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03-26-2015 02:25 PM
On 3/26/2015 Westie Mom said:Wow-I thought I was the only one with a problem-our doctor informed us that as of 12/31/14 she was going into private practice (had been a member of a group) and EACH PERSON would be charged $1,500 per YEAR! There are 3 of us-$4500 per year, every year, just seems insane. My husband has good insurance coverage so we typically don't pay even $500 per year for all three of us, if that. She will do "standard" tests, including xrays, in the office and we wouldn't be charged for them. "Other tests" we would have to pay out of pocket. And each office visit is $25. She doesn't want to deal with insurance companies. So we are currently without a family doctor. Has anyone else ever heard of such high charges? We live in NY and I'm not sure if it's just worse here or if the amounts are the same all over.
$4500 is a bargain if it includes everything except for non-standard tests. We pay nearly $11,000 a year in medical insurance and they (the ins. company) still find a way to deny medical charges which we end up paying out of pocket for. I would definitely be willing to pay $4500 and have only major medical coverage through a health savings account.
I'm glad this subject has come up because it helping me to decide exactly what my family needs to do. I'm happy to cut a great deal of insurance expense out of my life if I can. We are going to go with major medical coverage through an HSA and pay cash otherwise (with $ from the HSA). I get my insurance and have the money to pay small medical bills too. At least, if I pay my dr, I know they are getting paid. Insurance nickels and dimes them to death when they have office staff to pay, hundreds of thousands of dollars in student loans to pay, benefits for their employees, and all the rest of the baggage that goes along with having a practice. And if any of you have had to appeal a claim to an insurance company, you come to soon realize that they are like terrorists or the gestapo. The less I have to deal with them, the better off I will be.
03-26-2015 02:28 PM
On 3/26/2015 1978christian said:On 3/26/2015 ChynnaBlue said:On 3/26/2015 1978christian said:On 3/26/2015 VaBelle35 said:But you can keep your doctor. You pay cash and you are reimbursed the out of network rates.
Which would be more than what I would pay with a PPO. We already pay over $1600 a month for insurance through my husband's union and you can't opt out.Wow... that's your real problem. Why can't you opt out? You could probably get a cheaper plan through the ACA. My insurance is through my company and my annual cost is $572.
My husbands union has a healthcare package in his contract that includes dental, vision, and medical. So much per hour is deducted from their hourly wage to go toward health coverage. It is part of their package in their contract.
I also have a healthcare package (non-union) from my company and money comes out of my paycheck to cover it. Health, dental, and vision amount to under $800 annually for me alone. If I added another person, it might come out to $1600 a YEAR, not a MONTH. If anyone is paying $1600 a MONTH, that seems like it's not a very good deal and I would definitely lodge a complaint against any union that locked me into that deal. (And, though I'm not in a union, I'm a pro-union person - I'm just not pro-getting-shafted-by-your-union.)
03-26-2015 02:35 PM
On 3/26/2015 ChynnaBlue said:On 3/26/2015 HappyDaze said:On 3/26/2015 jaxs mom said:On 3/26/2015 HappyDaze said:On 3/26/2015 Tinkrbl44 said:Uh, people ....... This ISN'T about the ACA.
I read the OP's comments twice, and her MD is opting out of ALL PPO insurances, because of the insurance companies' actions and delays. That's not Obamacare.
I also agree with the other poster that said $1600 a MONTH to insure two people is BEYOND STUPID ...... and not being able to opt out? Yikes!
If it were me, I'd call the State Consumer Affair regulators and lodge a complaint!
Is it really necessary to call someone stupid?
It seems to me she is calling the union stupid because they are the ones providing the 1600 a month insurance and requiring union members to carry it.
well, if that is the case then I apologize. It came across like she was calling the poster stupid for paying that amount. I hope you are right.
Both posters were very clear that the OP could NOT OPT OUT of the $1600 cost and the poster who said that it was "beyond stupid" suggested the OP file a claim. That tells me that the person calling the policy stupid, not the poster. And I wholeheartedly agree with her - that's a ridiculous policy.
