Community Chat

[terrier3]

On 9/21/2014 adelle38 said:

I think that the people in sticker shock either haven't really looked at the final cost or are used to getting free health care subsidies from employers. Employers are taking advantage of the ACA to get out of the health subsidy business and some people are dealing with what the working poor have been dealing with for decades.

Universal Health Care would solve these problems.

I am working seasonally for a health insurance company helping people with these policies.

I have had weeks of training, and they are confusing to us too!

Just last week some of us were saying how much easier life would be for everyone if there was Medicare for all...of course, we would be out of jobs - but it is confusing and overly complicated.

It reminds me of taxes - there are lots of loopholes for companies to find ways to beat the system & make money.

There was a great article in the Times today about doctors allowing other doctors to enter operating rooms and act as assistants - when they are out of network & the patient will have to pick up the full bill. A patient negotiated everything very carefully (so he thought) only to get a bill for over $100,000 from a surgeon who "assisted" his operation - someone he wasn't told about in advance. Since the assistant was out of network - the patient was stuck with the entire bill! Doctors have been found to help each other out this way - since the average ortho surgeon's salary has gone down from $630,000 a year to $590,000 and they are looking to advisors to help them find loopholes to bill more money.

The doctors, hospitals and insurance companies are always looking for an "edge" to increase their compensation - on the average patient's tab!

[adelle38]

On 9/21/2014 terrier3 said:

On 9/21/2014 adelle38 said:

I think that the people in sticker shock either haven't really looked at the final cost or are used to getting free health care subsidies from employers. Employers are taking advantage of the ACA to get out of the health subsidy business and some people are dealing with what the working poor have been dealing with for decades.

Universal Health Care would solve these problems.

I am working seasonally for a health insurance company helping people with these policies.

I have had weeks of training, and they are confusing to us too!

Just last week some of us were saying how much easier life would be for everyone if there was Medicare for all...of course, we would be out of jobs - but it is confusing and overly complicated.

It reminds me of taxes - there are lots of loopholes for companies to find ways to beat the system & make money.

There was a great article in the Times today about doctors allowing other doctors to enter operating rooms and act as assistants - when they are out of network & the patient will have to pick up the full bill. A patient negotiated everything very carefully (so he thought) only to get a bill for over $100,000 from a surgeon who "assisted" his operation - someone he wasn't told about in advance. Since the assistant was out of network - the patient was stuck with the entire bill! Doctors have been found to help each other out this way - since the average ortho surgeon's salary has gone down from $630,000 a year to $590,000 and they are looking to advisors to help them find loopholes to bill more money.

The doctors, hospitals and insurance companies are always looking for an "edge" to increase their compensation - on the average patient's tab!

That is really shocking to me. What recourse do patients have in situations like that?

[terrier3]

On 9/21/2014 adelle38 said:

On 9/21/2014 terrier3 said:

I am working seasonally for a health insurance company helping people with these policies.

I have had weeks of training, and they are confusing to us too!

Just last week some of us were saying how much easier life would be for everyone if there was Medicare for all...of course, we would be out of jobs - but it is confusing and overly complicated.

It reminds me of taxes - there are lots of loopholes for companies to find ways to beat the system & make money.

There was a great article in the Times today about doctors allowing other doctors to enter operating rooms and act as assistants - when they are out of network & the patient will have to pick up the full bill. A patient negotiated everything very carefully (so he thought) only to get a bill for over $100,000 from a surgeon who "assisted" his operation - someone he wasn't told about in advance. Since the assistant was out of network - the patient was stuck with the entire bill! Doctors have been found to help each other out this way - since the average ortho surgeon's salary has gone down from $630,000 a year to $590,000 and they are looking to advisors to help them find loopholes to bill more money.

The doctors, hospitals and insurance companies are always looking for an "edge" to increase their compensation - on the average patient's tab!

That is really shocking to me. What recourse do patients have in situations like that?

The man's insurance company agreed to pay the extra doctor $113,000 (in full). It wasn't the patient's fault.

