It made the post college job search less stressful and of course I have more take home income to pay student loans with.
Tons of low income people in medicaid expansion states have also seen an improvement. The fact that certain states (who have some of the unhealthiest people) are putting politics above public health doesn't change that.
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The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.
I think I've benefited from staying on a parents' plan. It made the post college job search less stressful and of course I have more take home income to pay student loans with.
Tons of low income people in medicaid expansion states have also seen an improvement. The fact that certain states (who have some of the unhealthiest people) are putting politics above public health doesn't change that.
I've benefited because I no longer need COBRA which was 28% of my income because I had a small pre-existing condition.
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forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here. There is no state income tax. So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody. Since we don't have Medicaid extension here, there are still a lot of uninsureds. The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.
So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.
I never said that, that was just you putting words in my mouth. That was just a response to a PP who said that not everyone could get insurance, he/she didn't say "afford". The risk pool was expensive but if you really wanted insurance regardless of how sick you were, you could get it, it wasn't that it was unavailable. Moving the population from the risk pool to ACA is not a solution, that's all I'm saying.
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forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here. There is no state income tax. So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody. Since we don't have Medicaid extension here, there are still a lot of uninsureds. The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.
So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.
I never said that, that was just you putting words in my mouth. That was just a response to a PP who said that not everyone could get insurance, he/she didn't say "afford". The risk pool was expensive but if you really wanted insurance regardless of how sick you were, you could get it, it wasn't that it was unavailable. Moving the population from the risk pool to ACA is not a solution, that's all I'm saying.
The system used to work better here. We had a state health risk pool, EVERYBODY could get insurance, no one would be denied. The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state. Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.
Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.
But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.
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I like that Obamacare has standardized the way that health plans are presented. Prior to Obamacare is was difficult to compare plans. Now, you can easily compare the plans apples-to-apples. The nomenclature however is unfortunate in that it gives a false sense that Silver is better than Bronze; Gold better than Silver, and Platinum better than Gold. There is no difference in the actual coverage or the care that you are receiving. The difference essentially is do you want to pay now or pay later. If you believe with a high degree of likelihood that you will have considerable medical expenses, the more expense plans might make sense, but for most people I think Bronze is the way to go.
If your income is between 100-250% the federal poverty level, be sure to take into account the Cost Sharing Reduction subsidy only provided on Silver Plans http://obamacarefacts.com/insurance-exchange/cost-sharing-reduction-subsidies-csr/. This is in addition to the tax credit.
See GoCurryCracker http://www.gocurrycracker.com/obamacare-optimization-early-retirement/
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forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here. There is no state income tax. So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody. Since we don't have Medicaid extension here, there are still a lot of uninsureds. The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.
So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.
I never said that, that was just you putting words in my mouth. That was just a response to a PP who said that not everyone could get insurance, he/she didn't say "afford". The risk pool was expensive but if you really wanted insurance regardless of how sick you were, you could get it, it wasn't that it was unavailable. Moving the population from the risk pool to ACA is not a solution, that's all I'm saying.
In regards to the sentence I bolded above. Sure, you could get it...eventually, if you qualified and hadn't died in the interim.
IIRC, it wasn't that someone could decide they wanted to buy through the Texas risk pool. They first had to prove that they had been denied by multiple companies. Going through multiple applications, waiting for denials, and then finally applying to the risk pool and waiting for their review and approval in order to get a rather expensive plan.
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In my parents' state, you had to be uninsured to apply to the high-risk pool. So, my mother was paying $500/month for catastrophic insurance (no coverage until 10k out of pocket, no out-of-pocket maximum, poor coverage for 10k-50k in expenses). However, she couldn't apply to the high-risk pool unless she let her insurance lapse, which she was unwilling to do. The pools were very poorly utilized.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024120/
Before Obamacare, states were capping the number that were allowed to enter the pools, imposing waiting periods, or flat-out closed enrollment in them. It was not a good solution.
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In regards to the sentence I bolded above. Sure, you could get it...eventually, if you qualified and hadn't died in the interim.
IIRC, it wasn't that someone could decide they wanted to buy through the Texas risk pool. They first had to prove that they had been denied by multiple companies. Going through multiple applications, waiting for denials, and then finally applying to the risk pool and waiting for their review and approval in order to get a rather expensive plan.
