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Old 11-08-2015, 04:25 PM   #121
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I had unknown out of network docs for my DW's surgery.... was billed for two people for a very simple operation....

I called the group that did the service and said I was not going to pay for the second person and that the bill for the main doc was WAY too high for a 15 minute procedure... After some discussion, we agreed that they would take off the other doc (still never got a reason for them being there) and discount the main doc 50% if I paid now.... I gave them my CC number and it was done...


There were out of network docs that did 'emergency' testing on my mom.... but insurance said it was not an emergency.... we fought with the insurance company and they paid some, but some they did not.... I refused to pay any of the bills since they never consulted us nor told us there were out of network... one kept sending bills for over a year... actually went to a collection agency.... we never paid...

I am unwilling to pay a ridiculous high bill just because they say so... the only way they will get any money from me is to sue and win... now, if it is a legit bill etc. etc. and not out of line, I will pay it...
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Old 11-08-2015, 04:48 PM   #122
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Originally Posted by Texas Proud View Post
I had unknown out of network docs for my DW's surgery.... was billed for two people for a very simple operation....

I called the group that did the service and said I was not going to pay for the second person and that the bill for the main doc was WAY too high for a 15 minute procedure... After some discussion, we agreed that they would take off the other doc (still never got a reason for them being there) and discount the main doc 50% if I paid now.... I gave them my CC number and it was done...


There were out of network docs that did 'emergency' testing on my mom.... but insurance said it was not an emergency.... we fought with the insurance company and they paid some, but some they did not.... I refused to pay any of the bills since they never consulted us nor told us there were out of network... one kept sending bills for over a year... actually went to a collection agency.... we never paid...

I am unwilling to pay a ridiculous high bill just because they say so... the only way they will get any money from me is to sue and win... now, if it is a legit bill etc. etc. and not out of line, I will pay it...
I agree 100% with this. I am not paying for shady charges just because a piece of paper shows up at my house saying I owe some doctor some money. Its amazing how many charges and fees people pay just because they get a bill...and Im not just talking about health insurance.
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Old 11-08-2015, 05:03 PM   #123
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Originally Posted by Texas Proud View Post
I had unknown out of network docs for my DW's surgery.... was billed for two people for a very simple operation....

I called the group that did the service and said I was not going to pay for the second person and that the bill for the main doc was WAY too high for a 15 minute procedure... After some discussion, we agreed that they would take off the other doc (still never got a reason for them being there) and discount the main doc 50% if I paid now.... I gave them my CC number and it was done...


There were out of network docs that did 'emergency' testing on my mom.... but insurance said it was not an emergency.... we fought with the insurance company and they paid some, but some they did not.... I refused to pay any of the bills since they never consulted us nor told us there were out of network... one kept sending bills for over a year... actually went to a collection agency.... we never paid...

I am unwilling to pay a ridiculous high bill just because they say so... the only way they will get any money from me is to sue and win... now, if it is a legit bill etc. etc. and not out of line, I will pay it...

I like that attitude Texas, and gonna file it away in my memory bank in case its ever needed..... On the other side of the coin, I had a discussion with a friend about their company insurance rates this past summer. They have a 3k deductible and these are low wage small town factory employees making maybe 25k-35k tops is my guess. Anyhow my friend said he had a 2k bill to pay for his daughters procedure and it was killing him to scrap up the money to get it paid, but he hates owing people money. Then he proceeds to tell me all his coworkers said "he was crazy" to worry about the bill. He said they all just pay them $10- $20 a month and don't worry about. It will get paid off whenever... ...not their problem.
But remember, this is for an undisputed legitimate bill. I wonder how many people pay this way.


