SAJ-99
Well-known member
Not to derail the thread, but the first thing I thought of is getting a spam call offering an extended warranty on a knee replacement.
Health Insurance
- Thread starter CiK
- Start date
Irrelevant
Well-known member
Very similar experience as my sister. Only they were able to ambulance them to the nearest children's hospital, but then stayed for 6 weeks. Where they live there's is only one option for health insurance, they had the gold plan. When they were do the hospital sent them a bill for 244k, said it was out of network and not an emergency, since they came from another hospital... they tried to negotiate but there's only payment option was 2 years. Try paying for a house in two years, on top of already paying for a house, and you weren't working for like 2 months. They threatened to take her house. It was incredible scary as our entire family came together to figure out a way to pay it (cough @mulecreek ) as family doesn't let family go broke.
Thankfully randomly they got connect to the hospital CFO through a friend of a friend. He said that's outrageous and revised the bill to 7k. How is that ok, 244k to 7k...
Nemont
Well-known member
Couple of things.
Guaranteed issue individual insurance which is highly subsidized by the government, it is also highly regulated ergo it is also high cost if you don't get the Advanced premium tax credit.
A lot of things could reduce the cost of both care and premiums however it requires either a waiver from the Federal Government (CMS) or to move outside the ACA guidelines and offer non guaranteed plans.
For everyone complaining about their insurance, I wonder how many have taken the time to sit down and read what is actually covered. Like the person who claims the insurance company changed the way colonoscopy's are covered. Willing to bet one was pre ACA and the other post ACA because the policy language was required by the law to change how such procedures were covered. Also your insurance company would have been required to send you a new updated policy containing all of that info and I am willing to bet the pages were never turned to review how things were covered.
This isn't a defense of the insurance companies either. They drive me nuts with the imagining denials, step therapy requirements, changing formularies, narrow networks, per incident charges in addition to your out of pocket max, pick an issue and I deal with daily.
It's insane on both sides of the ledger, from what the companies do to what people expect or don't bother to find out.
Nemont
Guaranteed issue individual insurance which is highly subsidized by the government, it is also highly regulated ergo it is also high cost if you don't get the Advanced premium tax credit.
A lot of things could reduce the cost of both care and premiums however it requires either a waiver from the Federal Government (CMS) or to move outside the ACA guidelines and offer non guaranteed plans.
For everyone complaining about their insurance, I wonder how many have taken the time to sit down and read what is actually covered. Like the person who claims the insurance company changed the way colonoscopy's are covered. Willing to bet one was pre ACA and the other post ACA because the policy language was required by the law to change how such procedures were covered. Also your insurance company would have been required to send you a new updated policy containing all of that info and I am willing to bet the pages were never turned to review how things were covered.
This isn't a defense of the insurance companies either. They drive me nuts with the imagining denials, step therapy requirements, changing formularies, narrow networks, per incident charges in addition to your out of pocket max, pick an issue and I deal with daily.
It's insane on both sides of the ledger, from what the companies do to what people expect or don't bother to find out.
Nemont
Nemont
Well-known member
and if you think it is just the insurance companies raising premiums, think again.
www.cms.gov
Remember almost all reimbursement schedules are based of what Medicare does.
2022 Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts | CMS
On November 12, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2022 Medicare Part D income-related monthly adjustment amounts. Medicare Part B Premium and Deductible
Remember almost all reimbursement schedules are based of what Medicare does.
OntarioHunter
Well-known member
- Joined
- Sep 11, 2020
- Messages
- 5,990
And a normal person is supposed to wade through all that shit? Really?
Irrelevant
Well-known member
People expect...
1. that they are have the ability to purchase a plan to assist with healthcare costs
2. that by paying their premium they will receive some form of equitable value in their health costs
3. that it does not take a law degree to understand, implement, or derive, from #1 and 2.
D
Deleted member 28227
Guest
I know a pile of MDs, DOs, PA, NPs, Nurses... only person I've ever met in the medical community who really had a handle on billing was a hospital patient advocate attorney.
"We are all just trying to make it through the day with a shred of our soul intact." - Could not agree more.
