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Old 11-12-2015, 01:11 PM   #41
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Perhaps we need tort reform that eliminates frivolous and time consuming lawsuits while still holding medical professionals accountable for truly negligent and/or malicious behavior.
Apparently, tort and associated costs represent only a small fraction (2.4%) of healthcare costs: Medical liability costs in U.S. pegged at 2.4 percent of annual health care spending | News | Harvard T.H. Chan School of Public Health

I feel for those who are being stuck with higher insurance bills and the promise that you could keep your doctor and health plan was a foolish one to make in light of the the unfettered ability of insurance companies to exclude doctors from their networks and eliminate plans whenever they wished. In context, I suspect what the President was trying to say was that the ACA itself would not be directly dictating which doctor you could see or not see and of course, there was a provision to grandfather many plans. But ultimately, the insurance companies were always going to dictate which plans they would keep and for how long.

In my case, my pre-ACA plan premiums were slightly less than the closest corresponding ACA plan but the deductible was much higher than that for the ACA plan. But I am older and close to Medicare and so the age surcharge for premiums is less than it would otherwise have been pre-ACA.

I'm firmly convinced that a Medicare for all approach would ultimately be best. Insurance companies would be free to peddle their supplement and Advantage policies and everyone would be covered for the basics. My doctor's office would not need employees whose sole function appears to be shuffling the various insurance paperwork and dealing with the nuances of the myriad different policies. Private companies would not need to spend HR resources trying to figure out what insurance to offer at what cost every year.
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Old 11-12-2015, 02:01 PM   #42
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It works out great for many, but people caught just above the subsidy limit are scrambling to afford it.

They figured that it'll cost about $100k to pay for the next 7 years until they're Medicare eligible, so around 15% of gross income. So they're seriously considering just taking the penalty and chancing those years. If something bad happens and they lose everything, they can come stay with me.

I may just stop saving in taxable for ER and pay for the insurance for them.
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Old 11-12-2015, 02:03 PM   #43
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The pre-existing condition inclusion in ACA is very helpful though. With the surgery I had, I never would have been able to get insurance apart from an employer plan.
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Old 11-12-2015, 02:09 PM   #44
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I think we could've done a better job with a lot few pages of paper by just
1) Eliminate the preexisting disqualifier
2) Have the gov't pick up catastrophic coverage for everyone
3) Let everyone decide if they want any other coverage on their own.
That would not have worked because it would have been seen as a "Single Payer" / Government as Insurance Company. The Let 'em Die part would have stomped it. Besides if insurance companies could only charge for selling non-cat polices they wouldn't be able to take in gargantuan amounts of money to "cover" those costs

I did see that exact concept proposed as far back as the 90's to get around the Clinton Plan. There were a couple of Doctor's groups who backed it. The gov is already the backer of all things catastrophic anyway. That's what Gov does in fact. So, add this relatively minor duty to the list and jiu jitsu the whole problem away
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Old 11-12-2015, 02:16 PM   #45
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Our deductible is $10K, out of pocket is $13,900. It's a Bronze HDHP, and it's awful. Nothing even close to what we had with our employer policy. And why? It's the same hospitals, same doctors, same everything. Ugh, makes me absolutely crazy.

We no longer have a health care plan, all we have is a health insurance plan.
True. What you had before with your employer was healthcare, while your Bronze Plan now is health insurance. The difference was your employer subsidized the healthcare part, while you are now on your own. But that has changed with many employers. We have siblings still working, and they complain about their premium going up to several hundreds/month, and their deductible also goes up to a couple of thousands. One can blame that on the cost of healthcare, not on ACA.

By the way, the difference between healthcare and health insurance is the same as the difference between home maintenance and fire insurance. If we want State Farm to also cover our home maintenance cost in addition to the fire hazard, the premium is going to be higher.
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Old 11-12-2015, 02:37 PM   #46
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Count us in as thrilled to have been able to purchase insurance on the exchange. We bought a bronze plan that was HSA eligible.$534/month for four adults (two under 26), $12,500 family deductible.

I told my spouse we were going to roll the dice this year by purchasing the least expensive plan, and we ended up having an out of network event in another state resulting in a hospitalization. Long story short, our insurance kicked in, and we were able to negotiate the out of network charges down by 30% just by asking the out of network hospital billing department for relief.

Yes, after twenty five years of employer sponsored health insurance, paying a monthly premium is something of an annoyance, but the emergence of the ACA enabled us to retire relatively early and with the peace of mind that a hospitalization won't bankrupt us.
One of the things we all really needed... to see what insurance costs. So many people have been paying a small fraction of the insurance cost at their employers plans that most people don't really understand how much is paid in total when the employer's contribution is added to the employee's.
We still need to find out how to make it affordable in general.
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Old 11-12-2015, 02:48 PM   #47
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One of the things we all really needed... to see what insurance costs. So many people have been paying a small fraction of the insurance cost at their employers plans that most people don't really understand how much is paid in total when the employer's contribution is added to the employee's.
We still need to find out how to make it affordable in general.
So true. The way to get the public on board with cost containment is to increase their skin in the game.
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Old 11-12-2015, 02:49 PM   #48
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One of the things we all really needed... to see what insurance costs. So many people have been paying a small fraction of the insurance cost at their employers plans that most people don't really understand how much is paid in total when the employer's contribution is added to the employee's.
It's now a requirement that the cost of employer sponsored health coverage be disclosed annually on the W-2. Box, 12, code DD.

