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Old 11-11-2014, 04:55 PM   #21
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Originally Posted by robnplunder View Post
Off topic, I know. Is it my eye sight or MichaelB's avatar looks like Whoopie Goldberg in disguise?

Back to OP: good info, thanks. As my ER approaches, I have been asking my dentist, and general doctor to see if I will be covered under PPACA. I believe I need to pay my dentist out of pocket. My general doctor is "in" PPACA network and will cover me. Go ask you doctors, that's my advice.
It should be noted that dental insurance is not included except for children under the ACA. However it is available on the open market. There is not as much of a pre-existing condition since the insurance tends to have a farily low maximum annual pay out.
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Old 11-11-2014, 05:17 PM   #22
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Monty Python, The Cardinal, The Spanish Inquisition.



The confusion is understandable.
Did someone mention the Inquisition?

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Old 11-11-2014, 08:00 PM   #23
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Originally Posted by sengsational View Post
So THAT'S how it works! You gotta hand it to those sneaky insurance company b*stards! I don't pay the INSURANCE bill, and the DOCTOR gets stiffed! Give me a BREAK!

So it works like this?

1) The insurance policy premium account goes into "past due" status.
2) The policy holder goes to the doctor, and the doctor can't tell (or maybe it's even illegal to inform the doctor about past due premium account?).
3) The insurance company quits paying claims, so the doctor is left holding the bag?

Very interesting indeed, TN_Steve!
Actually this 90 day grace period is part of ACA law, NOT the insurance companies being "sneaky b*stards". Appears they stand to loose $$ along with the providers for those unpaid premiums AND subsidy $ already received. The law (via implementation reg's) requires them to keep HI in force during the grace period, and only need inform the providers during months 2-3 of the grace period. During the grace period, payments to providers are held subject to HI premium payment by the patient. If the HI premiums are not paid up by the 90 days, the insured is responsible for any provider payments and their HI premiums. So providers can indeed be left "holding the bag" in many cases- at least during part of the 90 days. But it appears this grace period provision cannot be done on an ongoing basis to continually pay only 9 monthly premiums each year. The grace period does not "reset" unless/until the missed payments are made.
http://www.cms.gov/CCIIO/Resources/R...5CR_100313.pdf

Should be noted that the above only applies to those covered under Exchange Plans who are receiving a subsidy. Those NOT getting a subsidy do not seem to be covered by this ACA 90 day grace period.
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Old 11-11-2014, 08:15 PM   #24
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..... I changed my primary doctor and when I called for an appointment, The first thing they asked is if my insurance (unitehealhtcare) is a regular insurance or Obamacare. I read a lot of doctors do not accept or refuse patients whose insurance is under the Obamacare. Is this true? Did anyone had the same experience? ......
This seems to vary a lot by region. Some folks report few issues while in other areas having Exchange Plan makes it somewhat problematic to find a good in-network doc/hospital. For 2105 my region now has 7 different companies participating but only one company's network includes all of the 4 major area hospital systems. Most include just 1 or 2. And some companies have changed which main hospital system they contract with since last year. A real PITA to keep track of if you are trying to pick your 2015 HI plan to let you keep seeing your same doc next year
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Old 11-12-2014, 07:30 AM   #25
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It should be noted that dental insurance is not included except for children under the ACA. However it is available on the open market. There is not as much of a pre-existing condition since the insurance tends to have a farily low maximum annual pay out.
I looked at dental insurance and was unhappy to find that they didn't cover much except cleaning for the first 6 or 12 months (depending on the policy). I get that they don't want you to wait till you need a root canal and then buy insurance, but I'd been covered continuously (and getting checkups 4X/year because I have implants) for years. I chose not to buy it. But, IMO, this is their way of excluding pre-existing conditions and getting a guaranteed profit the first year.

