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Old 09-26-2013, 05:34 PM   #361
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Here's the lengthy horror story of a man who decided to forgo insurance, then had the bad luck of being seriously injured in an accident.

Getting Stuck: Uninsured Patients Slammed with Lawsuits by Not-for-Profit Hospital - Page 1 - News - Houston - Houston Press
Sounds like the story of a misguidedly aggressive hospital legal dept. The article quotes one defense attny who stated he did not understand why the hosp's legal dept brought these suits since most of his clients were "judgement proof" (e.g. low assets) under (TX) state law anyway and the hosp eventually "dropped the cases in every instance".

BTW- I do not advocate going without HI, but considering the big annual costs of HI premiums plus (potential) big OOP max I can understand why some (e.g. young &/or low-income) still decide not to buy it. Even stretching their limited budget to pay HI premiums, many would still be bankrupt if accident/illness hits 'em for co-pays & OOP max (or even mult OOP max's if treatment goes on for yrs). HOWEVER- For ER's with significant non-protected assets, bankruptcy could mean losing huge chunk of the nest-egg
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Old 09-26-2013, 05:54 PM   #362
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How often are you going to be able to negotiate prices if you have to have something done?

That's presuming that an uninsured or cash payer would be paying for routine doctor visits and tests, to diagnose potential problems.

If you have to have something done quickly, you don't have a chance to shop around or negotiate. In fact, why would a provide negotiate knowing you have to have his services?
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Old 09-26-2013, 06:08 PM   #363
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How often are you going to be able to negotiate prices if you have to have something done??
I did have a surgeon, post op visit, offer to settle for a reduced rate. Emergency appendectomy done in the middle of the night, not at a hospital I would have chosen.

I had seen his pratice, patients, and how he was helping people that didn't know how to get help. Smiled and said, 'thank you please give someone else that break'.

I agree most negotiation is done up front.

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Old 09-26-2013, 06:57 PM   #364
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It takes a bit of page-clicking to determine your rating area.

At the second page I linked, follow a link at "For further information about rating areas, please see:" to view rating area designations by your home county. Then you can go back to the table showing the number of plans available by rating area and see which line applies to you.

I agree the actual prices and plan details are the required information for actual decision-making. Like Michael, however, I feel this first peek through the gate is anything but alarming or surprising.
In the case of Texas I suspect that you can sort of relie on the High risk pools breakdown by area. In any case 770,772,752 and 753 are in the are in the highest cost part of the state. Interestingly Bellarie and Alief are in 774 which is one class down. It appears that the ACA uses counties so its really Harris County that is the high cost area. Interestingly Waco and Temple and the Hill Country are the lowest cost areas in the state. San Antonio is in class 2 (Houston and Dallas are in class 6)

Checking the spread sheet at least for 2 places it seems to match the high risk pool in terms of costs. Which shows the rating areas to be consistent at least.
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Old 09-26-2013, 08:24 PM   #365
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Here's a PDF copy of Steve Brills article

http://files.parsintl.com/eprints/77249.pdf
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Old 09-26-2013, 09:19 PM   #366
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Without additional detail I don't think we can draw any meaningful any conclusions from the excel data.
Good point. A local ins broker has pointed out that despite only 3 carriers having signed up for state Exchange, there are some rather important differences between their Bronze plans.
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Old 09-26-2013, 09:49 PM   #367
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"Self-insuring" is not an option in the US because too many service providers have pricing tiers that are far too wide and make it impossible for an individual or family to deal with anything other than basic discretionary care. "One service one price" would be a big step forward in that direction.

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Good point. A local ins broker has pointed out that despite only 3 carriers having signed up for state Exchange, there are some rather important differences between their Bronze plans.
My guess is that basic network design - how may doctors, specialists, hospitals, etc - is the biggest driver between different policies, even with the same insurer, and will account for more than 50% of all price difference among policy alternatives.
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Old 09-27-2013, 09:24 AM   #368
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"Self-insuring" is not an option in the US.......
Whether they realize it or not, aren't the millions of American without HI functionally "self-insuring"? Even assuming ACA remains fully-funded, CBO estimates ~30 million will remain uninsured under ACA.
CBO | CBO
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Old 09-27-2013, 10:09 AM   #369
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There is a big difference between having resources and making a conscious decision to take a risk and self insure (for example, by deciding that dental insurance isn't worth the cost and accepting the risk of some dental bills) and not buying insurance because you don't want to spend the money and believe that society will step up for you should something bad happen.