As long as the negotiated prices (between insurance companies and providers) are secret, and the outcome data is muddled or unavailable, we don't stand a chance of getting prices down.
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Old 11-12-2015, 03:06 PM   #49
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Still everyone, rich and not rich, have the nagging prob lem of the unscrupulous sneaking in of the out-of-network maximum-profit-provider personnel if and when one dares to use the insurance.
Yeah, this scares the heck out of me. My insurer, Coventry, sent me a letter a month ago saying that my current coverage was no longer available after 1/1/16 but they sent a link to another Coventry policy I "might like". I checked the coverage summary on-line.

ZERO coverage on out-of-network. (Current policy is 50%- not great but not zero, either.)

This morning I met with an agent and got one with BCBS with a 40% co-pay on out-of-network and a $5K deductible instead of $6200 for a little more money. After 1/1, when the new policy is in effect, I'm sending a blistering letter to Coventry.

I wish the ACA had allowed for more cost transparency. DH is on Medicare and has been going to a wound care clinic weekly to treat a leg ulcer. It's healing nicely and he's just about done, but we have no idea what our share of these bills will be because we haven't seen any claim statements. Scary as heck. Whatever our share will be per visit, multiply that by 10. It won't break us, but it makes it impossible for us to determine cost v. benefit in any medical care decisions.
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Old 11-12-2015, 03:38 PM   #50
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As long as the negotiated prices (between insurance companies and providers) are secret, and the outcome data is muddled or unavailable, we don't stand a chance of getting prices down.
It's not secret.... after the fact.

I have a high deductible HSA plan. As I've mentioned many times- this has been a higher than planned medical year for our family with the various broken bones from sports injuries. I get an EOB every month that shows the "full price" and the "negotiated price". Even though I have Kaiser - which is closed network - so only Kaiser customers use Kaiser doctors - there's still a big difference between the full price and the negotiated price. Fortunately, I only pay the negotiated price OOP till the deductible is met.

Here's an example of the xrays done for younger son's broken elbow:
xray full price: $121
discount negotiated: (-$78)
amount I paid $43.

To restate this. I have a HDHP and the deductible had NOT been met - so I was paying 100% of the owed amount... but that amount was $78 less than it would have been if I didn't have insurance.

(Despite these negotiated rates - I still managed to rack up over $8k in OOP for my kids. They are accident prone.)
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Old 11-12-2015, 03:47 PM   #51
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Employer-subsidized insurance is no longer what it used to be, at least from my former megacorp. Just got my enrollment paperwork for 2016 and the premium is up nearly $100/month to over $400/month and the deductible and OOP max also went up slightly. But compared to what's available out on the market, it's still decent. My big concern is out-of-network as I still travel a good bit and also like the option to go to a specialist not in network. None of the marketplace plans offer out-of-network coverage, and a quick look at ehealthinsurance.com found only one that offers anything more than emergency care.

Dealing with the underlying cost issues in US medical care is way overdue, IMHO.
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Old 11-12-2015, 03:58 PM   #52
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Employer-subsidized insurance is no longer what it used to be, at least from my former megacorp. Just got my enrollment paperwork for 2016 and the premium is up nearly $100/month to over $400/month and the deductible and OOP max also went up slightly. But compared to what's available out on the market, it's still decent. My big concern is out-of-network as I still travel a good bit and also like the option to go to a specialist not in network. None of the marketplace plans offer out-of-network coverage, and a quick look at ehealthinsurance.com found only one that offers anything more than emergency care.

Dealing with the underlying cost issues in US medical care is way overdue, IMHO.
The market place ones... really all plans should offer out of network for emergency care, but they may play games with this. Make sure it is life threatening emergency care. I believe this was an ACA mandate. But some play some games about if it was necessary... or use an observation loophole.
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Old 11-12-2015, 04:28 PM   #53
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Well, that's a little mushy. Let's say I'm traveling and have a closed fracture (no bone sticking out). Life-threatening? Probably not. Resetting it after I've gotten to an in- network facility after it's started to grow back together crooked would be expensive and risky. So what would the insurer say if I got immediate treatment out of network?
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Old 11-12-2015, 04:28 PM   #54
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I recall the "old days" fondly. In 1992 I was diagnosed with hypertension, hospitalized, finally put on meds; my employer provided insurance covered that. My doc had impressed on me how serious this could be by telling me to call his home number if I felt bad. A couple of days later I started feeling bad, numb left arm, pain in chest... A trip to the ER was in order, no heart attack, then. The heart attack came when I received the bill. I'd had a panic attack, my policy had no mental health coverage! Took years to pay that adventure off. No thanks, what we had before didn't work.

