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Old 04-15-2014, 09:13 AM   #41
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Originally Posted by travelover View Post
I agree, but that needs to be coupled with transparent pricing. This nonsense of in network and out of network providers roulette is just a scam with the hospitals providing cover for the scammers.
I just got off the phone with my insurance company - so frustrating! I got an EOB for an ENT visit where my negotiated rate was only a couple dollars less than the full rate. Recently my son had an appt with a specialist where the negotiated rate was less than 1/2. How can I 'shop around' when I can't find out what things cost. The only way is to have specific codes for specific doctors and then they can look.

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Old 04-15-2014, 09:32 AM   #42
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I hate the idea of more regulation, but perhaps there should be a requirement that the provider tell you what the charges (or at least a range of charges) will be - after your insurance - prior to them performing a procedure.

We already require it for other things... mortgages, financings, some financial products, etc.

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Old 04-15-2014, 09:38 AM   #43
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Ugh! Just got off the phone with the insurance company again with a code this time and a doctor name and nope, I have to download a FORM, fill it out and fax it to them before I can find out any pricing info. That's total BS!
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Old 04-16-2014, 11:34 AM   #44
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While I agree with the PNHP that single-payer is a preferable approach, the OP's source is a "critical from the left" group. Here is a Kaiser Family Foundation explanation of the cost-sharing for premiums, deductibles AND co-pays for lower income Americans which I think is both more clear and a fairer assessment.

In Addition To Premium Credits, Health Law Offers Some Consumers Help Paying Deductibles And Co-Pays - Kaiser Health News

Our max OOP went up $5K while our total yearly premiums dropped $5K. That seems a win to me. Guaranteed issuance for continuous coverage has some drawbacks. (Texas, with it's extremely high rate of uninsurance, is surely not an example of good policy). What happens when you move between states? What happens if you have temporary financial problems and can't afford coverage for a while, etc.? I had a patient who let her COBRA eligibility lapse after she woke up one morning and found her husband lying dead next to her. She became deeply depressed and let everything lapse. Then she was unable to get insurance because of her history of depression.

I had continuous coverage for my auto-insurance before being sent overseas by an employer (to work for the US Army!) and was told that I would have to get coverage from the assigned risk pool due to the "lapse in coverage" until I examined the tiny print on my German policy and discovered that I had unwittingly purchased insurance from an Allstate subsidiary. After that Allstate had a hard time making the claim that I had been uninsured. I have a hard time trusting the good intentions of the insurance industry.

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