The cost of health care in the event of an accident or critical illness are so expensive it is not practical for most people to self insure (other than the very, very wealthy). IMO, if you can't afford to pay for your health care if you were to have an illness and you refuse to buy insurance because it is too expensive you are not self insuring, you are avoiding an unfortunate reality of life.
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Old 09-27-2013, 10:19 AM   #370
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........ Imo, if you can't afford to pay for your health care if you were to have an illness and you refuse to buy insurance because it is too expensive you are not self insuring, you are avoiding an unfortunate reality of life.
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Old 09-27-2013, 10:27 AM   #371
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There is a big difference between having resources and making a conscious decision to take a risk and self insure (for example, by deciding that dental insurance isn't worth the cost and accepting the risk of some dental bills) and not buying insurance because you don't want to spend the money and believe that society will step up for you should something bad happen.

The cost of health care in the event of an accident or critical illness are so expensive it is not practical for most people to self insure (other than the very, very wealthy). IMO, if you can't afford to pay for your health care if you were to have an illness and you refuse to buy insurance because it is too expensive you are not self insuring, you are avoiding an unfortunate reality of life.
You are certainly correct, but I wonder what a 27 year old with only a $100 left over each month is going to think. Do I use this to buy insurance and sit at home, or do I have a little fun and go chase some tail this weekend. Nothing is going to happen to me anyways so it's a waste of money. And even if something did, I couldn't pay the deductible anyways. Let them try to get blood from a turnip! I am certainly not advocating this position, but we have all become old foggies if we do not believe more than a few won't think this.
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Old 09-27-2013, 10:47 AM   #372
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You are certainly correct, but I wonder what a 27 year old with only a $100 left over each month is going to think. Do I use this to buy insurance and sit at home, or do I have a little fun and go chase some tail this weekend.
Low income 27 year olds will get subsidized, and higher income 27 year olds should have more than $100 left each month or they have bigger issues anyway.

Many 27 year old women especially are really going to have to struggle with the chase the tail vs. health insurance choice.
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Old 09-27-2013, 10:57 AM   #373
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Low income 27 year olds will get subsidized, and higher income 27 year olds should have more than $100 left each month or they have bigger issues anyway.

Many 27 year old women especially are really going to have to struggle with the chase the tail vs. health insurance choice.
I'm looking at it through a guys eyes. The ladies always have another coach purse they need to buy. . I am referring to the ones just outside the assistance level. People won't save for retirement, why would they give up their IPhones, electrical gadgets, entertainment money if they are right on the edge for health insurance? Now for my benefit I certainly hope I am wrong. But then again, I can see many of them a year and a half from now filling out their tax returns and asking "what's this health insurance penalty"? I didn't know I had to have insurance. And also probably quite a few who were eligible for assistance but never bothered to even apply. Remember 1 in 7 people are uninsured motorists and they even know they are supposed to have it.
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Old 09-27-2013, 11:04 AM   #374
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Remember 1 in 7 people are uninsured motorists and they even know they are supposed to have it.
Car insurance isn't subsidized for low income people.

I don't know how many 26 year olds would go without insurance. The issue is easily solved by increasing the penalty, if need be. Or Yahoo finance will surely have enough scare stories on 26 year olds who didn't get insurance and had some multimillion health disaster to scare them into buying it.
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Old 09-27-2013, 11:23 AM   #375
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The percentage of uninsured young people declined in Massachusetts after health reform was introduced there. Lower cost policies for them, combined with catastrophic coverage options, were enough to enable coverage for many.
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Old 09-27-2013, 11:26 AM   #376
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I asked this in another ACA insurance topic and never got a response so I'll try it here.

Not sure if this is the proper topic to ask this question but I didn't want to start another Obamacare topic....

Currently, when you have medical care and have insurance, there is a "retail" cost and then there is a negotiated rate or allowed amount. The allowed amount is what counts. You pay your portion of the allowed amount. This difference can be very significant. For example, a blood test has a retail price of $98 and your insurance allows only $10 and that's what you pay, the $88 difference is noted as the insurance discount.

Supposedly the $98 retail price is for people without insurance.

When Obamacare is fully implemented (and I hope it's running well) if everyone has to have insurance then will there be a retail rate and an allowed rate? Will different insurance carriers have different allowed rates?

