Consumer victory thanks to ACA

[EVT1]

healthaffairs.org/blog/2012/02/10/new-transparency-rules-for-health-plans-a-huge-win-for-consumers/

About damn time. Anyone have a problem with this onerous provision of 'obamacare'?

[Savoir Faire-Demogague in NJ]

A few years ago while self employed I acquired health coverage via an online web site that layed everything out side by side with numerous offerings.

Pretty simple stuff.

[rockon]

Hopefully this is one good aspect of this unpopular bill. With 2700 pages of stuff it seems there should be a couple good things in there somewhere if anyone finishes reading it. Maybe some damm republican slipped it in there when Pelosi was sleeping. To bad they didn't use this idea when they were writing the bill.

[workpublic]

ehealthinsurance.com

you'll still need a phd in contract law to understand how your policy works and whats covered and what's not and how it is or isn't. and your monthly payment will still increase in double digits % each year.

[Savoir Faire-Demogague in NJ]

Feb 10, 2012 15:15:37 GMT -5 workpublic said:

ehealthinsurance.com

you'll still need a phd in contract law to understand how your policy works and whats covered and what's not and how it is or isn't. and your monthly payment will still increase in double digits % each year.

One still must read and understand their health insurance, even if you get the benefit at your employment.

[EVT1]

Feb 10, 2012 15:18:57 GMT -5 Savoir Faire-Demogague in NJ said:

Feb 10, 2012 15:15:37 GMT -5 workpublic said:

ehealthinsurance.com

you'll still need a phd in contract law to understand how your policy works and whats covered and what's not and how it is or isn't. and your monthly payment will still increase in double digits % each year.

One still must read and understand their health insurance, even if you get the benefit at your employment.

Ahh come on man- they write so much bullshit into these contracts and you know it. Just looking at the cable bill I got last month I was trying to figure out why it was higher than it should have been and sure as shit you cannot get a solid explanation of charges- even looking at their website 'about your bill and how to understand it' it had no explanation or price structure set up to explain a damn thing. The same shit goes on with phone contracts- every month something is billed wrong- and always in their favor. Don't you ever get tired of companies trying to screw you any way they can? Is it too much to ask for clear and concise language explaining the deal so both parties know what they are agreeing to?

[jkapp]

Feb 10, 2012 16:17:28 GMT -5 EVT1 said:

Feb 10, 2012 15:18:57 GMT -5 Savoir Faire-Demogague in NJ said:

One still must read and understand their health insurance, even if you get the benefit at your employment.

Ahh come on man- they write so much bullshit into these contracts and you know it. Just looking at the cable bill I got last month I was trying to figure out why it was higher than it should have been and sure as shit you cannot get a solid explanation of charges- even looking at their website 'about your bill and how to understand it' it had no explanation or price structure set up to explain a damn thing. The same shit goes on with phone contracts- every month something is billed wrong- and always in their favor. Don't you ever get tired of companies trying to screw you any way they can? Is it too much to ask for clear and concise language explaining the deal so both parties know what they are agreeing to?

Yet a 2700 page health "reform" law is a-okay and easily understandable

[EVT1]

Consumers don't have to read it, do they? It isn't a contract either. It is a law, and that's what the compliance specialists are for.

[jkapp]

Feb 10, 2012 16:26:25 GMT -5 EVT1 said:

Consumers don't have to read it, do they? It isn't a contract either. It is a law, and that's what the compliance specialists are for.

So you're saying its okay for people to be ignorant and irresponsible in regards to the law, but being ignorant and irresponsible in regards to personal choices should not be allowed to happen?

[wyouser]

So what does that say about our illustrious members of congress? Did they ever give us a talley of how many EVER read the thing before they passed it? As Nancy said..we got to pass it so we can find out whats in it....ONLY THE PEOPLE ARE IGNORANT AND IRRESPONSIBLE in regards to the law?? ;D ;D ;D

[EVT1]

Feb 10, 2012 16:35:05 GMT -5 jkapp said:

Feb 10, 2012 16:26:25 GMT -5 EVT1 said:

Consumers don't have to read it, do they? It isn't a contract either. It is a law, and that's what the compliance specialists are for.

So you're saying its okay for people to be ignorant and irresponsible in regards to the law, but being ignorant and irresponsible in regards to personal choices should not be allowed to happen?