Actually it was that simple, I knew several people who would not qualify for regular insurance then, they applied to a regular insurance company, and then they applied with the Risk Pool with the decline letter from the insurance company, they got accepted by the risk pool. There were quite a few of them, it wasn't like what you mentioned. Maybe I just knew lucky people or just a minority.
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Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.
But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.
There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that. So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford). And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.
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In regards to the sentence I bolded above. Sure, you could get it...eventually, if you qualified and hadn't died in the interim.
IIRC, it wasn't that someone could decide they wanted to buy through the Texas risk pool. They first had to prove that they had been denied by multiple companies. Going through multiple applications, waiting for denials, and then finally applying to the risk pool and waiting for their review and approval in order to get a rather expensive plan.
Actually it was that simple, I knew several people who would not qualify for regular insurance then, they applied to a regular insurance company, and then they applied with the Risk Pool with the decline letter from the insurance company, they got accepted by the risk pool. There were quite a few of them, it wasn't like what you mentioned. Maybe I just knew lucky people or just a minority.
It has been a long while so I might not remember every detail correctly.
I had to provide 3 letters of denial - which meant scheduling with 3 agents, making the application, and waiting for them to turn around the denials (several weeks). I can't remember which company made me get a physical even though they acknowledged they were going to deny - what a horrid waste of time. If someone applied to the pool with the 3 denials then they were put on the list to qualify to apply - not accepted; put on the list.
Luckily for me, I landed a job with benefits - because the cost to have healthcare through the risk pool would have equaled half my salary at the time.
So, no. Not the simple, affordable process you are implying here. IMHO it sucked.
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Today I went to see a dermatologist. When I was completing the paperwork I read in capital letters – WE DO NOT ACCEPT COVERED CALIFORNIA OR ANY HEALTH PLANS ON THE EXCHANGE. My children’s pediatrician also as a sign in his office that says he doesn't accept exchange plans.
Those of use with a background in Economics, even a little, warned this forum that this wasn't going to work out the way the ACA was sold to the public. It's basic law of supply & demand stuff; in order for more people to get coverage while the overall cost to the public to decrease, the providers were going to have to get squeezed. This is one reason that the insurance industry was involved, they wanted to make sure that it wasn't them that got squeezed. And who is on the other side of the negotiation table from the insurance agencies? The hospitals & doctors' networks. So this is what you end up with; a private insurance market that has been gutted by regulations, counter balanced by semi-public medical plans that technically provide for a great deal, but functionally has no providers for the difficult stuff. Dentistry aside, I dare to try & find out what hospitals or doctors in your network have experience with cancer care. My suggestion is that you find an HSA plan, on the exchange or otherwise, and build up that balance. You are going to need it, regardless of how good your subsidy is in the future.
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It has been a long while so I might not remember every detail correctly.
I had to provide 3 letters of denial - which meant scheduling with 3 agents, making the application, and waiting for them to turn around the denials (several weeks). I can't remember which company made me get a physical even though they acknowledged they were going to deny - what a horrid waste of time. If someone applied to the pool with the 3 denials then they were put on the list to qualify to apply - not accepted; put on the list.
Luckily for me, I landed a job with benefits - because the cost to have healthcare through the risk pool would have equaled half my salary at the time.
So, no. Not the simple, affordable process you are implying here. IMHO it sucked.
I want to say it was within the 10-12 years before ACA started. Maybe they improved the process since you applied?! They only needed one decline, and the people I knew got accepted right away, they weren't put on a waitlist like you said.
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Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.
But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.
There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that. So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford). And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.
Yes, because TX has intentionally decided to screw the poor and not let them have the free insurance coverage that the federal government is paying for, those under 100% FPL are possibly worse off today. But that's not how the ACA was intended to work. And it took a pretty radical lawsuit and surprising SCOTUS decision to break the ACA in that way. The issue of affordability of employer-based coverage for families is another unintended snag. The wording could be a little bit off from what was intended in a huge bill like that. In a normal situation Congress would just fix that language. But of course fixing anything in the ACA is a nonstarter due to politics. So the Republicans will let people in that situation get screwed rather than letting something get fixed in the ACA until such time as the Republicans can achieve their goal of repealing the entire law.
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Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.
But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.
There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that. So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford). And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.
