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No health care for you! Come back one year...
Old 07-07-2009, 01:51 PM   #1
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No health care for you! Come back one year...

I got the results back on my application for a family high deductible/HSA plan today.

DD: Accepted
DW: Denied
Mine: The dog ate it?

So, DD is covered by a family high deductible plan, the wife isn't, and they lost my application. Uh huh. And all three of us applied on the same online form.

It looks like we'll be stretching the old COBRA out to the maximum (I can get a total of 36 months, with 20 remaining), after which we'll be eligible for HIPAA coverage. Then again, if we can manage to just not need any medical services for the next 1 1/2 years, we may be in a position to be approved next time we apply.

Or perhaps the Distinguished Congresscritters and Senators will come up with an exciting new plan while we wait. I'm not holding my breath, though.

And the ER healthcare adventure continues...
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Old 07-07-2009, 01:53 PM   #2
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Ouch. Keep your DD healthy so she can nurse you and DW when you are sick.
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Old 07-07-2009, 01:57 PM   #3
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I'm sorry about the denial. Weird about your application. How long did it take for them to get back to you?
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Old 07-07-2009, 02:06 PM   #4
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I wrote 3 different representatives in my State today.
I keep hoping something good will miraculously appears out of all the legislation. I'm not necessarily even a liberal person but I need good health care for my family in retirement. I would guess everyone on this board would be happy with good coverage at a better price.
I keep beating the drum and waiting,
Steve
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Old 07-07-2009, 02:24 PM   #5
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I wrote 3 different representatives in my State today. I keep hoping something good will miraculously appears out of all the legislation. I'm not necessarily even a liberal person but I need good health care for my family in retirement. I would guess everyone on this board would be happy with good coverage at a better price.
I keep beating the drum and waiting,
Steve
Good for you, Steve. Keep writing, and I hope others do, too. At this point it is not a liberal v. conservative matter - there is a great deal of cross-over on all the basic issues..

Even if it's only 1 sentence: "Regarding health care reform, I strongly favor universal access with no underwriting."
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Old 07-07-2009, 02:24 PM   #6
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Luckily my wife was denied for family high-deductible HSA. I say "luckily" because if she'd been accepted, we'd have had a combined $7,000 deductible rather than my $3,500 deductible and her $5,000 deductible. Also, on my HSA I can deduct her expenses anyway.

So, be careful what you wish for and read the fine print.
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Old 07-07-2009, 03:16 PM   #7
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We have a $10,000 annual deductible HSA for us and a 20-yr old son still in college. We are all healthy and are taking no medication. Yet, they kept raising our premium and sent letters saying the adjustments were for the entire group and not just for us. Good grief! And now, people are saying that in places like Anchorage, you can't get doctors to accept Medicare either.

So far, we have not cost them a penny. The only thing they have done for us is to get us negotiated group rates for exams, blood tests, and colonoscopy, etc...

Now, why are the health care providers setting higher rates for people who pay cash without health insurance? Why do I have to pay the insurance company for Mafia-like protection?

So, early or late retirement, most people will not have coverage when they detach themselves from a megacorp. Might as well do it early when you still have your health to enjoy what's left of your life. Medical care is overrated. There, I have said it.
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Old 07-07-2009, 03:41 PM   #8
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[quote=Now, why are the health care providers setting higher rates for people who pay cash without health insurance? Why do I have to pay the insurance company for Mafia-like protection?
[/quote]

NW:

You hit it right on. This is legalized highway robbery. We need reform now.
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Old 07-07-2009, 03:43 PM   #9
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I'm sorry about the denial. Weird about your application. How long did it take for them to get back to you?
Three weeks. Just long enough that the minimum three weeks to be allowed for a reassessment runs past the 'start of coverage' date.

I'm trying to get the appeal for reassessment together, but realistically I will almost certainly be canceling the new policy and applying for the COBRA extension.
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Old 07-07-2009, 04:33 PM   #10
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The whole situation is obscene. Providers are raising fees because of diminishing collections based on managed care, medicare and medicaid as their own office and hospital expenses rise like crazy. The burden of caring for the un- or underinsured is crushing many facilities. There is some greed on the provider side but most of it is reactive to the external pressures.

We are witnessing a system which is circling the drain.
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Old 07-07-2009, 09:13 PM   #11
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How in the world can the insanity continue? Small and large firms can't afford to cover workers any longer. The slightest incident and private coverage will be denied or rated. In our case to prepare for ER we've been on private High Deductible coverage now for 5 years with $3600 family coverage + HSA. One college daughter included. Now..in 5 years our premiums have gone up over 50% and we've only once been over the deductible due to a kidney stone incident. Now...premiums keep going up and "discounts" for network providers go down...we can always raise the deductible if it gets too high with the premiums. This whole set up was calculated to save on taxes and to be "independent" as we eye ER and needed coverage before age 65. Will we be able to afford it going forward We need a solution and alternative now...support the efforts of the administration to truly make something happen.
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Old 07-07-2009, 11:20 PM   #12
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How in the world can the insanity continue?
As long as they want.
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Old 07-08-2009, 06:48 AM   #13
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I think the thing that got me fired up enough to write was the lobbyist crap that appears to be going on. The legislators are more worried about the campaign contributions and back scratching than the people that vote for them.