No- but I can understand a law being hard to understand. What there is no excuse for is a contract being written that way intentionally to confuse people or hide critical information.

[Deleted]

I've been buying private insurance for a over a decade now. I don't think I've ever run into a company that didn't have a simple to understand summary and explanation of terms.

[djAdvocate]

Feb 11, 2012 11:27:00 GMT -5 @anne81 said:

I've been buying private insurance for a over a decade now. I don't think I've ever run into a company that didn't have a simple to understand summary and explanation of terms.

oh, they explain what they DO just fine. but they explain what they DON'T DO very very ill.

[Deleted]

Feb 10, 2012 14:56:35 GMT -5 rockon said:

Hopefully this is one good aspect of this unpopular bill. With 2700 pages of stuff it seems there should be a couple good things in there somewhere if anyone finishes reading it. Maybe some damm republican slipped it in there when Pelosi was sleeping. To bad they didn't use this idea when they were writing the bill.

Virtually every provision of the ACA that has been implemented thus far is supported by the majority of Americans. The only thing they don't like is the individual mandate - which *was* a Republican idea.

[vandalshandle]

evt
I think that you are being unfair to the insurance industry. I was a mid-level health insurance executive for most of my entire working life, and I worked very hard to come up with all the loopholes that are written into insurance contracts. I am particularly proud of the pre-existing illness exclusion and the rescission provisions that we put into these contracts. In layman's terms, if you have ever been sick before you applied for insurance, we may not cover that illness, and if you lied on the application, and we find out about it, we can return your premium and take away your coverage. Not only that, but we have a clause stating that misstatements on your applications are misrepresentations, but we don't tell you the definition of "misrepresentation". I am also pleased with the fact that we can deny any claim for any charge that is not "reasonable and customary", without having to tell you exactly what IS reasonable and customary (in our opinion... which is the only opinion that counts). Do you think that all this was easy? I worked on stuff like this for over 40 years, and I guarantee you that I have legal mumbo-jumbo down pat! So, a little respect, please!

[vandalshandle]

Contract negotiation, the Marx Brothers, "A night at the Opera'

[AgeOfEnlightenmentSCP]

I love when people run out to defend this wildly unpopular 2,700 page monstrosity with these tiny little examples that we'd already enjoy if government hadn't been in middle of the insurance market for so long. You think what we call 'free market' health insurance would be tolerated in an actual free market?

[EVT1]

Feb 11, 2012 11:51:31 GMT -5 vandalshandle said:

evt
I think that you are being unfair to the insurance industry. I was a mid-level health insurance executive for most of my entire working life, and I worked very hard to come up with all the loopholes that are written into insurance contracts. I am particularly proud of the pre-existing illness exclusion and the rescission provisions that we put into these contracts. In layman's terms, if you have ever been sick before you applied for insurance, we may not cover that illness, and if you lied on the application, and we find out about it, we can return your premium and take away your coverage. Not only that, but we have a clause stating that misstatements on your applications are misrepresentations, but we don't tell you the definition of "misrepresentation". I am also pleased with the fact that we can deny any claim for any charge that is not "reasonable and customary", without having to tell you exactly what IS reasonable and customary (in our opinion... which is the only opinion that counts). Do you think that all this was easy? I worked on stuff like this for over 40 years, and I guarantee you that I have legal mumbo-jumbo down pat! So, a little respect, please!

Thanks. I spent 3 years in law school to have people tell me I have no idea what I am talking about. I should have gone to the PBP school of awesomeness.

[vandalshandle]

evt,
I am also very proud of our "medically necessary" and "accepted medical procedure" clauses. if we decide that your treatment was not really necessary (in our opinion) then we won't cover that. If we decide that your treatment was not appropriate for the condition being treated, we won't cover that, either. All of that is pretty much up to us to decide, although, we reluctantly look to the AMA protocols for "appropriate treatment" guidelines. The states have always regulated the insurance companies, so one of my jobs was to make sure that every state's legal requirements were met. A contract issued in Nevada requires coverage for acupuncture, for example. The requirements that Pennsylvania had were so pervasive and all encompassing that I made the decision just to not issue any contracts in that state. New York was even worse. I'll say this, though. The present system of health insurance guarantees generations of attorneys with high paying jobs, paid for out of insureds premiums!

