Glad to have Health Insurance

[eytonxav]

In Dallas they go to the County Hospital who can't turn anyone away and the rest of us pay for them thru Hospital District taxes on our property tax bill.

I would also add that cost of medical insurance in Texas is among the most expensive in the nation since you end up subsidizing the free loaders.

 

[ziggy29]

This talk kind of makes me want to get a policy with no lifetime limits .

The policy I have now is only a measly $5 Million limit.

I thought these lifetime caps were abolished under PPACA, no?

 

[bUU]

Under the law, lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed on or after September 23, 2010.

Lifetime & Annual Limits | HealthCare.gov

 

[Mulligan]

I thought these lifetime caps were abolished under PPACA, no?

My individual plan is grandfathered in. My max limit is $7 million. Seeing the projected insurance premium costs under the new mandated guidelines coming next year, they will have to pry this grandfathered plan policy from my "cold, dead hands" Of course,the only thing I can control is making sure I make the monthly payment. I would assume, however, it is of benefit to the insurance company to keep a healthy, underwritten group of people under their control with a lifetime cap limit to protect themselves, also.

 

[bUU]

And, of course, if you ever do hit the lifetime cap, you can just dump the then-worthless policy and go to the health exchange to find a worthwhile policy that will cover your pre-existing conditions, and without any lifetime cap.

 

[Mulligan]

And, of course, if you ever do hit the lifetime cap, you can just dump the then-worthless policy and go to the health exchange to find a worthwhile policy that will cover your pre-existing conditions, and without any lifetime cap.

I hadn't actually thought about that. But if I have the need for more than 7 million dollars of medical care, I don't know if I want to be around for "added bonus coverage" . But then again, I have been fortunate enough to where a person making minimum wage could have paid for all the medical care I have received since I left the hospital at birth, so I haven't actually been involved much with the highly inflated cost of medical care.

 

[ERhoosier]

In practice, bicker is correct. ER's have become the 'primary care doc' for much of the un/under-insured in the US. It's not only liability concerns, but also that many come in to ER's claiming to have HI but not their insurance ID cards. Treatment is given & HI followed up later by billing dept. Sometimes folks are found to have HI or Medicaid eligibility, but often not. Some with HI also do not pay their deductibles &/or co-pays. This overhead has to be recovered somehow, and that is by higher charges for paying patients.

The actual interpretation of "grandfathering" under ACA may not be as iron-clad as it is being presented by some in the press. All still must have a "Qualified" HI plan. Courts are already weighing in on whether existing HI must be compelled to cover certain ACA mandated items (e.g. "morning after" birth control)-

Atty: Hobby Lobby Won't Offer Morning-After Pill - ABC News

No reason this stance might not be applied to other issues like life time caps, etc. Have to wait & see.

To OP- Glad things turned out OK.....and that your HI worked for ya.

 

[Midpack]

My individual plan is grandfathered in. My max limit is $7 million. Seeing the projected insurance premium costs under the new mandated guidelines coming next year, they will have to pry this grandfathered plan policy from my "cold, dead hands" Of course,the only thing I can control is making sure I make the monthly payment. I would assume, however, it is of benefit to the insurance company to keep a healthy, underwritten group of people under their control with a lifetime cap limit to protect [-]themselves[/-] other policyholders, also.

FWIW...

 

[easysurfer]

I thought these lifetime caps were abolished under PPACA, no?

I think maybe for future policies but not for existing ones.

I had a similar thought when I went for my colonoscopy at 50. I thought with the PPACA that procedure was covered. But after calling my insurance company, that doesn't apply for my current policy since at the time of the contract, that procedure is not covered. (Yet, like the OP's note, the cost was negotiated down pretty much so the cost wasn't that bad after all). I was given the option to get a plan that covers it, but then I'd have to be underwritten again, plus, my next one isn't due until 10 years from now. Plus, before then, I would have to option to go the PPACA route. Having options is not a bad thing

 

[eytonxav]

I suspect that insurance companies claim some denial or carveout in benefits is due to ACA when its to their advantage, but will say it doesn't apply to your policy when it is not to their advantage.