With that said mind you, I really don't want to see my future doctor office visits looking like things I've seen in some community welfare clinics. Where a person doesn't even feel safe in the crowd. So like others have pointed out we need to be careful about how far this thing goes.
Surely there is a good balance somewhere in this?
What happened to the thing about getting the same coverage that Congress has? Remember back when the health care reform first started being talked about in the media? I haven't heard a thing about that in a while.
Steve
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Old 07-08-2009, 10:28 AM   #14
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As long as they want.
More accurately, as long as the campaign contributions hold out.

The current model is fairly profitable for insurance companies. Group insurance as provided by employers presents little risk for the insurers, as the typical large company (the bulk of the providers of employee healthcare) self-insures, with the insurance company providing processing and payment services for a cut of the action.

Large employers pay, and pay some more. Independents, contractors, and us FIRE types pay, and pay, and pay, with insurers cherry-picking the 'eligible', and rejecting the rest to go uninsured or join the state high-risk pool.

Hey, want a laugh? Two of the four items used to disqualify DW:

* Hospitalization and/or outpatient or skilled nursing care within the last 12 months. (Yes, she had outpatient treatment.)

* Sought treatment in a medical professional's office within the last 12 months.

The other two items are personal, but appear bogus. We're going to try to avoid seeing a doctor for the next 13 months, and apply again.
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Old 07-08-2009, 01:39 PM   #15
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How in the world can the insanity continue? Small and large firms can't afford to cover workers any longer.
This may be a big driver of real reform. My employer is smallish professional services consulting firm (under 50 employees). The president is a staunch conservative. But in talking to him about our investments earlier this week, he has come around to the conclusion that something is broken in our health care system and something should be done at some point. Our company health insurance premiums keep rising dramatically every year. In an effort to combat increases in premiums to employees and the firm, the deductibles and copays have been going up every year and coverage is getting thinner. Family coverage costs our lowest paid employees 1/3 to 1/4 of their salary. The median employee would pay around 20% of their salary to pay for family health insurance.

I don't know how firms with lower paid employees are able to provide insurance at all since it would be an even greater proportion of their salary. Maybe that is why more employers are dropping coverage??

Eventually the business community will lobby for true reform and the small business owners will get behind it too. As the market fails more, there will be more people seeking change.
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Old 07-08-2009, 03:40 PM   #16
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The whole situation is obscene. Providers are raising fees because of diminishing collections based on managed care, Medicare and medicaid as their own office and hospital expenses rise like crazy.
The amazing thing is I've seen what my insurance pays for treatment and compared it to the original fees submitted by the doctors. The insurance company receives about a 55% discount. From what I've read here Medicare/caid have extremely low payouts. I would think a 55% discount is a very good price. From what I've seen of the payments given to the doctors from my insurance, they seem reasonable to me.
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Old 07-08-2009, 03:50 PM   #17
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I do have had similar issues. BSBC rejected me because I had one high blood pressure reading, 142/85, at the doctors office. Comment was that I had to have no reading above 120/80 ever!! Said I was a risk even though the only thing I do is go for a yearly exam, and I take no drugs. Am 56.

If it is not too personal, can you tell us what insurance company rejected your DW and lost your application. Just want to make sure, when I try again, not to use that one.

Thanks
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Old 07-08-2009, 03:51 PM   #18
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The amazing thing is I've seen what my insurance pays for treatment and compared it to the original fees submitted by the doctors. The insurance company receives about a 55% discount. From what I've read here Medicare/caid have extremely low payouts. I would think a 55% discount is a very good price. From what I've seen of the payments given to the doctors from my insurance, they seem reasonable to me.
You've got it right. There are at least two ways carriers use to determine payment. One is a discount on "usual and customary" though they determine what that means. Then they slash at it and profile your practice. To see $100 on a service, you almost have to charge $200, and the spiral continues.

The other is by binding you to a proprietary fee schedule that you agree to accept (in return for acces to large patient panels), even though it is lower than your usual fee. Generally you are not allowed to charge medicare patients a different fee from the fee you charge everyone else. Fair enough, but now you have to charge your "usual" MC fees knowing you agreed to a lesser amount with another carrier. The difference gets written off; sometimes the patient gets a notice from the insurance company stating that your fees exceed "usual and customary" which creates an image problem.
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Old 07-08-2009, 04:05 PM   #19
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I got rejected for a high deductible HSA plan and I didn't even get a reason. I just got charged a buck a page to send over the medical requires. Fortunately for me Kaiser is pretty affordable $185/month so I am sticking with them.
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Old 07-08-2009, 04:26 PM   #20
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The amazing thing is I've seen what my insurance pays for treatment and compared it to the original fees submitted by the doctors. The insurance company receives about a 55% discount. From what I've read here Medicare/caid have extremely low payouts. I would think a 55% discount is a very good price. From what I've seen of the payments given to the doctors from my insurance, they seem reasonable to me.
55% sounds about right on average. The small stuff like a regular dr's visit or physical typically gets paid a little higher from what I have seen, but big stuff like hospital stays, obgyn baby delivery, radiology/ultrasound, and lab fees were paid at more like 25-35% of the actual charges. It is amazing when a $600 ultrasound turns into a $105 charge. Or $250 in routine labwork along with a physical turns into $18. As consumers we would be getting screwed big time without an 800 lb insurance company setting the billing straight. I know the dr's have to do this to make an honest buck.

And after seeing what a relative pittance they get after all the hoops they must jump through, I have no problem paying the full $50-75 out of pocket through my high deductible plan. Heck, I can't hardly get an appliance repairman, handyman, electrician, HVAC tech, or plumber to see me for that amount of money, let alone actually do anything.

I wonder what the typical average aging of collections is for GP medical practices? 100 days? 150 days?
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