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Old 11-08-2015, 06:25 PM   #124
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Just a short history I retired in 2006 and my medical coverage was $5000.00 that year it has now increased to $17,500.00 for 2016 with Cigna. The plan is about the same but the in-network doctors have reduced and out of network I have to pay 50% of the bill regardless of amount.
Most of the doctors in the Chandler, AZ areas i.e. Cartiologist, etc. will not accept ACA plans, period. With my wifes continually going to the doctor for something my medical expense will be somewhere around $22,000 in 2016.
Retirement prior to 65 is a bit*h and very expensive. Sure cuts into any retirement budget.
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Old 11-08-2015, 06:59 PM   #125
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He said they all just pay them $10- $20 a month and don't worry about. It will get paid off whenever... ...not their problem.
But remember, this is for an undisputed legitimate bill. I wonder how many people pay this way.
The larger of two hospitals in my area has a $50 per month no interest payment plan for the remaining OOP after insurance pays. This only applies to the facility's charges and not the professional bills. It's also the one not included in narrow networks.
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Old 11-08-2015, 07:13 PM   #126
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I'd guess because HSA-eligible plans can't have an OOP maximum above $6,550 (single) or $13,100 (family), and some bronze plans have higher OOP maximums than that. So the ones with an OOP max too high to be eligible for an HSA are probably going to be the cheapest.
This has me scratching my head. Why isn't the max OOP the same for both HSA limits and the ACA plans? I thought they were in prior years. How come there are now max OOP for plans with like $6700 yet the max OOP for an HSA is like $6550?

This shows that HDHP max OOP for 2016 is $6550, yet the ACA max OOP for 2016 is $6,850.

Yet that difference is only $300. How can that cause such a huge difference in premiums. HSA plans should only cost $25 more a month to cover the difference. See - http://www.kellerbenefit.com/news-an...of-pocket-rule

Yeah, I know!!!!
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Old 11-08-2015, 07:24 PM   #127
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This has me scratching my head. Why isn't the max OOP the same for both HSA limits and the ACA plans. I thought they were in prior years. How come there are now max OOP for plans with like $6700 yet the max OOP for an HSA is like $6550?
The inflation adjustment for HSA MOOP is different, and less, than the criteria mandated by HHS for HDHP. As years go by, the spread will become greater if no changes are made.

Reminder: ACA's Out-of-Pocket Limits Differ from HSA-Qualified HDHPs Starting in 2015 | Proskauer's ERISA Practice Center Blog
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Old 11-08-2015, 07:37 PM   #128
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Originally Posted by SCGamecock View Post
The inflation adjustment for HSA MOOP is different, and less, than the criteria mandated by HHS for HDHP. As years go by, the spread will become greater if no changes are made.

Reminder: ACA's Out-of-Pocket Limits Differ from HSA-Qualified HDHPs Starting in 2015 | Proskauer's ERISA Practice Center Blog
I see - they were only the same in 2014. What a pain!
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Old 11-08-2015, 07:50 PM   #129
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Yes, this is true -- but as far as I know it doesn't prevent balance billing. All it means is that all emergency care needs to be paid on the same schedule as in-network care.

In other words, if an in-network ER incident would pay out 90% of an allowable amount of $20,000, but you went out of network at a place that bills for $30,000, the insurer will pay $18,000 (90% of their $20K allowance) but you can still be billed the remaining $10K, for a total of $12K instead of $2K.
This is the issue. It is the balance billing that is the problem. ER charges can be insane. About a year ago, my daughter went to the urgent care clinic and they referred her to the ER after checking various things, including a negative flu test. I took her an in-network ER (thank goodness). We were there several hours. She never saw a physician (she did a nurse practitioner). After various tests, they decided that she had abdominal pain due to the flu.

The bill was over $20,000. Now, the hospital was in network and they paid a tiny fraction of the bill so it was fine. But, had the hospital been out of network and they agreed this was emergency care (note we did go to Urgent Care first and they sent us to the ER), the entire balance beyond whatever the insurer wanted to pay could have been billed.

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I have read one story total which caused somewhat of a financial ruin and it was not from this site. IIRC it was about a woman on vacation who went into early labor and had some pretty big hospital bills from the local out of network hospital. I think it was on the order of $50k to $100k, which would wipe out most Americans but might be withstood from most on ER.org. IIRC she is fighting the charges too.