WHOOPS ..... My apologies for the confusion! .... I wasn't calling the OP stupid .... just that the union did a HORRIBLE job negotiating health insurance rates, and then expecting the union members to go along with it ..... maybe that's why they can't opt out, because someone really screwed up the negotiations.
Again, sorry!
03-26-2015 02:35 PM
On 3/26/2015 Icegoddess said:On 3/26/2015 jackthebear said:On 3/26/2015 Icegoddess said:Not defending the insurance companies because I think they are a lot of the problem, but the ACA tells the insurance companies all sorts of things they MUST cover that maybe they weren't covering before depending on what plan you have. I have no need for pediatric or obstetric coverage (including pediatric dental and optical) but it must be included in my plan. Yet, I have to get separate plans for dental and optical for myself (and they aren't any good anymore). Also, remember the insurance companies are having to cover all those people with pre-existing conditions so those of us that are healthy are subsidizing the coverage for those that have a lot of expenses.
My daughter has run into this issue with her son's ADHD doctor changing over to cash only.
I don't have a huge issue with the dental coverage being mandatory, as there are kids who don't get to the dentist at all, and good teeth are very important.
And as for dental and optical insurance we have never had any.
I don't have children at home, so I don't see why I need pediatric dental or optical. I also don't need obstetric care but have to have that too.
Completely agree. Why single men and post menopausal women are required to have policies that cover treatments that they will never need is beyond me.
03-26-2015 02:36 PM
I experienced the "cash only" practice with a doctor more than a decade ago, so this is not a new thing. This doctor specialized in natural hormone replacement and she was the only one in my immediate area. I used her services for the hormone replacement as well as routine pap smears, etc. Her charges for routine services were always competitive with other doctors in the area. To make it easier for her patients, her staff prepared all of the paperwork that I had to send to the insurance company. All I had to do was sign the paperwork and mail it. I always received a reimbursement check from the insurance company within 2 weeks -- amazing! I was fortunate to have the cash to pay up front, but I realize for many patients that's just not feasible.
03-26-2015 02:38 PM
On 3/26/2015 Chrystaltree said:Your doc isn't dumping you, she's dumping the insurance companies and it has absolutely nothing to do with the Affordble Care Act. This might be new to your area but it's been happening elsewhere for several years now. Some call them boutiqe practices. Physicians have fewer patients, they can spend more time with each patient and what care or tests or surgeries they order don't require authorization from an insurance company. Insurers have made it difficult for physicians to do what they were educated to do, care for their patients. There are thousands of rules and books of paperwork; audits; payment reductions. So some doctors have decided that it's easier for them to opt out agreements with insurance companies. I think this trend will grow. You can stay with your doctor as a self pay patient. Call your insurer and ask them how to submit a claim for reimbursement; make sure you request the proper forms for reimbursement and make sure you understand....really understand the process for reimbursement. You can also find a new doctor; a 3-4 month waiting list isn't such a long time to wait at all. I've been with the same physician group for 30 years and I have to wait that long for routine or yearly physicals.
I agree. I live in a city with a population approx 400,000 and we have a few of these "boutique" practices. Some call themselves Concierge Medicine.
My suggestion is, you make that appointment with the new Dr 3-4 months out. Didn't your Dr give you some kind of notice ahead of this? See your Dr one more time, make sure you have adequate medications/refills to see you through the wait. Once you get established with the new Dr, you will probably find the waiting time less. New patients are last priority in a busy practice.
As to your insurance premiums and your inability to opt out....I have to question that.
03-26-2015 02:40 PM
On 3/26/2015 Westie Mom said:Wow-I thought I was the only one with a problem-our doctor informed us that as of 12/31/14 she was going into private practice (had been a member of a group) and EACH PERSON would be charged $1,500 per YEAR! There are 3 of us-$4500 per year, every year, just seems insane. My husband has good insurance coverage so we typically don't pay even $500 per year for all three of us, if that. She will do "standard" tests, including xrays, in the office and we wouldn't be charged for them. "Other tests" we would have to pay out of pocket. And each office visit is $25. She doesn't want to deal with insurance companies. So we are currently without a family doctor. Has anyone else ever heard of such high charges? We live in NY and I'm not sure if it's just worse here or if the amounts are the same all over.
