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Old 03-18-2016, 10:47 AM   #61
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Exactly. It pains me to hear people act like paying for medical care started with the ACA.
Well, it certainly wasn't my intention to cause anyone pain with my comment. But it is certainly foolish to not recognize that the entire landscape of health care and the ensuing payment for such has not changed significantly.

As I worked for the last three decades I understand the payment of my healthcare was not "magic". I know exactly what it was. An additional enticement to work for the organization I was employed with. An accoutrement to my salary. Medical insurance was always a factor in my decisions to change jobs unless the pay was so substantially better that it didn't matter. That only happened to me once. And I certainly never would have worked somewhere that didn't offer it.

Are you saying it is not somehow different now? That premiums and out of pocket expenses are not substantially more? I get the impression, forgive me if I'm not correct, that you and, perhaps athena53, are taking what I said as some slam on Obamacare. That wasn't my intention. If you simply believe I'm just ignorant, that's okay. I'm not.

I think we are all just becoming "business owners" in the sense that an expense we gave little thought to before because it was shopped for, supplemented and supplied by someone else is now in the forefront of our planning because we are bearing more of the cost. We are in a learning curve, us as consumers and and health care professionals as providers. That was my point.
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Old 03-18-2016, 11:34 AM   #62
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I think we are all just becoming "business owners" in the sense that an expense we gave little thought to before because it was shopped for, supplemented and supplied by someone else is now in the forefront of our planning because we are bearing more of the cost. We are in a learning curve, us as consumers and and health care professionals as providers. That was my point.
There is a lot of truth in that statement. Those of us with individual policies seem to be more aware (painfully so) of the cost of healthcare in the US. Even when there is a subsidy, we still see the real (and barely affordable) price first. The same is not true of employer provided or Medicare.

Here's a link to a survey KFF does every year (link). Lots of very good information and data. Exhibit 1.11 shows the average premium for employer provided healthcare since 1999. You will see that premiums have been high for many years, also growing at a rapid rate. ACA policies from the health exchanges have costs that are similar to the employer premiums. In fact,the only things notable that has happened recently regarding healthcare costs is the rate of increase has slowed considerably since the introduction of the ACA. In my humble opinion this is coincidence, has less to do with the reform and more to do with the fact that healthcare has become unaffordable, so the price increases are forced to slow.
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Old 03-18-2016, 01:25 PM   #63
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Kaiser Permanente doesn't cover skin tag removal at all. Mine were noted in the record, but I was told removing it would be cosmetic rather than medical. They're happy to give you a list of clinics/dermatologists that will take care of it for you - on your own dime.

I'm ok with that.
Interesting. I have Kaiser (Mid-Atlantic) and I've had them remove skin tags three times. Just mentioned them to my PCP, she gave me a recommendation for the dermatologist, and I made an appointment and they froze them off. No big deal.


Total cost, whatever the copay was at the time.
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Old 03-18-2016, 02:09 PM   #64
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I think the location of skin tags or 'barnacles' is a factor. I had barnacles on my face and got a referral.
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Old 03-18-2016, 03:04 PM   #65
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...we both use clinics such as CVS Minute Clinics for minor things.
Can you elaborate on your experience with the quality of care at these convenience clinics? I've noticed they have popped up around here, and since DW & I will be on a HD plan beginning next year & I'm curious what type of care these and other Urgent-Care type facilities may offer. Tnx.


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Old 03-18-2016, 03:22 PM   #66
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DH is on Medicare but we both use clinics such as CVS Minute Clinics for minor things.
I'd be desperate before I went to the CVS around here for any kind of medical treatment. Staff turnover is very high and even the pharmacists rarely last longer than a year. This strongly suggests that it's a lousy place to work, staff is underpaid, or both. The doctors office says they have more issues with CVS messing up prescriptions than anywhere else. CVS also made 24/7 Wall St. "12 worst places to work" spot last year.

I only go there because my prescription plan is run by CVS and I'd have much higher copays if I went elsewhere. I'm seriously considering doing that anyway but I'm not sure any of the others would be much better.

