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Old 10-02-2014, 08:08 AM   #21
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The small company I work for is looking at a 40% increase in costs to provide insurance to their employees. Apparently this is due to the ACA requirement that insurance coverage include bundled prescription coverage. The company currently is able to source the prescription coverage separately at a significant savings. They are also concerned about how family coverage changes under ACA. They are working feverishly over the next couple of weeks to figure things out. I expect that they will end up having the employees pick up the additional costs but nothing is for sure at this point.
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Old 10-02-2014, 09:00 AM   #22
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Most of the "complaints" are general complaints about our health insurance system and not ACA related. I asked my doctor how the ACA is going for his practice and it's mostly a footnote. No change in their patient profile that he's noticed. They aren't newly declining insurance plans and remain in network with all the major exchange plans.

The few legitimate complaints I've heard are:

1. My employer coverage is considered "affordable" but my share of family coverage is $700/month. They base affordability on what a single person would pay for their own coverage through the employer, which is often heavily subsidized (at least everywhere I've worked) whereas the increase in premiums due to family coverage is often not subsidized by the employer or subsidized a small amount. So my BIL is paying around 25% of his gross pay for HI. If his employer (a factory) stopped providing HI, then almost all their employees would qualify for subsidies, and my BIL would pay maybe $100-200/month for better HI.

2. "I don't make enough to qualify for an ACA exchange plan and subsidies and my state didn't agree to medicaid extension to all under 133% of FPL." This covers my MIL. She has virtually no assets and would get free care in emergency rooms (courtesy of bankruptcy protection), hence costing the tax payers and other patients of the hospital. Hopefully she can make it the next couple of years until she hits 65 and reaches medicare eligibility. It's hard to blame the drafters of the ACA for this problem. The Supreme Court's decision that generally upheld ACA but struck down the mandatory medicaid extension "caused" this problem. In other words, lower income people get no insurance whereas lower middle income people get virtually free insurance that's silver plated (low co-pays and deductibles).

3. General lack of understanding of how the ACA works. I don't want to get political but I'll suggest that certain groups have engaged in a smear and misinformation campaign regarding the ACA in order to make it unpopular and win votes. My parents (at age 61-62) still don't understand how they can use the ACA to get guaranteed issue health insurance with heavy subsidies until they reach age 65 (medicare age) as long as they can keep their AGI under $60k (which would be easy given their taxable investments and cash savings). So they keep working in spite of health issues that could be remedied by quitting work for one of them.
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Old 10-02-2014, 09:44 AM   #23
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Originally Posted by misanman View Post
The small company I work for is looking at a 40% increase in costs to provide insurance to their employees. Apparently this is due to the ACA requirement that insurance coverage include bundled prescription coverage. The company currently is able to source the prescription coverage separately at a significant savings. They are also concerned about how family coverage changes under ACA. They are working feverishly over the next couple of weeks to figure things out. I expect that they will end up having the employees pick up the additional costs but nothing is for sure at this point.
I must not understand your post. The Megacorp insurance I used pre ACA, and after; had a medical provider and a separate prescription provider. They're doing it again this year. Now it does appear bundled(I guess) in that you pay one premium, with one set of OOPs.

Am I misunderstanding your post?



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Old 10-02-2014, 10:00 AM   #24
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Complaints?

Well, my main complaint is the 30 hour rule which, IMHO, is keeping many people under employed.
Another complaint is that it has not addressed the huge disparity between medical costs in the USA and those in other 1st world countries like Belgium, France, Germany, etc. Why should a hip replacement cost less than 20K in Belgium and more than 80K in the USA?

You didn't ask, but I think there are benefits. Many who, through no fault of their own, were under and uninsured can now get insurance. And, many insured people don't have to worry about losing insurance, exceeding benefit caps, etc.
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Old 10-02-2014, 10:02 AM   #25
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There is one political party trying to repeal the ACA so there are lots of suggestions about the shortcomings. Have you read anything with hard numbers about the out of network problem bigger than it was, other than being bigger because now millions more people have health insurance?
Im curious where you arrived at the "millions more people have health insurance" claim? I've seen sources claiming insured Americans remains flat pre and post Obamacare. Can you provide me with a source?
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Old 10-02-2014, 10:12 AM   #26
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I must not understand your post. The Megacorp insurance I used pre ACA, and after; had a medical provider and a separate prescription provider. They're doing it again this year. Now it does appear bundled(I guess) in that you pay one premium, with one set of OOPs.

