ACA complaints at one year

[misanman]

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.

 

[Hamlet]

In U.S., Uninsured Rate Lowest Since 2008

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?

 

[tryan]

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.

 

[daylatedollarshort]

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/Number-of-Uninsured-Adults-Continues-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.

 

[pullmyfinger]

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.

 

[ERD50]

"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

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. ...

-ERD50

 

[sengsational]

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.

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.

 

[daylatedollarshort]

The internet is a wonderful thing. And then there's...

Many Americans still lack health insurance - CBS News



-ERD50

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."

 

[Live Free]

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.

 

[Chuckanut]

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.

 

[GTFan]

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.

 

[ERD50]

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.

-ERD50

 

[daylatedollarshort]

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.

-ERD50

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/2014/09/16/obamacare-uninsured-survey_n_5825472.html

 

[pb4uski]

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.

 

[John Galt III]

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.

 

[BellBarbara]

Fuego

If you BIL pays more than 9.5% of his pay towards his contribution to employer provided healthcare, he can drop that healthcare, and apply through the exchange and get subsidy. I just researched this for my son - his company was acquired and has an expensive plan with almost no deductible, raising his portion to more than double what he paid before.

 

[BellBarbara]

Living in Mass, let me say it is widely accepted and well received. It did take a number of years to get that uninsured number down (I think it's still at 5% but I am too lazy to look it up). We are only a year in with ACA, the longer we go on, more will sign up. I wish congress would improve things, but it will not happen anytime soon.

 

[daylatedollarshort]

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.

That sounds like the medical equivalent of "resort fees":

Hidden hotel fees gaining exposure - Chicago Tribune

Or a vet I went to once that added on a "room use" fee after I, too, had taken the time to call around and rate shop.

 

[modhatter]

i could not pull up link that the OP posted, so not sure if this one is different

http://www.nytimes.com/2014/09/29/u...&region=Marginalia&src=me&pgtype=article&_r=0

Here's an article that talks about the "assistant surgeon" problem.
http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

Seems like we are really suffering from provider ethics in this country.

 

[FUEGO]

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.

My BIL has "affordable" insurance, therefore his household is ineligible for ACA exchange subsidies because he's covered by workplace insurance.

My MIL could get exchange insurance without subsidy but I think it's closer to $350/mo for anything reasonable. Catastrophic for her would be paying $5-10k+ out of pocket under a catastrophic plan (that's all she's got sadly enough though partly through no fault of her own - she's a refugee who came here later in life). Paying $350/month is money she doesn't have. So like many uninsured, her plan A for major medical issues is emergency room and treatment and then bankruptcy or if the ambulance takes her to the right hospital, getting the hospital and doctor's fees waived through the state's charitable health care program (IIRC <250% FPL gets fees waived if you meet certain criteria).

As for my parents, I agree they just need to go through the process. They aren't ignorant people (engineer and teacher with advanced degrees, etc) but I guess they've heard ACA is on uneasy footing and it's horrible for America so often that they believe it on some level even though it could benefit them greatly. I think they are also in OMY status and my father is hoping to make it 3 more years to medicare eligibility. Unlike me ( ) they're also a bit old fashioned about receiving gubmint benefits and might not want to line up at the gubmint feeding trough a la ACA.

 

[explanade]

i could not pull up link that the OP posted, so not sure if this one is different

http://www.nytimes.com/2014/09/29/u...&region=Marginalia&src=me&pgtype=article&_r=0

Here's an article that talks about the "assistant surgeon" problem.
http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

Seems like we are really suffering from provider ethics in this country.

One of the original links showed that emergency room doctors saw their pay increase from $240k to $310k in the last 4-5 years.

I think there are consultants at work, teaching them how to maximize revenues, hot to optimize taxes, etc. Like the idea to set themselves up as an independent contractor in the first place.

Some elective fields of medicine, like cosmetic surgery, probably has similar conferences and workshops teaching surgeons on business models.

 

[FUEGO]

Fuego

If you BIL pays more than 9.5% of his pay towards his contribution to employer provided healthcare, he can drop that healthcare, and apply through the exchange and get subsidy. I just researched this for my son - his company was acquired and has an expensive plan with almost no deductible, raising his portion to more than double what he paid before.