The reason I'm asking this is that DH and I will be considering his retiree insurance (open enrollment 10/01/13 to 10/31/13) vs. ACA insurance and I want to create a few spreadsheets to show examples of our options using previous years medical bills. Some of the options will have higher deductibles instead of a co-pay. All I have to go by is what the allowed amount was on previous bills and I don't have any info about how this will all play out in 2014 or 2015.

How does this work in Massachusetts?
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Old 09-27-2013, 11:45 AM   #377
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IMO, if you can't afford to pay for your health care if you were to have an illness and you refuse to buy insurance because it is too expensive you are not self insuring, you are avoiding an unfortunate reality of life.
"Avoiding" or else making the decision to pass the burden of providing your medical care on to others if a really bad event happens.

This decision to make health insurance "affordable" for everyone should come with real penalties for those who act irresponsibly despite all that is being done. For example, I'm not sure why emergency rooms and other providers should be under any obligation to provide care to those who have made a conscious decision not to purchase (affordable, often subsidized) health care coverage. These uncovered costs then get passed along to other people who are buying insurance (and taxpayers who are paying for the subsidies). We're not talking about the indigent, we're talking about the willfully negligent. At what point do we finally say "enough! You are an adult!"?
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Old 09-27-2013, 11:52 AM   #378
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I asked this in another ACA insurance topic and never got a response so I'll try it here.

Not sure if this is the proper topic to ask this question but I didn't want to start another Obamacare topic....

Currently, when you have medical care and have insurance, there is a "retail" cost and then there is a negotiated rate or allowed amount. The allowed amount is what counts. You pay your portion of the allowed amount. This difference can be very significant. For example, a blood test has a retail price of $98 and your insurance allows only $10 and that's what you pay, the $88 difference is noted as the insurance discount.

Supposedly the $98 retail price is for people without insurance.

When Obamacare is fully implemented (and I hope it's running well) if everyone has to have insurance then will there be a retail rate and an allowed rate? Will different insurance carriers have different allowed rates?

The reason I'm asking this is that DH and I will be considering his retiree insurance (open enrollment 10/01/13 to 10/31/13) vs. ACA insurance and I want to create a few spreadsheets to show examples of our options using previous years medical bills. Some of the options will have higher deductibles instead of a co-pay. All I have to go by is what the allowed amount was on previous bills and I don't have any info about how this will all play out in 2014 or 2015.

How does this work in Massachusetts?

You may not have gotten any replies because of your last line asking about how it works in Massachusetts. There are many differences between what I have heard about Massachusetts and what is rolling out as the ACA.

It is my understanding that the different insurance companies will not have standardized insurance coverages for different procedures except in a few cases where they are "free." What is being mandated are the items covered, deductibles and out-of-pocket maximums for the bronze, silver,etc. The insurance cost for different items can vary widely and I suspect there will be no way to determine what the cost of every specific item is until you see the bill. I also don't believe that copays are standardized. Someone may jump in and correct me.

One of the things people don't always realize is that copays typically continue to be required even if the OOP maximum is met and they don't count towards meeting the OOP max. That is true with the non-high deductible plan where I work now and it was true for my previous employer's plan.
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Old 09-27-2013, 11:55 AM   #379
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" At what point do we finally say "enough! You are an adult!"?
The point where chemistry teachers have to resort to cooking crystal meth to pay for their cancer treatments?

On a related note, what if Breaking Bad were set in the UK?

http://www.buzzfeed.com/lukelewis/if...-set-in-the-uk
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Old 09-27-2013, 12:23 PM   #380
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"Avoiding" or else making the decision to pass the burden of providing your medical care on to others if a really bad event happens.

This decision to make health insurance "affordable" for everyone should come with real penalties for those who act irresponsibly despite all that is being done. For example, I'm not sure why emergency rooms and other providers should be under any obligation to provide care to those who have made a conscious decision not to purchase (affordable, often subsidized) health care coverage. These uncovered costs then get passed along to other people who are buying insurance (and taxpayers who are paying for the subsidies). We're not talking about the indigent, we're talking about the willfully negligent. At what point do we finally say "enough! You are an adult!"?
I totally agree with you that the only way our "voluntary" health care system can work is if there are dramatic consequences for poor decisions. I have for years thought that unless as a society we are willing to require those who refuse to buy health insurance like the rest of us to be turned away from the system or rely on charity care that our "voluntary" health care system isn't viable. The real poor are covered by Medicaid (warts and all). Those of lower means had a plausible excuse that health insurance was too expensive. That excuse is eroded by Obamacare subsidies.
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