 

[okapi]

In Israel people all get healthcare but different levels for different folks.Germany and Canada spend half that we do.People I"ve talked to from other countries are fine with there healthcare.I do not listen to cable news drama about death panels etc.This nation truly needs to have a grownup discussion on healthcare.

 

[Midpack]

In Israel people all get healthcare but different levels for different folks.Germany and Canada spend half that we do.People I"ve talked to from other countries are fine with there healthcare.I do not listen to cable news drama about death panels etc.This nation truly needs to have a grownup discussion on healthcare.

It's not just Germany and Canada, it's basically ALL other countries...many are less than half. And most other countries have better medical outcomes as well...

 

[haha]

In Israel people all get healthcare but different levels for different folks.Germany and Canada spend half that we do.People I"ve talked to from other countries are fine with there healthcare.I do not listen to cable news drama about death panels etc.This nation truly needs to have a grownup discussion on healthcare.

Not sure why that would happen. We don't have grownup discussions about anything else.

IMO, nothing reasonable will ever happen until we have truly hit the wall, and have suffered major damage damage that affects all sectors of the population.

Ha

 

[wanaberetiree]

I would change the title to say "So un-Glad WE have such Health Insurance"

 

[Khufu]

So, for those who do not have insurance, do they simply walk away without paying? What would happen then?

A lot of them die.

Harvard study finds nearly 45,000 excess deaths annually linked to lack of health coverage | Physicians for a National Health Program

 

[palomalou]

I want an answer too.
And why do the medical providers agree to accept an insurance payment much lower than their original bill. Could it be that the bills were inflated in the first place?

This. So nobody else is paying, IMO. But even those "negotiated" prices are inflated to pay for those who cannot. Not saying this in anger, just sayin'.

 

[bUU]

I don't think it makes sense to put the costs of providing service to people who cannot pay on the people who provide the service. Should we expect the tollbooth attendant to pay tolls for the cars that roll up to the booth without any cash in them?

 

[photoguy]

I don't think it makes sense to put the costs of providing service to people who cannot pay on the people who provide the service. Should we expect the tollbooth attendant to pay tolls for the cars that roll up to the booth without any cash in them?

Well in the longer term everybody else pays due to higher rates because of the increased cost of doing business.

 

[bUU]

Yes.

 

[ERD50]

I don't think it makes sense to put the costs of providing service to people who cannot pay on the people who provide the service. Should we expect the tollbooth attendant to pay tolls for the cars that roll up to the booth without any cash in them?

The difference is, there is a law that says people can't be turned away for emergency treatment - so somebody has to pay.

The tollboth attendant can say - sorry, no admittance.

-ERD50

 

[bUU]

I'm not sure I understand why that makes a difference, i.e., why the law should place an expectation on those who provide service to cover the cost of the service. I think, in that regard, the two scenarios are the same.

 

[photoguy]

Well if it's not the provider who pays directly (as a cost of doing business) then it would be the government. But single payer is a non-starter in the US and increasing the amount of government funded healthcare is incredibly difficult (e.g., fight over PPACA).

I guess now with essentially mandatory coverage (and insurance rebates for low-income folks), this scenario should happen less.

 

[Meadbh]

The reason why hospitals and providers have to build in an allowance for unpaid accounts receivable is that many people present for health care as an emergency when there is no opportunity to check their financial ability to pay before beginning treatment. There are ethical issues why they cannot be turned away. The extra cost is built into hospital budgets and inflates your health care costs.

 

[bUU]

There are ethical issues why they cannot be turned away.

Legal issues, as well.

 

[MichaelB]

Legal issues, as well.

Please provide a snippet or summary of the link so members don't have to open it to find out what it is.