Anyway, another data point on the OP: I retired in May and bought a private policy through Coventry because I figured we wouldn't qualify for subsidies because I was paid through 7/1 plus earned, unused vacation and we have investment income. When I called my regular doc for an appointment and told them I had Coventry, they said they accept the private version but not the Coventry purchased through the Exchange. No problems with reimbursement from my checkup-it was all covered.
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Old 11-12-2014, 08:24 AM   #26
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Regarding dental insurance and PPACA: I notice the Healthcare.gov website lets you shop for dental insurance, gives you premium amounts, and a list of prices, coinsurances, deductibles, etc. But nowhere is it clarified, unless I missed it, whether or not cost sharing or premium subsidies will apply to dental. From what I saw, the website does not state whether or not there will be subsidies and cost sharing for dental, but I am assuming there will not be. While looking at regular health ins plans on hc.gov, I can click into something that shows my cost sharing, but there is no analogous click to let me see any dental cost sharing or subsidies, while browsing the dental options. Anyone know for sure? Thanks.
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Old 11-12-2014, 08:46 AM   #27
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In my case the policies offered to me in ACA (un-subsidized) were at a much higher premium than what I've been paying privately on the outside, for basically the same policy. Not sure I see the tie in to ACA polices resulting in lower reimbursement cost to doctors.
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Old 11-12-2014, 08:57 AM   #28
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I asked my primary care doctor and they seemed confused as to why they wouldn't accept the insurances from big name insurers like BC, Aetna, UHC, (what's available through the exchanges). Of course there might be some insurers they don't accept at all, but I didn't get the impression that they were planning on discriminating based on exchange/non-exchange procured insurance.

I asked our dentist if he accepts the dental plan from the state's Children's Health Insurance plan (our kids will get dental included in their health insurance). Yes. No copay or maybe $5 for procedures they said. Way better than what we pay now if there's a procedure.
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Old 11-12-2014, 09:23 AM   #29
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Originally Posted by John Galt III View Post
From what I saw, the website does not state whether or not there will be subsidies and cost sharing for dental, but I am assuming there will not be. While looking at regular health ins plans on hc.gov, I can click into something that shows my cost sharing, but there is no analogous click to let me see any dental cost sharing or subsidies, while browsing the dental options. Anyone know for sure? Thanks.
I think it depends on how the dental is obtained. Some health plans include a dental option so it is included in the premium. If you get a stand alone dental plan in addition to a medical plan, there is a premium for each. I believe your subsidy is applied to your total premium. BUT, the subsidy is calculated based on the second cheapest silver plan, if it doesn't include dental then the cost of dental is not being included in your subsidy ( I think ). I never thought dental was worth it so I never bought it , same with vision option.


https://www.healthcare.gov/coverage/dental-coverage/

From kaiser FAQ, Health Reform FAQs | The Henry J. Kaiser Family Foundation

It looks like pediatric dental benefits are only offered through stand-alone plans in my state Marketplace. Will my tax credit premium cover the cost of the stand-alone dental plan?
No, the premium tax credit will not be increased to also cover the cost of a stand-alone dental plan.
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Old 11-12-2014, 09:26 AM   #30
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Shop, that's how to avoid the issue.

My ACA plan last year included(in my area) all major hospitals, my doc and many others. I was hospitialized twice. Saw 4-5 specialists, all for my copays(lower than Megacorps). I went max OOP in June, haven't paid a dime since then.
Point is sounds like your plan doesn't cover the provider's you need. Has nothing to do with 'Obamacare', same thing happened before ACA.
Are there any independent sources that rate the networks? So far all we have been doing is looking providers on their website and seeing which doctors are available. It would be nice if there was a more systematic rating.

Also there's always a possibility that we missing some speciality because we don't know what to look for. E.g. you think you are ok because there's an orthopedic surgeon but you forgot to check for a anthesiologist.
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Old 11-12-2014, 09:31 AM   #31
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In the November issue Consumer Reports ranked health insurance providers/networks by state.
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Old 11-12-2014, 09:34 AM   #32
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When I shopped for my PPACA plan last year I noticed that every plan on the exchange was also on the BCBS NC site. There is nothing on my insurance card that would indicate whether I shopped directly on the BCBS NC site or PPACA site.