The way I understand it is that if his portion of premiums for his "self-only" insurance is more than 9.5% of AGI, then it's unaffordable and he can drop it. But the family coverage can exceed 9.5% and that doesn't matter, since the employer is still providing the employee (but not employee and his family) affordable coverage. Hence the reason I cite this as a real problem under the ACA. You have a guy making maybe $40k/yr including some overtime and paying around 20-22% toward HI premiums for the family.

But if the rule has changed or been reinterpreted, please let me know because it'll save BIL a ton of cash!

 

[FUEGO]

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.

My insurance usually won't pay the $7 extra BS charges like that. They'll have a footnote on the EOB that says "this charge is customarily included in the charge for the main procedure (blood test in this case) and will not be reimbursed separately as it is a duplicate charge".

We get charged a couple hundred bucks for the kid's immunizations, then occasionally an extra $30-40 "immunization admin charge" and the ins. co. always calls BS on that charge to administer the immunization (the 3 minutes to fill the syringe, swab the arm, and poke it in by the nurse or nurse's assistant, oh, and slap a bandaid on).

 

[pb4uski]

My BIL has "affordable" insurance, therefore his household is ineligible for ACA exchange subsidies because he's covered by workplace insurance.....

The way I understand it is that if his portion of premiums for his "self-only" insurance is more than 9.5% of AGI, then it's unaffordable and he can drop it. But the family coverage can exceed 9.5% and that doesn't matter, since the employer is still providing the employee (but not employee and his family) affordable coverage. Hence the reason I cite this as a real problem under the ACA. You have a guy making maybe $40k/yr including some overtime and paying around 20-22% toward HI premiums for the family. ....

I guess what I was thinking is that even if BIL doesn't qualify for subsidies, if he and his family are relatively healthy they might be better off with a catastrophic plan then paying 20-22% for HI. Alternatively, perhaps he could take his employer's plan for himself only (since the employer subsidizes it heavily) and his wife/kids could get their own cat or bronze plan through the exchange and it might still be less than insuring the whole family through his employer.

In the end, we need to totally divorce HI from employment to get rid os such inequities.

 

[Katsmeow]

Did she consent to have an "assisting surgeon"? Was the need for 2nd surgeon due to a surprising new finding or an emergency situation? Was the procedure so complex that it routinely would require a 2nd surgeon? If not, I would think she would be justified in telling the 2nd surgeon to buzz off and dispute/refuse the bill. Or threaten to sue the second surgeon for assault, since (apparently) that she had not consented to have him/her touch her or even be in the OR during her surgery.
That said, for most procedures I've had the pre-op consent says something to the effect that I was consenting to have 'whateversurgery' performed by or under the direction of 'Dr. X'. IIUC, to ensure that Dr X actually does the surgery you must modify that consent clause to state specifically that you consent to have ONLY Dr X perform the procedure unless there is an emergency or specific unforeseen circumstances. If I were traveling cross-country for surgery I would make damn sure this issue was crystal clear before I even left home.

The problem you run into in one I ran into a few years ago (so this is all pre-ACA). I was having surgery and I wanted to make sure everyone was in network. The doctor and hospital were. But, the hospital said that none of the anesthesiologists were in network nor would the assistant surgeon be in network. (The assistant surgeon was required by the hospitla). This was because the anesthesiologists and assistant surgeons were not in any network. So I looked into going to another hospital. However, the same group of anesthesiologists and assistant surgeons provided those services to all the hospitals in the area.

What really irritated me was when the assistant surgeon billed something like 10x what insurance paid the actual surgeon. The policy we had did provide that the insurer would treat the anesthesiologist and radiologist and a couple of other provides as in network and reimburse at that rate rather than the out of network rate. I also got the insurer to agree to pay the assistant surgeon at the in network rate.

Of course, the issue that could have come up was that the insurer paid them the same discounted rate they would have paid an in network doctor. I was worried that these out of network providers would try to come after me for the difference, but they didn't.

Still it was so annoying since there was literally no one that was in network for those services.