Yes, because TX has intentionally decided to screw the poor and not let them have the free insurance coverage that the federal government is paying for, those under 100% FPL are possibly worse off today. But that's not how the ACA was intended to work. And it took a pretty radical lawsuit and surprising SCOTUS decision to break the ACA in that way
It wasn't all that much of a surprise. They just upheld the literal wording of the law as passed. Whether or not you agree that was the intent of Congress or not is irrelevant. Anyone with any sense knew that there was no wiggle room for SCOTUS on this one, or they would have wiggled. The plain language of the law prohibited the federal government from creating a federal exchange for states that refused to set up a state exchange.
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Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.
But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.
There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that. So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford). And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.
Yes, because TX has intentionally decided to screw the poor and not let them have the free insurance coverage that the federal government is paying for, those under 100% FPL are possibly worse off today. But that's not how the ACA was intended to work. And it took a pretty radical lawsuit and surprising SCOTUS decision to break the ACA in that way
It wasn't all that much of a surprise. They just upheld the literal wording of the law as passed. Whether or not you agree that was the intent of Congress or not is irrelevant. Anyone with any sense knew that there was no wiggle room for SCOTUS on this one, or they would have wiggled. The plain language of the law prohibited the federal government from creating a federal exchange for states that refused to set up a state exchange.
Two misses with one swing: that's an impressive amount of concentrated being wrong.
1) The case forummm was talking about was National Federation of Independent Business v. Sebelius which allowed states to "opt out" of Medicaid expansion under the ACA and was widely considered a surprise (http://content.healthaffairs.org/content/31/8/1663.abstract).
2) The case King v. Burwell (https://en.wikipedia.org/wiki/King_v._Burwell) confirms the ability of the federal government to create an exchange for states that refused to set up a state exchange.
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Two misses with one swing: that's an impressive amount of concentrated being wrong.
Well, I suppose that it's good that is unusual. Otherwise you'd never benefit from my wisdom, as I would too often just agree with you.
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to the original concern: Do the plans in question allow for you to file for reimbursement, so that you could pay out of pocket and subsequently be paid back?
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Two misses with one swing: that's an impressive amount of concentrated being wrong.
Don't look at his post history unless you want to be really impressed.
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Two misses with one swing: that's an impressive amount of concentrated being wrong.
Don't look at his post history unless you want to be really impressed.
Beltim has a much greater right to call me to task when I err than you do Forummm.
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I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.
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I'm guessing you mean this hospital. Interesting:
http://surgerycenterok.com/about/
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I'm guessing you mean this hospital. Interesting:
http://surgerycenterok.com/about/
More and more providers are going this route and even more wish they did also, but don't have the balls to try it out on your own.
All over the country over the last few years free standing emergency departments and urgent care centers are popping up that don't take medicare and medicaid and are extremely successful.
The way I see it, Insurance companies are no different than bookies who take a cut on every transaction while the government is making the practice of medicine more difficult though bureaucratic red tape and regulations. Every 3-6 months I see new regulations that make physician's workload more difficult and more time consuming with little to no patient benefit and sometimes even patient harm.
Simple human nature and economics will dictate that as the process continues and worsens, more and more physicians will stop accepting health insurance as well as medicare/medicaid.
It is a sad state of affairs that has only worsened over the last few years.
Yeah, more people have health insurance but still can't pay the deductible which means they aren't paying their bill or going into debt for repayment. But hey, at least they have insurance right?
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I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.
You are going to get hit with the penalty for "non credible" coverage going this route. Hope you have a lot of money.
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It is a bit unrealistic to think that the only healthcare you will need is elective surgery or emergency care related to trauma. Young healthy people get hospitalized for things they can't control all the time. They have a pneumonia and require breathing support. They get influenza and are placed in an intensive care unit. They have gallbladder or kidney stone attacks, which often cannot be fully treated in an emergency department and may require surgery or other expensive procedures. And while emergency departments (freestanding and otherwise) take all comers, they do bill you for the services. If you have no assets, the bill is no problem. However, if you have $1 million sitting in a bank account, you can fully expect the hospital to try to collect for services rendered.
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We seem to be creating “have” and “have nots” related to healthcare at least where I live.
I have two family members who work in insurance, and they say that's exactly the situation towards which we're heading. They say the next thing that's coming is "boutique medicine", which will be small groups of doctors who'll require "membership" in their group and won't accept insurance.
I personally don't have enough insight into the nuances of ACA to have an opinion.
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I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.
You are going to get hit with the penalty for "non credible" coverage going this route. Hope you have a lot of money.