When you do your shopping, there is a link on healthcare.gov that lets you see the network of participating doctors. It is your responsibility to make sure that you book your appointments with doctors that accept your insurance, or live with the consequences. That's easy when you're an outpatient, but if you're in the hospital, it's more problematic. There's other thread on this forum that relate horror stories about some extra doctor standing around in the OR while the real surgeon did the work, and the other doctor was out of network. If I go to the hospital, I'm going to put a sign around my neck that says, unless you take my insurance, turn around and leave!

Maybe an additional post it note securely positioned over the incision point with a declaration of... Any surgical staff not covered by my insurance carrier will be considered gratuitous work. Sign and initial sticky note before entering.


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Old 11-12-2014, 09:44 AM   #33
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In the November issue Consumer Reports ranked health insurance providers/networks by state.
Thanks. I don't have a subscription anymore but I found this link on their website for rankings:

Health Insurance Search Results - Consumer Reports Health

The criteria are consumer satisfaction, prevention, treatment (for common conditions), and accreditation (not sure what this means). They don't report on network size but I assume this would be rolled into the listed criteria (or affect them indirectly).
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Old 11-12-2014, 11:33 AM   #34
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...
The law (via implementation reg's) requires them to keep HI in force during the grace period, and only need inform the providers during months 2-3 of the grace period.
...
Thanks for clarifying that it's in the law that they must inform doctors. The insurance companies still might be sneaky, since I'm sure they had a hand in writing the legislation.

My current insurance company (BCBS NC) is as slimy and slipery as they get. They just deny random claims, now that I've met my deductible and they need to start paying. I call and ask for them to explain the denial and instead of admitting fault or even saying they're sorry, they just say,
"we'll send it through again, and don't call back until 45 days from now". Meanwhile, the doctor is not getting paid, and my account, which I am ultimately responsible for, is getting whacked with 18% interest charges.

But back on the original topic of this sub thread, I see now that the doctors have one out of 12 months of exposure to collections from patients. Not great, but not asw horrible as I originally thought. I guess if the patient is not paying premiums, money might be tight enough to ignore the doctors' urgings for payment. The other problem is that there is another step in the administration (the premium payment validation step). Just what we need more red tape.
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Old 11-12-2014, 11:33 AM   #35
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I asked my primary care doctor and they seemed confused as to why they wouldn't accept the insurances from big name insurers like BC, Aetna, UHC, (what's available through the exchanges). ....
Sounds like these folks are not in the billing area, or at least not familiar with the issue facing them. Two years ago my doc's office had the same mistaken outlook. Now looks like I'm losing my doc of 20+yrs over HI changes.
Each company sells multiple different HI products (plans). Used to be that providers participated (joined to be in network) for all products from a certain company, but that has been changing rapidly. Net payment (reimbursement) rates docs/hospitals get often vary between HI plans offered by the same company. Exchange plan pay rates are almost always lower than typical private (commercial) HI rates in any specific region. It's a big way HI companies use to control costs.
A Doctor’s Perspective On Obamacare Plans | Kaiser Health News

Some doctors wary of taking insurance exchange patients

Plus, as mentioned previously, providers can be left unpaid for services to folks with Exchange HI who have stopped paying their premiums (due to the 90 grace period in subsidized ACA Exchange plans).
The Fourth Obamacare Shock Wave Is About To Reach Us - Forbes