YMMV.
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Old 03-18-2016, 03:28 PM   #67
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I'm curious what type of care these and other Urgent-Care type facilities may offer.
Most Urgent Care facilities only deal with minor illnesses and injuries like colds, flu, sprains, minor cuts and scrapes, etc. The benefit is you can usually get same day treatment and it's probably a lot cheaper than going to the emergency room.
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Old 03-18-2016, 03:29 PM   #68
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..........Are you saying it is not somehow different now? That premiums and out of pocket expenses are not substantially more? I get the impression, forgive me if I'm not correct, that you and, perhaps athena53, are taking what I said as some slam on Obamacare. That wasn't my intention. If you simply believe I'm just ignorant, that's okay. I'm not. ...........
I don't think that "medical insurance" and "Obamacare" can be used interchangeably unless one is trying to make some kind of a political point. The costs for medical care keep going up faster than inflation and employers are getting tired of eating the extra premiums cost and hope that making employees share the pain will make them shop for medical care with cost in mind. I agree, it sucks, but the problem did not begin with the ACA and will not disappear without the ACA.
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Old 03-18-2016, 03:43 PM   #69
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I definitely did not interpret your post as a slam against ObamaCare. It's not perfect but it did solve some major problems with the system (definitely not all of them!).

I do think that somehow the changes brought about by Obamacare have accelerated the shifting of costs from employers and insurance payouts to directly from your out of the patient's pocket. If I were idealistic I might expect that it would cut costs in the long run as we become better consumers and the insurance company's overhead is removed from part of the costs but it hasn't happened yet. As we've noted here and elsewhere, it's hard to be an educated consumer when they expect you to write a blank check.
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Old 03-18-2016, 07:43 PM   #70
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There's a website called walkinlab.com where you can go and order blood tests. They take your money by CC and then refer you to the local Quest or whatever. You don't need your docs prescription to go there as they get around that by having "their doctor" order it. My PSA cost $110 at the normal doctor recommended place , but only $37 here.

Also, on the Blue Shield website there's a way of comparing local places for the cost of X-rays, MRIs, blood tests etc. Quite interesting to look at the major differences locally. Definitely stay away from hospitals for any tests.


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Old 03-18-2016, 11:49 PM   #71
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I don't think that "medical insurance" and "Obamacare" can be used interchangeably unless one is trying to make some kind of a political point.
Well, I wasn't. And since that was not my intent I won't argue the point.

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The costs for medical care keep going up faster than inflation and employers are getting tired of eating the extra premiums cost and hope that making employees share the pain will make them shop for medical care with cost in mind. I agree, it sucks, but the problem did not begin with the ACA and will not disappear without the ACA.
You really should go back and read what I said. I know you are upset that I used the words "Obama Care" but your comments have little to do with my posts.

Nothing, actually.

To clarify what I said in comment #57, Obama Care, the ACA or whatever honorific you would like to give it, is not free. That is what I said. I meant it is not a government program or invisible entity that is paying for these over-priced and, often times, unnecessary procedures. We are. You, me and the young woman I was commenting about. Doctors and care givers need to remember this. As far as my comments in #61, I did not, in any way, "interchangeably" use "medical insurance" and "Obamacare". Not once. If anyone made such a correlation, it was you that did so, not I.

I'm not going to apologize because you took offense where none was intended. And I really don't want to argue with you. But, really, you made this a political issue for no reason.

Not a big deal. We can certainly move on. Do you like Scotch? I don't know where you live but I'll travel to bend an elbow.
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Old 03-19-2016, 06:43 AM   #72
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Well, I wasn't. And since that was not my intent I won't argue the point...........
Oh, so you'd like to see physicians more aware of the costs for medications and procedures that they prescribe? Well I would, too!

I had lunch with an intern recently and I asked him why he thought that medical costs were so high. He said it was simple, the insurance companies were charging too much.
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Old 03-19-2016, 07:09 AM   #73
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Many years before anyone ever heard of Obama, or "Obamacare", I had a large deductible plan. I was due for a colonoscopy. Just for the hell of it I called the doc and the facility where it would be done and attempted to get an estimate of what the bill would be. They would not provide one. Basically, nobody actually knew what it would cost because they are in contract with so many different insurance companies at so many different negotiated rates, they were clueless, and they simply REFUSED to tell me up front what the charge would be for an uninsured patient.
I began to think that they thought I was a reporter writing a story on their ridiculous pre-insurance charges, and were worried they were going to read about this in the local newspaper.
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Old 03-19-2016, 07:39 AM   #74
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I had lunch with an intern recently and I asked him why he thought that medical costs were so high. He said it was simple, the insurance companies were charging too much.
One of my FaceBook contacts posted an item stating compensation of CEOs of 4 major health insurers and blaming high premiums in CEO pay. I did a little math and responded that if those 4 companies covered 80% of the US population and we reduced their pay to zero, it would decrease the average policy by $71. (Even if it's 40% due to Medicare, Medicaid and the uninsured, it's not a major dent in annual premiums.)