Am I misunderstanding your post?
I was told by HR that bundling was a requirement of ACA but maybe that was incorrect or I did not understand correctly. One additional piece of data: the prescription drug coverage was "self insured" by the company. As I understand it, the coverage provider administered the coverage but billed the company for actual prescription costs plus management fee. This was less expensive (maybe because of the "employee group" was healthier than the general population?). It might have been this aspect that is no longer allowed - i.e. "you can't just pay for the actual drugs prescribed, you have to buy the drug insurance". There were also changes in family coverage that was going to result in substantial changes to what the coverage would cost based on individual family configurations. Our employees are consultants that are billed on the basis of cost plus. But we are now officially prohibited from asking about family details before hiring an individual. And since the costs will vary depending on the family configuration, that makes it hard for us to determine a rate for a new employee that we are hiring to fill a customer requirement. Before, we could just ask them if they needed family coverage and we knew what that would cost.

A big company may be able to average costs over a larger population. With a small population, it's more difficult.

Our company is less than 50 employees, so I think there's a chance they may decide to drop coverage and have employees buy their own insurance on the exchanges.
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Old 10-02-2014, 10:22 AM   #27
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Originally Posted by Snidely Whiplash View Post
Im curious where you arrived at the "millions more people have health insurance" claim? I've seen sources claiming insured Americans remains flat pre and post Obamacare. Can you provide me with a source?
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Old 10-02-2014, 11:23 AM   #28
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That means they'll pursue the patients.
Geez ... is it any wonder why the majority of those with poor credit (below 600) have outstanding medical bills.
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Old 10-02-2014, 11:36 AM   #29
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Im curious where you arrived at the "millions more people have health insurance" claim? I've seen sources claiming insured Americans remains flat pre and post Obamacare. Can you provide me with a source?

"In total, probably 7.26 million but perhaps as many as 9.9 million people got insurance since the last quarter of 2013, bringing the number of uninsured Americans down from 43.5 million to 36.3 million, Gallup says.

“We feel pretty comfortable attributing much of this change to the Affordable Care Act,” Witters told NBC News."


Obamacare Helped Up to 10 Million Get Insurance, Gallup Finds - NBC News


"QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014"

"Though estimates of the size of the net gain in coverage vary across surveys, there is consistent evidence of ongoing gains in insurance coverage under the ACA"

http://hrms.urban.org/quicktakes/Num...s-to-Fall.html

Where are you reading no net decrease in numbers of uninsured? These numbers have been picked up by most of the major media outlets and have been pretty widely reported. I have never read about any credible survey that did not report drops in uninsured in the millions, post ACA. Even if the Gallup poll was off by 50%, the uninsured drop rate would still be around 4 million.
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Old 10-02-2014, 11:38 AM   #30
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Look at the bright side, if this were pre-ACA she would have still been billed for the assisting surgeon. This stuff was going on well before the ACA.

But then, were this pre-ACA and if she was on her own insurance (not thru an employer), her insurance provider would most likely have cancelled her policy, because there was nothing prohibiting the insurance co from doing so, and she was clearly costing them money.

And then, she would have truly been up sh!t creek because no other insurance carrier would touch her.

Just sayin.
Yes, that is my thought as well. While I definitely feel bad for the patient with the ridiculous bill, I am glad that at least she can't be dropped from her insurance.

Admittedly, I am a fan of the ACA, in 2007 DH and I were pursuing applying for permanent residency in Canada and health insurance was a huge factor. With the ACA now we are no longer doing that and we feel comfortable retiring early knowing that we will be able to get health insurance. Yes, I know that I will pretty much be paying cash for my health care, another reason for me to keep jogging and cut back on my salt. I am fortunate to be healthy, at least I think I am at this moment.

My hope is that all these charges, which to me seem unethical will come to light and help us as consumers vote with our dollars. Of course this is cumbersome to do when healthy, and pretty much impossible to do when one is sick.
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Old 10-02-2014, 11:46 AM   #31
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Originally Posted by daylatedollarshort View Post
"In total, probably 7.26 million but perhaps as many as 9.9 million people got insurance since the last quarter of 2013, bringing the number of uninsured Americans down from 43.5 million to 36.3 million, Gallup says.

“We feel pretty comfortable attributing much of this change to the Affordable Care Act,” Witters told NBC News."


Obamacare Helped Up to 10 Million Get Insurance, Gallup Finds - NBC News


"QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014"

QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014

Where are you reading no net decrease in numbers of uninsured? These numbers have been picked up by most of the major media outlets and have been pretty widely reported.
The internet is a wonderful thing. And then there's...