The problem is that still could happen... IOW, say you went to an out of network facility and they deemed it not an emergency.... they might not pay it.... now, I could be 100% wrong on this.... but you do hear horror stories....
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Old 11-12-2015, 04:34 PM   #55
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True. What you had before with your employer was healthcare, while your Bronze Plan now is health insurance. The difference was your employer subsidized the healthcare part, while you are now on your own. But that has changed with many employers. We have siblings still working, and they complain about their premium going up to several hundreds/month, and their deductible also goes up to a couple of thousands. One can blame that on the cost of healthcare, not on ACA.

By the way, the difference between healthcare and health insurance is the same as the difference between home maintenance and fire insurance. If we want State Farm to also cover our home maintenance cost in addition to the fire hazard, the premium is going to be higher.

Employer plans can be priced high also... my last companies plan was priced higher than what I can get on the exchange...

I looked at the district where my DW does some sub teaching and the premiums are 1.5X or higher.... now, it was a better plan, but I still think it was higher than a similar exchange plan...


The problem is that health care costs have continued to go up at a much higher rate and someone has to pay for it...
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Old 11-12-2015, 04:40 PM   #56
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Perhaps we need tort reform that eliminates frivolous and time consuming lawsuits while still holding medical professionals accountable for truly negligent and/or malicious behavior.
In Wisconsin we have had tort reform. Here is the result: No Relief | Watchdog Report - Medical malpractice lawsuits plummet in Wisconsin
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Old 11-12-2015, 04:41 PM   #57
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The market place ones... really all plans should offer out of network for emergency care, but they may play games with this. Make sure it is life threatening emergency care. I believe this was an ACA mandate. But some play some games about if it was necessary... or use an observation loophole.
Yes, ACA requires that *legitimate* emergency care (using the "reasonable lay person" standard in most cases) is covered at the same reimbursement rate for out-of-network providers. But the 800-pound elephant in the room is the remaining balance billing which can still happen in most states -- if an insurer will pay (say) $25K for a particular emergency in-network, they also have to pay $25K to an out of network provider. The difference is that the in-network providers would consider that $25K (plus your in-network share) to be payment in full, whereas out of network, you can still be billed many thousands more.
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Old 11-12-2015, 04:45 PM   #58
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Employer-subsidized insurance is no longer what it used to be, at least from my former megacorp. Just got my enrollment paperwork for 2016 and the premium is up nearly $100/month to over $400/month and the deductible and OOP max also went up slightly. But compared to what's available out on the market, it's still decent. My big concern is out-of-network as I still travel a good bit and also like the option to go to a specialist not in network. None of the marketplace plans offer out-of-network coverage, and a quick look at ehealthinsurance.com found only one that offers anything more than emergency care.
Yeah, this is my first FEHB open enrollment and I'm noticing that the premiums are (on average) about 8% higher than last year -- sometimes 20% more, sometimes actually *down* slightly -- but also with higher deductibles and OOP limits in most plans. To me, the main difference is that most of the FEHB plans still have relatively strong PPO networks.

In reality, if I were still fully retired, looking at the HMO-only offerings on the Marketplace might get me interested in dusting off my resume. Yeah, there's that Humana PPO plan that is offered in my county, but over $500 a month just for me is a little steep, especially with no subsidy or tax deduction for the premiums...
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Old 11-12-2015, 04:55 PM   #59
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The market place ones... really all plans should offer out of network for emergency care, but they may play games with this. Make sure it is life threatening emergency care. I believe this was an ACA mandate. But some play some games about if it was necessary... or use an observation loophole.

I can speak to this. In our case, our emergency required care in another state, and the out of network hospital provided care in the ER and in the ICU for six days. I called our insurance company within hours of admission to inform them of the situation, and they assured me that we had coverage.

It sounds silly now to admit this, but I thought that we were required to write a check to our insurance company for the amount of the deductible. It took several explanations for it to sink in that as far as our insurance company was concerned, our deductible had been met. We were responsible for any bills from the out of network provider. So, we waited through several billing cycles to receive our final bill, and just this morning, I called their billing office to see if I could negotiate a cash payment. We settled on an amount that is less than our deductible. Not having ever had to deal with hospital bills before, I was pleasantly surprised at the ease with which this was handled.

I don't know if this is relevant, but our insurer, and the out of network hospital both used Epic software, so we were easily able to transfer records from the out of network hospital to our local health care provider. Amazing.
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Help! My health Ins is about to double!
Old 11-12-2015, 04:56 PM   #60
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Help! My health Ins is about to double!

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In Wisconsin we have had tort reform. Here is the result: No Relief | Watchdog Report - Medical malpractice lawsuits plummet in Wisconsin

The two parts of medical cost I hear about is doctors salaries and malpractice. But they combined are way less than 15% of total healthcare cost. Malpractice was about 3% I believe.... Now defensive medical care used to prevent successful lawsuits I am sure is not part of that though. It is just hard to wrap your arms around the whole wasteful process... I havent...


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