So I see it as a valid concern but perhaps not the 'OMG we are all going bankrupt next year' type of concern.
I think in most instances out of network costs won't immediately bankrupt someone. I think the major risk would be someone in an accident and taken to an out of network hospital and the person was not conscious for several days. Even if the insurer paid for the hospital like it was in network, the balance billing could be brutal.

I will say that this year and last year year we have had several instances of out of network providers that we didn't know about. Mostly, it was ER docs or as anesthesiologist or radiologist. It doesn't bankrupt us but it is annoying.

A big issue really is ambulances. They can charge huge amounts and it varies from one ambulance company to another. I saw an ambulance bill that was from a psychiatric hospital transporting someone to ER at another hospital and then there was transport back. One ambulance company going one way was almost double the ambulance company going back. And, the patient has no choice in any of it. And, usually these ambulances are out of network. Maybe the transport to the ER is considered emergency but an insurer might see sending the patient back to the original hospital as a non-covered non-emergency transport. But, the patient actually has no choice in any of this.

Will this bankrupt someone? No. But it could sure be annoying to get a $3000 bill for something where the patient had no choice whatsoever.

The real situations where I could see out of network really bankrupting someone.

1. You think the hospital is in network. You look it up on the website and it says the hospital is in network and you go there and are hospitalized for several days and have major care and it turns out the hospital really wasn't in network. I agree that this isn't real likely, but could happen.

2. The second one is more of a choice but a difficult one. Imagine that you have a life threatening cancer and there is a treatment that is helping you. But, your plan is discontinued at the end of the year and you have to go another plan. The one hospital with that treatment is no longer in network. What do you do?

http://www.houstonchronicle.com/busi...er-6603232.php
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Old 11-08-2015, 11:31 PM   #130
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If I stay with BCBSTX, and accept the Bronze HMO+ plan they want to move me to (from their PPO), then the increase will only be 3.5%.

If I want to stay in a PPO, then I have only one option from Humana, and that increase will be like 56%!

Although - the 2016 price is just very slightly higher than what I paid in 2013 for a PPO when I was in the Texas Health Risk Pool. We've had two years of much lower insurance premiums.

I noticed that in 2014, Humana PPO was about 47% more expensive than the BCBS PPO, so the difference this year compared to last year BCBS PPO is fairly inline, if not even lower considering the typical annual jumps. From 2014 to 2015 my BCBS PPO rate jumped 27%.
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Old 11-09-2015, 12:06 AM   #131
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Statistics can be misleading when the carriers change deductibles/copays/Out of pocket max for a plan. Factor those items in when comparing year over year and I suspect the increases would be much more substantial.
As I understand it, California uses standardized benefit design where these items are all fixed by metal tier. So insurers cannot really play pricing games on these lines. I suppose there could be some price inflation as coveredca may allow copays to increase from year to year but I don't think that could amount to much. My main concern is with shrinking networks which their report did not evaluate.

My own health plan actually saw a 6% decrease in premium despite being a year older. So I'm pretty happy with that. Also some benefits have increased like medical imaging moving to copays instead of deductibles. (I suppose whether this is a benefit or not depends on usage if you max out your deductible.)
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Old 11-09-2015, 07:15 AM   #132
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If I stay with BCBSTX, and accept the Bronze HMO+ plan they want to move me to (from their PPO), then the increase will only be 3.5%.

If I want to stay in a PPO, then I have only one option from Humana, and that increase will be like 56%!

Although - the 2016 price is just very slightly higher than what I paid in 2013 for a PPO when I was in the Texas Health Risk Pool. We've had two years of much lower insurance premiums.

I noticed that in 2014, Humana PPO was about 47% more expensive than the BCBS PPO, so the difference this year compared to last year BCBS PPO is fairly inline, if not even lower considering the typical annual jumps. From 2014 to 2015 my BCBS PPO rate jumped 27%.
BCBS Florida had very similar increases, more than 50% over the 2 years. Humana is closer to 15% here for an equivalent PPO network, it's 2016 premium is about the same as the BCBS premium 2 years ago.

It would help if there was just one risk pool for all their insured in each state.
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