Many Americans still lack health insurance - CBS News

Quote:
It's worth noting that the U.S. Census Bureau normally does a good analysis of changes in insurance coverage from year-to-year, but the government recently changed its survey methodology, which made year-to-year comparisons impossible. ...
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Old 10-02-2014, 11:55 AM   #32
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If I were her I would offer to pay whatever she would have had to pay if the assisting OR was in-network and not a penny more. I would favor regulation that if you go to an in-network hospital and your doc is in-network that the facility can only bill of in-network unless you are informed and sign off on out-of-network charges. That would nip these jerks in the bud.

There is no way a consumer can sort this out ahead of time - the facility has to do it and pay the consequences if they screw it up.
That's what I'd do. I'd say if you want a dime, then send me a letter that says the in-network rate is considered payment in full. No letter, no money.

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We had to pay out of network costs for a surgery last year. Out of network charges at in network hospitals have been a big issue in U.S. health care well before the the affordable care act became law. In our case it wasn't an emergency but how do you shop around for medical services you don't even know you need and then they are performed in the hospital OR while you are unconscious? The whole process is a scam to consumers.
This is an issue that needs legislation. I'm not a big fan of more laws, but the consumer has zero power here. And it seems to be getting worse!

My solution has been to hand-write "I will accept billing only from in-network providers" on any form they hand me that has to do with billing. But most recently, they would not accept my signed paper forms! They had a computer screen with a stylus pen and so I couldn't add anything to the form. The consumer is at a disadvantage when getting health care, and it's seems to be getting worse, so we need some protections.
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Old 10-02-2014, 12:11 PM   #33
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The internet is a wonderful thing. And then there's...

Many Americans still lack health insurance - CBS News



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Thanks for the link. It includes yet another survey showing millions more insured post ACA:

"Although the rolls of the uninsured have dropped dramatically since the Affordable Care Act, better known as Obamacare, took effect in January, a nagging 15 percent of the population remains uninsured, according to a new survey sponsored by the Transamerica Center for Health Studies. Still, the percentage of Americans without health coverage has dropped markedly from 22 percent to 15 percent over the past 11 months, according to the poll of 2,624 adults under the age of 64."
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Old 10-02-2014, 12:40 PM   #34
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Thanks for the link. It includes yet another survey showing millions more insured post ACA:

"Although the rolls of the uninsured have dropped dramatically since the Affordable Care Act, better known as Obamacare, took effect in January, a nagging 15 percent of the population remains uninsured, according to a new survey sponsored by the Transamerica Center for Health Studies. Still, the percentage of Americans without health coverage has dropped markedly from 22 percent to 15 percent over the past 11 months, according to the poll of 2,624 adults under the age of 64."
And the number of uninsured could drop further if some states would expand their medicaid program.
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Old 10-02-2014, 01:59 PM   #35
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She went through all the pre-approval process with her insurance company and the medical facility before the surgery (she had researched the surgeon she wanted and traveled across the US to have him do the surgery). She got a $10K bill from another surgeon who was in the OR assisting her primary surgeon. The assisting surgeon was not in-network. She had no idea there was even going to be an assisting surgeon and had no idea who was in the OR during surgery, outside of her primary surgeon.
I just ran this method of extorting extracting extra money from unwilling customers past my Uncle Guido, who is retired from his career as a 'collections agent' for the 'family'. He is envious that the family did not come up with this idea years ago. It would have greatly enhanced revenue to the 'organization'. He is going to turn the idea over to our current godfather CEO for a few test runs in in a neighborhood with a high percentage of medical professionals. At least they can get their broken bones fixed cheaply.
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Old 10-02-2014, 02:55 PM   #36
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The internet is a wonderful thing. And then there's...

Many Americans still lack health insurance - CBS News
And which also confirms the point that the uninsured rolls have been greatly reduced with the advent of the ACA.

Once again we see from this thread that politics often get in the way of reform. The ship has sailed, it won't be repealed in 2016 or later no matter how much some folks want to do so. What we need to do now is make it work better which IS the real point that should be taken here, but our Congress is too busy trying to win primaries instead of working together.
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Old 10-02-2014, 02:59 PM   #37
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And which also confirms the point that the uninsured rolls have been greatly reduced with the advent of the ACA.

Once again we see from this thread that politics often get in the way of reform.
The point was not political, it was that it isn't a straightforward measurement, we need to be sure that the comparisons are apples-apples.

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Old 10-02-2014, 03:26 PM   #38
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The point was not political, it was that it isn't a straightforward measurement, we need to be sure that the comparisons are apples-apples.