When I posted a link to a Harvard study calculating the extra costs on our healthcare system due to obesity and its consequences (I think it was $1.5 billion in 2009) she was livid. I had to back off.
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Old 03-19-2016, 08:22 AM   #75
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Your friend can't be right.... MLR requires that at least 80% of health insurance premiums (for individual health insurance, 85% for large groups) be spent on care so that leaves 20% or less for overhead and profit/return on capital.
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Old 03-19-2016, 08:31 AM   #76
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I was watching a show on hospital rates for supplies and services. Apparently they just make up prices out of thin air for their list. That is how you get a charge of $10 for a Tylenol. They expect to be negotiated downward if they bill a person.
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Old 03-19-2016, 08:40 AM   #77
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There's a website called walkinlab.com where you can go and order blood tests. They take your money by CC and then refer you to the local Quest or whatever. You don't need your docs prescription to go there as they get around that by having "their doctor" order it. My PSA cost $110 at the normal doctor recommended place , but only $37 here.

Also, on the Blue Shield website there's a way of comparing local places for the cost of X-rays, MRIs, blood tests etc. Quite interesting to look at the major differences locally. Definitely stay away from hospitals for any tests.


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Bmcgonig, Thanks for the referral to walkinlabs.com. I assume you do not need insurance there? And I agree the Blue Shield website is good for discovering costs. I used it when I had bcbs. Funny thing though, bcbs was telling me to avoid hospitals for tests since they were so expensive, but when I went to the website, it recommended a hospital for an ultrasound, when there was a much cheaper independent lab available. I called them up about it and they said just go to the hospital for the ultrasound, no problem, just a small copay for me. Oh well, I tried. to keep costs down but they didn't seem to care. I decided to go tothe expensive hospital since that is where my doctor suggested I go. I saw the bill for the ultrasound, which was $1,500 for the actual ultrasound, and another $1,500 for a doctor interpreting the ultrasound. bcbs paid the hospital about $600 for the ultrasound and paid the doctor $600 for the interpretation. So bcbs paid them almost half of what they billed, as opposed to the usual 20 percent. I guess I'm not supposed to care since I just have the small copay.
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Old 03-19-2016, 08:51 AM   #78
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Your friend can't be right.... MLR requires that at least 80% of health insurance premiums (for individual health insurance, 85% for large groups) be spent on care so that leaves 20% or less for overhead and profit/return on capital.
Hmmm. It now makes sense why my bcbs policy paid so much for my ultrasound, which was done in December, 2015. Maybe bcbs realized they had to pay out more in claims to reach the 80%, so they started funneling high payments to certain hospitals where they have some sort of kickback program established. That way bcbs doesn't have to rebate as much (or any) money to the premium payers for 2015. They'd keep it all *in house*. Just a theory....
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Old 03-19-2016, 09:29 AM   #79
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One of my FaceBook contacts posted an item stating compensation of CEOs of 4 major health insurers and blaming high premiums in CEO pay. I did a little math and responded that if those 4 companies covered 80% of the US population and we reduced their pay to zero, it would decrease the average policy by $71. (Even if it's 40% due to Medicare, Medicaid and the uninsured, it's not a major dent in annual premiums.)

When I posted a link to a Harvard study calculating the extra costs on our healthcare system due to obesity and its consequences (I think it was $1.5 billion in 2009) she was livid. I had to back off.
$71 a month or a year? Because the former would be significant to most people.
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Old 03-19-2016, 09:32 AM   #80
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I was watching a show on hospital rates for supplies and services. Apparently they just make up prices out of thin air for their list. That is how you get a charge of $10 for a Tylenol. They expect to be negotiated downward if they bill a person.
That's my understanding.
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