Every issue is nuanced but my anecdotal interjection about American medicine being insane. My mom's total hip which she got while working in Europe (European employer) cost her $0. My uncles in CA cost something obscene, and he is a hospital administrator.
"Oh but the medical quality of ..."
So weird coincidence, my uncles surgeon did his fellowship under my moms surgeon in Vienna.
longrunner
Member
- Joined
- Mar 2, 2019
- Messages
- 77
Little known fact; medical bills are negotiable, most don't know that so never ask. Yes, you can do payment plans. If your out of pocket is substantial and they don't want to play, do minimum payments, set it on autopay and forget it, they may tire of it and write you off at some point.
Nemont
Well-known member
You realize policy language is required to be able to be read at a 4th grade level in most states?
Look I get it the system sucks, trust me I know. Tell me what the American public would accept as an alternative and I will be in your corner
Hydrophilic
Well-known member
Increasing share of Americans favor a single government program to provide health care coverage
63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year.
www.pewresearch.org
TwistedSage
Well-known member
A doctor has never talked cost with me. Do you bring it up to them before you leave or before they leave the room? I was once charged about 350 for a docor to walk into the room and ask if I had any questions after passing kidney stones to which the only question I had was, what's the best way to avoid kidney stones in the future. I definitely would have let the nurse know don't bother had I know it would cost me for him to walk into the room for 5 minutes.
DouglasR
Well-known member
DouglasR
Well-known member
Thanks everyone for the feedback.
Gonna have to sharpen my pencil and do some of that damned thinking stuff.
In my line of work my net income can drift a bit from year to year and it’s kinda alarming how much that can affect the tax credit you receive but whateves
I’ll prob end up picking up one of the policies just so that in the event of a catastrophe I can say
“I was trying to do the right thing!”
Gonna have to sharpen my pencil and do some of that damned thinking stuff.
In my line of work my net income can drift a bit from year to year and it’s kinda alarming how much that can affect the tax credit you receive but whateves
I’ll prob end up picking up one of the policies just so that in the event of a catastrophe I can say
“I was trying to do the right thing!”
DouglasR
Well-known member
1. Sorry for being an immature fool Sunday morning.
2. When I turned 26 and got booted off my moms plan I tried to do the right thing and get insurance.
If I remember correctly I picked up a policy on my bday on April 27th while I was living in the apartment in my dads rig shed.
In august of that year I bought a house and moved out.
Since it was my parents place and I frequently have to go there for work I never changed the address on my health insurance policy and just collected the bill from their mailbox and made the payments.
During the open enrollment for the following year starting in January I changed the address to my new home.
I received a bull for January at my new address.
The bill for February went to my parents house.
I did not receive a bill in March.
I received a bill in April for March and April and promptly paid it.
In may I went to the doctor and upon presenting them with my insurance card I was informed that my policy wasn’t active.
I thought that was weird, but I knew it wasn’t gonna cover the visit anyway so whatever.
Around the same time I received a refund for my March and April bill and a letter saying my policy was cancelled at my new address.
I assumed correcting this clerical error would be quick and painless but boy was I wrong.
I spoke with 3 different agents who told me my policy absolutely would not be reinstated due to me Aca guidelines and me missing a payment by more than 30 days.
Remember that bill for March I mentioned I never got?
Remember how they’re sending bills back and forth to my old address and new one?
After raising 10 kinds of hell on the phone I finally got ahold of someone who would listen and I had to take off work and go show them all the bills I’d saved that had been going back and forth between my old address and new one and finally he reinstated the policy.
He had a sign in his office that said:
-no foul language
-no violence
-no weapons
what a weird line of work to be in. And for the record they never offered to refund January or February so they were gonna pocket that and I’d have to pay the old tax penalty.
After that I heard Dan Pena talking about healthcare on JRE
And decided since I really didn’t have anything to lose I was just gonna roll the dice and go uninsured In the past 5 years of being uninsured the only time I’ve ever wished I had insurance or could go to the doctor is when I passed out after the covid vaccine that I probably didn’t need and suffered serious head and neck trauma.
But I just had to sign the release form and hobble out of the ambulance
Neck still hurts.