My doctor changed over to concierge service (MDVIP) a couple of years ago. I pay $1500/year for it. For that I get a full physical every year and then only pay a copay for office visits and any labwork I have done which I can file with my insurance company. My deductible is $6000/year and being healthy I wouldn't ever meet that without a major medical event anyway. My insurance premium is $1500/month. I don't exactly understand why, but having a HSA is why the premiums and deductible are so high. That does not include dental or optical.
03-26-2015 02:42 PM
On 3/26/2015 Tinkrbl44 said:On 3/26/2015 ChynnaBlue said:On 3/26/2015 HappyDaze said:On 3/26/2015 jaxs mom said:On 3/26/2015 HappyDaze said:On 3/26/2015 Tinkrbl44 said:Uh, people ....... This ISN'T about the ACA.
I read the OP's comments twice, and her MD is opting out of ALL PPO insurances, because of the insurance companies' actions and delays. That's not Obamacare.
I also agree with the other poster that said $1600 a MONTH to insure two people is BEYOND STUPID ...... and not being able to opt out? Yikes!
If it were me, I'd call the State Consumer Affair regulators and lodge a complaint!
Is it really necessary to call someone stupid?
It seems to me she is calling the union stupid because they are the ones providing the 1600 a month insurance and requiring union members to carry it.
well, if that is the case then I apologize. It came across like she was calling the poster stupid for paying that amount. I hope you are right.
Both posters were very clear that the OP could NOT OPT OUT of the $1600 cost and the poster who said that it was "beyond stupid" suggested the OP file a claim. That tells me that the person calling the policy stupid, not the poster. And I wholeheartedly agree with her - that's a ridiculous policy.
WHOOPS ..... My apologies for the confusion! .... I wasn't calling the OP stupid .... just that the union did a HORRIBLE job negotiating health insurance rates, and then expecting the union members to go along with it ..... maybe that's why they can't opt out, because someone really screwed up the negotiations.
Again, sorry!
I still doubt they could put in their contract they cannot opt out though. I would think that would be against the law. DH is in the same type situation with the Union but not getting ripped off. They have to take the Ins. they give them in their contract but they can opt out if they can prove they have Ins some place else.
03-26-2015 02:50 PM
My husband opted out of insurance participation 5 years ago because he saw the writing on the wall. He didn't want the government and other third parties dictating the kind of medicine he practiced. With the roll out of the ACA has come a slew of new regulations---not the least of which is EMR and meaningful (we call it "meaningless") use--which simply put is the government telling us what is 'important" to document in the electronic record. Add to that the never ending paperwork, prior authorizations for even the most common medications, etc., etc., and more and more physicians have finally had enough. I remain employed part-time and my husband just shakes his head at the mound of extra work heaped on me by new regulations.
"Boutique" medicine is an antiquated term. These practices have been around for a long time and typically have very expensive fees associated with them. My husband's practice (more commonly called a DPC model---direct primary care) has grown substantially with the roll out of the ACA and the addition of very high deductible plans. Patients have to pay cash until they meet their deductibles, which in some cases can be as high as $12,500 a year. His fees for a family of 5 comes out to about $1500 a year. There are no co-pays for office visits and it includes an annual comprehensive exam. Best yet he has TIME to spend with his patients---his appointments are 30 minutes long. Sometimes longer. Most hospital employed physicians have quotas they must meet now---some being forced to see as many as 8 patients an hour. That's not medicine. That's an assembly line. And most importantly he doesn't have government intrusion and non-physicians dictating to him what he has to do. It's like the good old days---he provides quality care at an affordable price----and there are only two people in the exam room, the patient and him. Not the government. Not third party billers.
03-26-2015 02:51 PM
We have many docs in our area going to the cash deals. Pathetic, that they felt a need to do that. I had the most perfect insurance before it got messed up. I have to pay all kinds of costs I didn't before. Mad as heck at the people who voted for this nightmare.
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