The word you're looking for is tax. Whether I pay the tax or pay the mandated direct subsidy to a private business depends mostly on which is cheaper. Even if it's only marginally more expensive to pay for a service I have zero interest in having or using I may go that route so as not to give the money to government goons.
In any event, hopefully this ACA nonsense will be over and done with by the time I ER. If not, it's just another expense to plan for. The tax savings from relocating out of a high COL big government police state to a LCOL relatively free state once ER will be far greater than the tax for not complying with the government mandate. So just on taxes it's still a net decrease in taxes paid, not even considering everything else being cheaper.
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The ACA is the one of the best things to happen for early retirees, I don't understand the hostility. The system is very easy to game if you know the ins and outs. Pre ACA you have no way game anything, and many couldn't get insurance at any reasonable price.
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I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.
You are going to get hit with the penalty for "non credible" coverage going this route. Hope you have a lot of money.
The word you're looking for is tax. Whether I pay the tax or pay the mandated direct subsidy to a private business depends mostly on which is cheaper. Even if it's only marginally more expensive to pay for a service I have zero interest in having or using I may go that route so as not to give the money to government goons.
In any event, hopefully this ACA nonsense will be over and done with by the time I ER. If not, it's just another expense to plan for. The tax savings from relocating out of a high COL big government police state to a LCOL relatively free state once ER will be far greater than the tax for not complying with the government mandate. So just on taxes it's still a net decrease in taxes paid, not even considering everything else being cheaper.
And you only pay the tax from your income tax refund. If you have no refund, no tax to pay.
In other words, even though the tax is to be collected through the IRS the IRS has no power to bill you. It can only keep money in its possession.
I am pretty sure this is correct but if I'm wrong, you MMMErs will let me know!
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The ACA is the one of the best things to happen for early retirees, I don't understand the hostility. The system is very easy to game if you know the ins and outs. Pre ACA you have no way game anything, and many couldn't get insurance at any reasonable price.
Sure, its good for me, and in a few months as an early retiree I will jump on that ACA bandwagon. But is it good overall? No. Is it good for some people? Sure. Is it a mismash of convoluted laws? Yep.
Now someone will come on to remind us all in a ponderous way that the ACA is really a tool of the Republicans because its the only thing the Democrats could push through Congress. Yet, Republicans did not vote for it to pass. It is quaint thinking that the ACA is a Republican effort, it is not.
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It seems the best thing for many people would be to shop around for a plan that covers the doctors you want to go to and don't assume that a plan will cover any services by default. If you can't find a plan that will be very usable in your area, buy the cheapest bronze plan that's available in order to have some basic coverage for unplanned catastrophic injuries/illnesses and have cash available for the various services the plan won't cover.
Mike
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We seem to be creating “have” and “have nots” related to healthcare at least where I live.
I have two family members who work in insurance, and they say that's exactly the situation towards which we're heading. They say the next thing that's coming is "boutique medicine", which will be small groups of doctors who'll require "membership" in their group and won't accept insurance.
I personally don't have enough insight into the nuances of ACA to have an opinion.
Next thing? That is exactly how my doctor works. She doesn't accept any form of insurance, and a monthly membership fee is expected. I also get my regular meds at wholesale through her office as a membership benefit. The markup on common meds is incredible.
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Two misses with one swing: that's an impressive amount of concentrated being wrong.
Don't look at his post history unless you want to be really impressed.
Beltim has a much greater right to call me to task when I err than you do Forummm.
Thanks for proving my point.
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It is a bit unrealistic to think that the only healthcare you will need is elective surgery or emergency care related to trauma. Young healthy people get hospitalized for things they can't control all the time. They have a pneumonia and require breathing support. They get influenza and are placed in an intensive care unit. They have gallbladder or kidney stone attacks, which often cannot be fully treated in an emergency department and may require surgery or other expensive procedures. And while emergency departments (freestanding and otherwise) take all comers, they do bill you for the services. If you have no assets, the bill is no problem. However, if you have $1 million sitting in a bank account, you can fully expect the hospital to try to collect for services rendered.
Um, pneumonia or flu requiring icu and vent are not "common conditions" for young, healthy people. In fact, they are very rare for young healthy people.
And the gall bladder/stones is a great reason to go to the surgery center in OK.