But the article said that insurance companies are starting to drop doctors from their list of providers for sliding other docs into the operating room (that are out of network & can charge whatever they choose by billing the patient directly). And the insurers are coming down on hospitals that are allowing this practice.

I had a similar (yet less costly) issue when I had hand surgery. The surgeon was in my provider network - so was the hospital. The nurse anesthesiologist (spelling?) at the hospital's free standing surgical clinic WAS NOT. And the person who took the bandage off me & was going to remove the stitches WAS NOT, even though he was part of the MDs group practice.

I refused to pay the nurse's bill - my insurance eventually paid. I also refused to pay when they went to remove the bandage & 5 stitches on my finger - they said it was going to be $700 and I had to pay upfront. My cousin is a PA and she removed the stitches in her kitchen.

[adelle38]

terrier, It seems to me that doctors who try and maneuver should suffer legal as well as financial consequences. I hope these matters are brought to ethics committees and licensing boards.

[brewhaha]

I thought this was going to be about the NFL.

[SoX]

On 9/21/2014 Gooday said:

Our BC/BS is through the City of Chicago. DH is 68 and I am 61. Our current monthly premium s $700.00 a month with a 2K deductible with 80/20 coverage until we make a 2500. out of pocket. Mayor Emmanuel announced last week he wants to raise the premiums 40% for retirees!!!!!! It goes against the Illinois State Constitution but hey...he does not care.

We were together with our retired police friends and when one of them said if you think it's bad now, go to the AHC site and you will really go into sticker shock.

Wow, Gooday, that's really steep ... I'm only guessing here, but maybe it's because you're not eligible for medicare because of your age. Once you hit 62, shouldn't this go down?

[Cakers1]

On 9/21/2014 terrier3 said:

I am working seasonally for a health insurance company helping people with these policies.

I have had weeks of training, and they are confusing to us too!

terrier: I hope you asked many questions - I hope you were thinking outside the box of the scripts that I know reps use. Believe me - I can call my ins.co 5 times and get 5 different answers, and all of them wrong.

It's become so frustrating and I've also noticed the issue with changes in tiers for prescriptions.

[madzonie]

On 9/21/2014 terrier3 said:

On 9/21/2014 Gooday said:

Our BC/BS is through the City of Chicago. DH is 68 and I am 61. Our current monthly premium s $700.00 a month with a 2K deductible with 80/20 coverage until we make a 2500. out of pocket. Mayor Emmanuel announced last week he wants to raise the premiums 40% for retirees!!!!!! It goes against the Illinois State Constitution but hey...he does not care.

We were together with our retired police friends and when one of them said if you think it's bad now, go to the AHC site and you will really go into sticker shock.

The ACA policies are set up to guarantee that not more than 9% of a person or family's NET income will be spent on healthcare.

The ACA pricing might look high, because that is BEFORE the tax subsidy, which varies by income. There is also another form of assistance for people making between 138-250% of poverty level for deductibles and co-pays.

Thank you, terrier3!!

[terrier3]

On 9/21/2014 Cakers1 said:

On 9/21/2014 terrier3 said:

I am working seasonally for a health insurance company helping people with these policies.

I have had weeks of training, and they are confusing to us too!

terrier: I hope you asked many questions - I hope you were thinking outside the box of the scripts that I know reps use. Believe me - I can call my ins.co 5 times and get 5 different answers, and all of them wrong.

It's become so frustrating and I've also noticed the issue with changes in tiers for prescriptions.

My first question for potential ACA customers is "Do you like your current doctor and do you want to keep your current doctor?" That narrows the choices for a lot of people.

I have noticed through personal observation that a lot of people just looked for the cheapest plan, and then got a terrible shock when they found out the cheapest plans have the fewest number of doctors in network and also have the highest deductibles.

Plus, it does look like sticker shock when you just see the medal rates - and don't use the calculator to determine how much you will actually be paying in premiums, deductibles and co-pays.

Too many people stopped at the medal rates and didn't continue the application to find out what THEY would be paying.

[Cakers1]

terrier: Are you working for an insurance company or the Marketplace or both?

You don't have to name the company - just wondering if you are doing one or both.