Sadly, with increasing numbers of docs' practices being taken over by hospitals or HC 'systems' many individual docs no longer have the choice of which HI plans to accept or not. It's become a corporate decision.
Hospitals buying more doctors' practices
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Old 11-12-2014, 12:18 PM   #36
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But back on the original topic of this sub thread, I see now that the doctors have one out of 12 months of exposure to collections from patients. Not great, but not asw horrible as I originally thought.
"Not as horrible as I originally thought"? How would you feel if your revenue might randomly drop because someone hasn't paid insurance premiums? And how would the doctor know you haven't paid your insurance premiums before they render the care? Does the insurance company send out a memo to all doctors in the area with your name? The insurance company doesn't know ahead of time who you have appointments with or when those appointments are.
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Old 11-12-2014, 01:07 PM   #37
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Regarding the OP's question, I recently called my GI doc's office to schedule a repeat colonoscopy. The office worker asked me if my insurance had changed since my last procedure 5 years ago. Since I had enrolled in a Blue Shield ppo plan this year, I said "yes" and provided the requested subscriber ID number. She immediately responded, "That's Covered California!" in an accusatory derisive voice. Somewhat stunned, I said it was not, that I paid a high insurance premium for it. She then rechecked the number and proceeded to schedule an appointment. So for a brief 30 seconds, I felt what it was like to be treated like a disgusting gutter rat. If it weren't for the fact I really like my GI specialist, I would stay away from that office.

I have since talked to several other medical providers, and they have mentioned that many of their patients are having trouble finding specialists who accept Covered California insurance (ACA, Obamacare) because of low reimbursements. So the patients resort to traveling significant distances to receive specialist care. So while they eventually find the care they need, it seems that for some it's pretty inconvenient.
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Old 11-12-2014, 01:09 PM   #38
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RBMRTN, Thanks. The health plan I plan to use does not have adult dental, so it looks like, yes, the dental premiums and costs they are showing at hc.gov will not be reduced by a subsidy/ cost sharing. I may opt to self-insure for dental this year.
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I think it depends on how the dental is obtained. Some health plans include a dental option so it is included in the premium. If you get a stand alone dental plan in addition to a medical plan, there is a premium for each. I believe your subsidy is applied to your total premium. BUT, the subsidy is calculated based on the second cheapest silver plan, if it doesn't include dental then the cost of dental is not being included in your subsidy ( I think ). I never thought dental was worth it so I never bought it , same with vision option.


https://www.healthcare.gov/coverage/dental-coverage/

From kaiser FAQ, Health Reform FAQs | The Henry J. Kaiser Family Foundation

It looks like pediatric dental benefits are only offered through stand-alone plans in my state Marketplace. Will my tax credit premium cover the cost of the stand-alone dental plan?
No, the premium tax credit will not be increased to also cover the cost of a stand-alone dental plan.
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Old 11-12-2014, 01:10 PM   #39
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Did someone mention the Inquisition?
I certainly did not expect that!


The challenge I have with medical insurance is complete overload of information and opinions. I have been in a High Deductible plan for a number of years through mega-corp. It is provided during retirement. I understand what the costs have been, and how my HSA functions to pay that max out of pocket. Now things are changing slightly, and some folks (retired from same megacorp) are squealing about the premiums going up. I see letters that could be interpreted as limiting coverage, but yet do not see any evidence or hear of any problems with that. The increase in premiums is very slight, and I believe that the 'outrage' from a few folks is mostly grandstanding. (Something like $20/month.)

Thus, perhaps unfortunately, I believe that I have good insurance (with the known high deductible limitations), right up to the point where I end up with an unexpected bill.

I think there are a lot of people in the same mode. Everything is fine, until it isn't.
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Old 11-12-2014, 01:13 PM   #40
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Are there any independent sources that rate the networks? So far all we have been doing is looking providers on their website and seeing which doctors are available. It would be nice if there was a more systematic rating.

Also there's always a possibility that we missing some speciality because we don't know what to look for. E.g. you think you are ok because there's an orthopedic surgeon but you forgot to check for a anthesiologist.
Not that I'm aware of. Great idea!

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