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I also agree that the boutique medicine mentioned is already here. Lots of dr are opting out of taking any insurance. Cash for service. Patient can then file insurance paperwork if they want to. I'm sure we will see more and more of this. Remember, insurance is not the same thing as health care.
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Some states require doctors to accept Medicaid as a condition of maintaining their license to practice. I believe Massachusetts is one. It also requires lawyers to provide a certain number of pro bono hours to keep your license.
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Some states require doctors to accept Medicaid as a condition of maintaining their license to practice. I believe Massachusetts is one. It also requires lawyers to provide a certain number of pro bono hours to keep your license.
I can't find any evidence of that for Mass. Do you know how many patient hours the MD is required to see?
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I also agree that the boutique medicine mentioned is already here. Lots of dr are opting out of taking any insurance. Cash for service. Patient can then file insurance paperwork if they want to. I'm sure we will see more and more of this. Remember, insurance is not the same thing as health care.
Actually, I've discovered that this depends upon the state. I recently was referred to a radiologist, and rather than use my HSA, I was going to pay it out of pocket. So my doctor referred me to one in Southern Indiana that offers a rather significant discount for cash-up-front scheduled services. When I asked about taking the receipt and using it against my deductible, the receptionist said, "Well, you can try, but Indiana law now prohibits us from telling your insurance company how much your procedure actually costs, because it was a discounted cash event." "So if they call to check, you can't talk to them?" "Correct."
So that won't apply to my deductible either. Oh well, it was a pretty good discount.
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I don't know of any state that requires you to take Medicaid patients. I never heard of a state requiring pro bono hours either.
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Here's the pro bono requirement. It's a "should" but since it is part of our ethics rules, most people treat it as mandatory. You can buy out of it though.
http://www.mass.gov/obcbbo/rpc6.htm
Edit:
I'm looking for a citation on the medical requirement. I worked there in 2003-2004 with kids on medicaid. Maybe the requirement was limited to the pediatric version of medicaid but I remember being told that my kids (meaning my caseload) had it good in Mass because doctors were required to take their healthcare.
Years later I found myself on the board of a medical facility in another state and a doctor speaking there confirmed that Mass required acceptance of those patients while our state did not. I'm not sure if that is an old law, an ethical rule, or limited to kids or what. If I find out more about it I will post it.
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Another NY Times article related to this topic: "Think Your Obamacare Plan Will Be Like Employer Coverage? Think Again" (http://www.nytimes.com/2016/08/20/upshot/think-your-obamacare-plan-will-be-like-employer-coverage-think-again.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region®ion=top-news&WT.nav=top-news&_r=0)
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When I was looking for a primary care doctor in my area, I found a "boutique" place nearby that had a weird monthly membership fee. Good for them if they find people to pay it, I just looked on and am perfectly happy with my non-boutique doctors office. Frankly if someone wants to pay some monthly fee so that they can be extra pampered when going to the doctors office, I couldn't care less.
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I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
And this is how it should be. The doctor charges a reasonable rate so that people can pay out of pocket. No dealing with insurance companies. I do not know why either presidential candidate hasn't brought this up. Forget about the expensive premiums and outrageous hospital bills---why won't either candidate mention this? People will not need insurance if rates are reasonable. Once a third-party member (insurance companies) arrived on the scene, costs went haywire.
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With Covered CA plans, like Mike said, the insurance will show as active if a patient pays one month premium for up to 90 days, the insurance will authorize everything, pay the doctor for the visits, and then demand all the payments back from the doctor. If the doctor doesn't pay the insurance company back, they will just deduct it from future payments for other patients. So, as a patient, you could pay one month of premium, never pay a premium again and get thousands of dollars of treatment, surgery, etc. over 90 days, the doctor would bill, get paid by the insurance, and then have to pay all of that money back to the insurance plan and go after the patient who is never going to pay because they weren't even willing to pay more than one month of insurance premium. So why would any doctor accept Covered CA unless it was already an established trustworthy patient. It will bankrupt a practice in short order. Quite possibly what it was designed to do.
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I don't know yet whether it will factor into my FIRE plans, as I expect at least some changes in the ACA and/or plans that are on the exchange in the next few years. However, it was the deciding factor in my decision of whether or not to elect COBRA after leaving my previous job this year. See, COBRA is quite expensive, so I went on the Georgia exchange to see my options. Hey, there actually were over 60 plans available, and many of them had reasonable premiums, though most had associated high deductibles (which doesn't mesh well with the remainder of my medical year). I clicked on the provider list for every single exchange plan and discovered that none of my doctors are in any of the networks. Well, I wasn't about to disrupt my treatments or change the doctors whom I love, and since I could afford the extra cost of COBRA, I stuck with that. (I'm just on sabbatical and planning to get another job so expect to get better health insurance then.)