[formerexpat]

I am also very proud of our "medically necessary" and "accepted medical procedure" clauses. if we decide that your treatment was not really necessary (in our opinion) then we won't cover that. If we decide that your treatment was not appropriate for the condition being treated, we won't cover that, either.

Sounds like you worked in the HMO industry. PPO's don't work like that.

Interestingly enough, the shitty product that we got with an HMO can be directly traced back to the government and the Act in 1973.

[Savoir Faire-Demogague in NJ]

Medicare spent $2.2 million on penis enlargers
AP reports:

hosted.ap.org/dynamic/stories/U/US_ERECTILE_PUMPS_MEDICARE_FRAUD?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2012-02-10-21-11-09

An Illinois man was sentenced Friday by a federal judge in Rhode Island to more than three years in prison for shipping unwanted penis enlargers to diabetes patients as part of a larger fraud scheme that prosecutors say bilked $2.2 million from Medicare over four years.

The fraudster, Gary Winner, bought toys at adult stores for as little as $26 each, repackaged them with information sheets claiming that they helped "bladder control, urinary flow and prostate comfort," and then charged Medicare an average of $284 each. The government spent $2.2 million on the devices before someone discovered a problem.

Soon, the government will be running your healthcare too.

[vandalshandle]

"Soon, the government will be running your healthcare too."

Having been insured by Medicare for the last 4 or 5 years, the government already controls my health care, and I am very happy with it. In fact, being retired, I would have been in serious trouble last November without it, because my hospital bill that Medicare paid for me was $20,000. I was told that the hospitalization saved my life. That works for me!

[jkapp]

Feb 12, 2012 17:33:14 GMT -5 vandalshandle said:

"Soon, the government will be running your healthcare too."

Having been insured by Medicare for the last 4 or 5 years, the government already controls my health care, and I am very happy with it. In fact, being retired, I would have been in serious trouble last November without it, because my hospital bill that Medicare paid for me was $20,000. I was told that the hospitalization saved my life. That works for me!

Lucky us...and of course you have absolutely no problems with the $60-70 BILLION dollars medicare fraudulently wastes every year. Oh, but medicare only has 3% overhead...on their $70 BILLION dollars of waste, fraud and abuse

[Savoir Faire-Demogague in NJ]

Lucky us...and of course you have absolutely no problems with the $60-70 BILLION dollars medicare fraudulently wastes every year. Oh, but medicare only has 3% overhead...on their $70 BILLION dollars of waste, fraud and abuse

....and that is only thre fraud that was uncovered.
The 3% overhead number is a bogus comparison anyway and has no relevance. Medicare does nothing to control costs, they pay anything without question.

[workpublic]

they pay anything without question.

apparently anything fraudulent.

but legitimate claims maybe not so much. that might be why so many doctors are refusing to take medicare?

[The Walk of the Penguin Mich]

that might be why so many doctors are refusing to take medicare?

Not quite. Medicare pays a fraction of what private insurance companies pay and many times it's far less than what treatment actually costs.

Here's an example. Last year I had a hip replacement. My insurance company and myself paid my orthopedic surgeon ~$3500 for his services. My insurance company paid the hospital about $45,000 for surgery and hospitalization. Large, west coast city. My other replacement 4 years earlier paid about the same, maybe 10% or so less.

Another woman on my hip group had a hip replacement about the same time. Another large, west coast city. Her surgeon was paid $1200 by Medicare and the hospital was paid $21,000 for her surgery and hospitalization and she was hospitalized 2 days longer than I was.

I imagine that the true costs are somewhere in the middle such that those of us with private insurance are supplementing what Medicare doesn't pay. Medicaid pays even less....

[vandalshandle]

"Medicare does nothing to control costs, they pay anything without question."

Where do you get your information, SF? The hospital bill I received was for about $20,000. Medicare paid them a contracted fee of $6,500. My copay was $650. Medicare pays anything without question? I don't THINK so!

BTW, after I retired from my career in health insurance, I took a nichol and dime job billing Medicare charges for Charity Hospital in New Orleans, just so I could have health insurance until I was 65. Katrina closed the hospital down for good in August, but I remember that for the month of July, 2005, Medicare denied almost $10,000,000 in charges that we billed them for eligible Medicare patients, for various reasons. It was a normal month for us.