Irrelevant
Well-known member
Massive anti trust efforts against health insurance providers.
noharleyyet
Well-known member
Is there some type of supplemental health coverage that covers Tinder activity?1. Sorry for being an immature fool Sunday morning.
2. When I turned 26 and got booted off my moms plan I tried to do the right thing and get insurance.
If I remember correctly I picked up a policy on my bday on April 27th while I was living in the apartment in my dads rig shed.
In august of that year I bought a house and moved out.
Since it was my parents place and I frequently have to go there for work I never changed the address on my health insurance policy and just collected the bill from their mailbox and made the payments.
During the open enrollment for the following year starting in January I changed the address to my new home.
I received a bull for January at my new address.
The bill for February went to my parents house.
I did not receive a bill in March.
I received a bill in April for March and April and promptly paid it.
In may I went to the doctor and upon presenting them with my insurance card I was informed that my policy wasn’t active.
I thought that was weird, but I knew it wasn’t gonna cover the visit anyway so whatever.
Around the same time I received a refund for my March and April bill and a letter saying my policy was cancelled at my new address.
I assumed correcting this clerical error would be quick and painless but boy was I wrong.
I spoke with 3 different agents who told me my policy absolutely would not be reinstated due to me Aca guidelines and me missing a payment by more than 30 days.
Remember that bill for March I mentioned I never got?
Remember how they’re sending bills back and forth to my old address and new one?
After raising 10 kinds of hell on the phone I finally got ahold of someone who would listen and I had to take off work and go show them all the bills I’d saved that had been going back and forth between my old address and new one and finally he reinstated the policy.
He had a sign in his office that said:
-no foul language
-no violence
-no weapons
And for the record they never offered to refund January or February so they were gonna pocket that and I’d have to pay the old tax penalty.
After that I heard Dan Pena talking about healthcare on JRE
In the past 5 years of being uninsured the only time I’ve ever wished I had insurance or could go to the doctor is when I passed out after the covid vaccine that I probably didn’t need and suffered serious head and neck trauma.
But I just had to sign the release form and hobble out of the ambulance
Neck still hurts.
BigHornRam
Well-known member
Trojans.
DouglasR
Well-known member
That’s what the $40 a month guy’s for.
I’m gonna continue seeing him as my primary even after I pick up a policy.
Dudes a doctor with a newborn baby and still went back to the Middle East to run fades like 2 years ago.
Core AF
LousyResident
Well-known member
- Joined
- Sep 19, 2016
- Messages
- 3,104
Just for reference, this is what is available to my family through Healthcare.gov as a self employed guy with a wife and 3 kids. We qualify for just a minimal tax deduction at best.
Firstly, the overall lowest premium plans. Notice the deductibles and out of pocket costs.
Now the lowest deductible plans overall. The nitty gritty shows a lot of co-pays (from a $45 regular doctor visit to 50% for imaging and $3,000/day for hospital stays) and in-network coverage only.
Getting into the "Gold" level plans really gets expensive, probably more than a lot of mortgage payments. Lowest premium first.
And now lowest deductible. There are still a bunch of co-pays here, but they are much more reasonable.
No matter how you slice it, my family ends up out of pocket anywhere from $13,176 to $30,608 just based on the premiums alone (the most expensive plan is not shown above). As a cash payer with two kids in glasses and wife getting orthodontic work we have yet to spend nearly that much in annual medical/dental costs. Now, I know things can happen, but so far we're coming out ahead.
Firstly, the overall lowest premium plans. Notice the deductibles and out of pocket costs.
Now the lowest deductible plans overall. The nitty gritty shows a lot of co-pays (from a $45 regular doctor visit to 50% for imaging and $3,000/day for hospital stays) and in-network coverage only.
Getting into the "Gold" level plans really gets expensive, probably more than a lot of mortgage payments. Lowest premium first.
And now lowest deductible. There are still a bunch of co-pays here, but they are much more reasonable.
No matter how you slice it, my family ends up out of pocket anywhere from $13,176 to $30,608 just based on the premiums alone (the most expensive plan is not shown above). As a cash payer with two kids in glasses and wife getting orthodontic work we have yet to spend nearly that much in annual medical/dental costs. Now, I know things can happen, but so far we're coming out ahead.
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