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I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
And this is how it should be. The doctor charges a reasonable rate so that people can pay out of pocket. No dealing with insurance companies. I do not know why either presidential candidate hasn't brought this up. Forget about the expensive premiums and outrageous hospital bills---why won't either candidate mention this? People will not need insurance if rates are reasonable. Once a third-party member (insurance companies) arrived on the scene, costs went haywire.
Sure, this is very common in mental health, but new visits may be $300 and follow up $100, so it depends on what you consider "reasonable." And often the patient takes their receipt and files it with their insurance company themselves.
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I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.
I choose to pay the tax which is about $700 for this year. I haven't had insurance for 11 years. Have paid cash for a couple of minor things that came up and have a great dentist in Guatemala. I took a look at the Oklahoma hospital website and the prices look good for the US but still looked to be more than double what you can find in other countries. And contrary to the belief of many, the US doesn't have the best healthcare in the world. I refuse to buy into this scam because it doesn't offer much that I would want. I prefer to lead a healthy lifestyle and usually cure myself naturally. Yes, there is somewhat of a gamble with my approach but aren't many of our life choices. I'm 59 and feel that the longer I go without insurance, the cup just gets more full.
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Huh. I think without health insurance, a couple terrible bouts of kidney stones that need to be surgically removed or a cancer in the US would bankrupt most folks.
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Huh. I think without health insurance, a couple terrible bouts of kidney stones that need to be surgically removed or a cancer in the US would bankrupt most folks.
If you feel soreness in the kidney area similar to muscle soreness, without being able to relate it to physical activity, you may be developing kidney stones. If the soreness worsens the next day, that's more telling. Kidney stones often begin to develop due to dehydration so the first thing to do is start drinking a lot of water. Keep it up for several days. There are also herbs that will dissolve kidney stones. Check with a local acupuncturist or Chinese herbalist for those.
To help prevent cancer, stop ingesting sugar in all its forms. Stop putting chemicals on your body and limit breathing in chemicals as much as you can. Limit the stress in your life and do things that calm your nervous system. Keep your inner body clean. Some cancers seem to be genetic and some people will get cancer even if they lead a cancer preventative lifestyle. When someone gets cancer, it's up to them to decide how they want to address it. I believe that I would chose natural alternatives to the immune system destroying drugs and radiation that are the norm in allopathic treatment.
So, "healthcare" (insurance) doesn't often provide me with what I want in order to live a healthy life for as long as possible. I could get in a serious accident and be unable to travel to another country for treatment. There's my gamble. But I'm not willing to pay probably a minimum or $500 per month plus go through the stress of the US healthcare system to give me the "security" that insurance will take care of me if that were to happen.
I'm not necessarily advocating that everyone look at this issue as I do but I do advocate everyone to learn about true healthcare and take the time to tune into your body.
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I work in the medical field. We don't take any insurance at our office. Reimbursement is too low to make it work. Too much paperwork. Too much intrusion by insurance company. We see plenty of medicaid patients who just pay out of pocket. If you want to see a mental health provider who takes insurance you will be waiting months.
And this is how it should be. The doctor charges a reasonable rate so that people can pay out of pocket. No dealing with insurance companies. I do not know why either presidential candidate hasn't brought this up. Forget about the expensive premiums and outrageous hospital bills---why won't either candidate mention this? People will not need insurance if rates are reasonable. Once a third-party member (insurance companies) arrived on the scene, costs went haywire.
Sure, this is very common in mental health, but new visits may be $300 and follow up $100, so it depends on what you consider "reasonable." And often the patient takes their receipt and files it with their insurance company themselves.
Well, some patients do file for out of network benefits. Medicaid patients can't. Obamacare patients can't. Many of the Medicaid and Obamacare patients prefer to spend the money and get the care they want. They see physicians not physician extenders. They get to choose their physician. This is nice although I certainly would not consider it a "boutique" practice. Just good medical care. They pay the office visit fee but all labs, xrays, and meds are covered through the insurance. That is the majority of medical bill usually. Many of these patients are not poor despite being on these programs. As we see on this forum - people can have money - lots of it sometimes - and still qualify for medicaid. At least in my state. Or family members are picking up the tab. We see a percentage of people for "no cost" which is not seen often these days. I agree - it is nice to cut out the insurance company from the picture.