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Even if the surveys mentioned above were all oddly independently wrong by a 50% margin of error, there would still be around 5 million or so more people with health insurance.

Ten million more consumers with insurance in the U.S. - that is like the entire population of Sweden or Portugal gaining health insurance. Even five million would still be like the entire population of Finland or Norway going from every person uninsured to all covered by health insurance.

Those are huge improvements. Even imperfect insurance has to beat none at all. The no health insurance rate for the surgery in our family last year was $150K. I don't have the exact number in front of me but with OOP max and out of network costs we paid something like $15K total, plus premiums of over $2K a month (pre ACA rates). That still isn't affordable for many families, but it is sure more affordable than the entire $150K would have been.

A few more survey results -

"In an article published in the New England Journal of Medicine, the Department of Health and Human Services and the Harvard School of Public Health pegged the number of people who gained coverage since last year at 10 million. The Congressional Budget Office projects 12 million people will gain health insurance by year's end."

Source: http://www.huffingtonpost.com/2014/0...n_5825472.html
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Old 10-02-2014, 04:37 PM   #39
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Most of the "complaints" are general complaints about our health insurance system and not ACA related. I asked my doctor how the ACA is going for his practice and it's mostly a footnote. No change in their patient profile that he's noticed. They aren't newly declining insurance plans and remain in network with all the major exchange plans.

The few legitimate complaints I've heard are:

1. My employer coverage is considered "affordable" but my share of family coverage is $700/month. They base affordability on what a single person would pay for their own coverage through the employer, which is often heavily subsidized (at least everywhere I've worked) whereas the increase in premiums due to family coverage is often not subsidized by the employer or subsidized a small amount. So my BIL is paying around 25% of his gross pay for HI. If his employer (a factory) stopped providing HI, then almost all their employees would qualify for subsidies, and my BIL would pay maybe $100-200/month for better HI.

2. "I don't make enough to qualify for an ACA exchange plan and subsidies and my state didn't agree to medicaid extension to all under 133% of FPL." This covers my MIL. She has virtually no assets and would get free care in emergency rooms (courtesy of bankruptcy protection), hence costing the tax payers and other patients of the hospital. Hopefully she can make it the next couple of years until she hits 65 and reaches medicare eligibility. It's hard to blame the drafters of the ACA for this problem. The Supreme Court's decision that generally upheld ACA but struck down the mandatory medicaid extension "caused" this problem. In other words, lower income people get no insurance whereas lower middle income people get virtually free insurance that's silver plated (low co-pays and deductibles).

3. General lack of understanding of how the ACA works. I don't want to get political but I'll suggest that certain groups have engaged in a smear and misinformation campaign regarding the ACA in order to make it unpopular and win votes. My parents (at age 61-62) still don't understand how they can use the ACA to get guaranteed issue health insurance with heavy subsidies until they reach age 65 (medicare age) as long as they can keep their AGI under $60k (which would be easy given their taxable investments and cash savings). So they keep working in spite of health issues that could be remedied by quitting work for one of them.
Just thinking out loud here, but in scenario 1 would your BIL be better off getting single coverage through his employer and an exchange plan for the remainder of the family? Would someone like your MIL in scenario 2 qualify to buy catastrophic coverage since the cost of the lowest bronze plan is unaffordable (> 8% of income)? (Our unsubsidized cat coverage is $213/month). On scenario 3 your parents just need to go through the process or visit healthsherpa.com and it should tell them what a plan would cost them if they retired but you're right that it is hard to fix ignorance unless they are willing to explore their options.
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Old 10-02-2014, 06:05 PM   #40
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Agree there are still many "gotchas" used by insurance companies AND providers to scoop more cash from the patients. Latest example : I asked beforehand how much I would have to pay for a blood test. Answer from ins co was "five dollar copay, that's it". Got the bill, and there was an extra charge on it, for $7, for the "phlebotomy" (blood draw). Haven't summoned the will to call the ins co yet about it (endless BS, on hold forever, etc) since it only a $7 ripoff.

But it reminded me of something I read in the ins co contract, under the heading of "What's Not Covered", which stated that there may be charges that would not be paid for by the ins co, but no specifics were given !


If they rip me off for $7 for the blood test, for an "uncovered charge" I wonder what future ripoffs await me for more expensive procedures.

Calling ahead doesn't seem to help much.

In the past, when provider has tacked on charges, simply refusing to pay has worked for me. If you cross all the t's and dot all the i's and they still try to rip you off, all you can do is refuse to pay, I suppose.
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