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Old 11-22-2014, 07:46 PM   #21
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I'm in process of shopping for health insurance for the two of us on the exchange and the HMO policy that I'm looking at covers out of network urgent care and emergency services with the same copay as in network. All of our doctors, specialist and facility are in network but no other out of network services are covered.

So if traveling anywhere in the US we're covered for emergency and urgent care but if we have to cross the border into Canada that is a different story. Although when some friends needed emergency care while visiting Toronto a few years ago they received it free of charge and were never billed for it.

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Old 11-22-2014, 08:30 PM   #22
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Originally Posted by papadad111 View Post
This is very complicated.

What a messed up system.

So much for universal health care.

God damn you , ACA.
Yeah. It was so much simpler when I was simply turned down for insurance.

(High risk pool? First, go without insurance for six months. Then, apply for the waiting list. When enough enrollees pass...)

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Old 11-22-2014, 08:39 PM   #23
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Originally Posted by Brat View Post
What we have is health insurance, not universal health care. I agree that a single payer system would be a whole lot easier but our citizenry isn't ready for that. I think we got what was do-able, nothing more.
Health insurance and universal care are 2 distinct issues. Switzerland and Netherlands are private HI-based systems which are generally rated very highly in care delivery.
In Switzerland, A Health Care Model For America? : NPR

In fact, earlier this Fall the Swiss overwhelmingly voted AGAINST a shift to single payer HC.
Swiss voters reject shift to state-run health insurance - Business Insider

Even in the progressive (liberal) Commonwealth Fund's latest ranking of HC systems of 11 wealthy nations, the top 2 (UK, Switzerland) and bottom 2 (Canada, US) were evenly split between single-payer and private HI systems.

It is execution, not type of HC system, that matters.
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Old 11-22-2014, 09:12 PM   #24
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Originally Posted by Helen View Post
You might be right on this, but it really ticks me off that I have to pay a monthly premium and high deductibles and still not be covered everywhere in the US.

I'm struggling with this right now. An advantage of going on Kaiser is that if I am here in Portland I know that all the services will be in the network. If I go on a PPO, I don't know if all the services provided will be done in network. And, the PPOs that I have found that have extensive networks don't see that extensive when I look into them.

I'm thinking my two choices are Kaiser or a policy that puts a cap on out of network care.
One of the benefit changes I had for 2015 was that if my in-network provider somehow screws up and gets me an out of network provider (an anesthesiologist for example), I was no longer going to be charged a $500 fee and balance billed. I would be covered as if they were in network. I presume the ACA made them do that and your available health plans may do the same. That is a nice "gotcha" to get rid of, though my docs managed to avoid any problems previously.
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Old 11-24-2014, 03:00 PM   #25
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I was with a mega corp and that insurance covered me globally due to very frequent overseas travel. Was I think Aetna Global.
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Old 11-24-2014, 04:12 PM   #26
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Originally Posted by ERhoosier View Post
It is execution, not type of HC system, that matters.
Yep. And since big business has such influence here in setting the rules, and the most of the common folk who need to wade through this crap are in "safe seat" districts, well, you get the idea. I'm not holding my breath for it to get better any time soon. And yes, it was even worse before PPACA.

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