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Well, some patients do file for out of network benefits. Medicaid patients can't. Obamacare patients can't.
I believe this is not correct as far as Obamacare goes. If you have a PPO under Obamacare, you should be able to get out of network benefits.
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Well, some patients do file for out of network benefits. Medicaid patients can't. Obamacare patients can't.
I believe this is not correct as far as Obamacare goes. If you have a PPO under Obamacare, you should be able to get out of network benefits.
That was my original reaction as well. Then I remembered: In my state, the one and only ACA supplier dropped all of its PPO options. So... at least in my case, this is probably true.
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Yes, it could be by state. I am not that familiar with options outside my own little corner of the world.
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It is a bit unrealistic to think that the only healthcare you will need is elective surgery or emergency care related to trauma. Young healthy people get hospitalized for things they can't control all the time. They have a pneumonia and require breathing support. They get influenza and are placed in an intensive care unit. They have gallbladder or kidney stone attacks, which often cannot be fully treated in an emergency department and may require surgery or other expensive procedures. And while emergency departments (freestanding and otherwise) take all comers, they do bill you for the services. If you have no assets, the bill is no problem. However, if you have $1 million sitting in a bank account, you can fully expect the hospital to try to collect for services rendered.
Um, pneumonia or flu requiring icu and vent are not "common conditions" for young, healthy people. In fact, they are very rare for young healthy people.
Hell, they're relatively rare for old people.
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I manage a medical practice in Texas and also have experience doing our billing. I can add a little light onto this subject, as I have the same concerns on a personal level as well. First of all, yes.....the rates SUCK on BCBS HMO product. That is why many docs won't take it. In some instances, it's less than Medicaid and we would lose money on each patient seen who comes in with Blue HMO. The other big reason the Exchange plans are lousy deals for docs - let's say patient comes in and their benefits are verified. If they don't pay their premiums for the month they are seen, the insurance company will cover that cost. The second and third month, even though they show "active," if the premiums are not up to date, the doctor has to GIVE BACK the money they have been paid by insurance. So we have learned to collect upfront from patients if they are in this period and we happen to find it out.
Next issue - HMO's in general, or EPO's now. Aetna and United both have EPO's in Texas. Higher benefits with a referral. So do the patients know that they need a referral? Do they come in with one? NO! So we have our employees call their PCP's and spend countless hours helping patients secure their referrals so that they can receive care. We have patients come in with no wallet, no method of payment.....expecting to be treated. I can't walk into a grocery store, and expect to walk out with my cart full of food and expect to be "billed." This all affects the bottom line and the ability of medical offices to pay their staff and their ever-rising costs of staying compliant. The costs are mounting every year. We spend thousands and thousands of dollars just to utilize an EHR system and then more money on top of that for the extra staff it takes to use it. Doctors are spending hours each day beyond patient care documenting what is required. Then add ICD 10 on top of that and now you have to document not only that you broke your nose, but how (altercation, falling from a building, accidental, etc.)
I know I'm ranting - but it's important for people to understand the other side of this. For every 100 claims that we send out, I will get at least 10 to 15 back requesting either medical records or being held or denied for multiple reasons. Most, with time and effort, will end up getting paid. But....they bank on the fact that most offices will have to let some of these claims go because there is a break-even point where you can't pay your staff to use any more of their time on a $68.00 claim.
So the guy on this thread who said they don't take insurance - no it's not being lazy - they are trying to provide care and stay in business. We are surgeons so it would be more difficult for us to operate under those parameters.
So yes - I think the insurance issue should be prominent in your mind as you are planning for FI. The talk is that premiums will rise significantly in 2017, and the exchange will shrink in competition. Be very careful and research what's available. If you get cancer, do you want the ability to be seen at M.D. Anderson in Houston (for the Texas folks). Well check your plan, cause most likely you won't be going. And if a doctor IS willing to take such reduced rates......gotta wonder why.
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But....they bank on the fact that most offices will have to let some of these claims go because there is a break-even point where you can't pay your staff to use any more of their time on a $68.00 claim.
And then, oddly enough, the office sends the patient a bill for $68.00.