The Captain
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Post by The Captain on Nov 5, 2014 9:55:39 GMT -5
... All "single payer" would be is another Ponzi scheme where we demand more than we can afford ... I want a Lexus to get me to work but all I can afford is a bus pass. I want chemo to cure my cancer but all I can afford is an aspirin. And your point is? I'm not sure if you are mocking me or not... At some point everyone who is born will die. A significant portion of medical spending is not in "curing" cancer, but merely prolonging the life of those who develop it, or other end of life care. Tell me, if you knew for a fact that your kids and grandkids would have to personally pay off your medical bill of $400K or more just so you could have a few more years on the planet would you take the treatment? I think most folks would not burden their family with that kind of debt. But let's make it a cost to "society" and then it suddenly becomes more palatable? Yes, medical advances are amazing - but I think we've advanced beyond the point where equal access to those expensive advances is feasible for all.
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Deleted
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Post by Deleted on Nov 5, 2014 9:57:17 GMT -5
Call me one person on an ACA plan who wouldn't be shocked to have to pay up front. That said, both the pediatrician and eye doctor Kids saw this week said they would bill the insurance first, then get back to me... ![](http://syonidv.hodginsmedia.com/vsmileys/idunno.gif)
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Shooby
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Post by Shooby on Nov 5, 2014 9:57:37 GMT -5
Not sure what the point is? If I can afford a Lexus and I want one, I am going to buy one.
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973beachbum
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Post by 973beachbum on Nov 5, 2014 10:19:59 GMT -5
What insurance company card do medicaid enrollees get? Because in PA an Access card is not the same as a Blue Cross card... The enrollees get the insurance card for whatever HMO they enrolled in. That doesn't change if they have medicaid nor Family care. PA seems to be the same except for places that don't have enough HMO coverage as shown by this link and some people get both because of their individual issues.
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movingforward
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Post by movingforward on Nov 5, 2014 10:27:43 GMT -5
Call me one person on an ACA plan who wouldn't be shocked to have to pay up front. That said, both the pediatrician and eye doctor Kids saw this week said they would bill the insurance first, then get back to me... ![](http://syonidv.hodginsmedia.com/vsmileys/idunno.gif) I have ALWAYS had to pay my deductible up front. Going back 15 yrs I had to pay $1500 up front for surgery, 5 yrs ago I had to pay $2000 up front. Yeah, I am not sure why anyone would think they wouldn't have to pay their deductible up front. Isn't that what a deductible is... the charges you are responsible for?
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Formerly SK
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Post by Formerly SK on Nov 5, 2014 10:28:52 GMT -5
Dr's are not dumb and they do not have to treat you. A lot of people with the new high deductibles are going to find out that they will be required to prepay. A Dr is not going to take the risk of collecting. When I had surgery recently I had to prepay for the Dr charges before they would do the surgery. Those people on their new ACA policies are going to be very shocked when they are asked to pay upfront to get treated. Honestly, I'd be THRILLED if doctors posted their fees upfront. The most frustrating thing about health care (and ACA didn't address this at all ![](http://images.proboards.com/new/angry.png) ) is the cost of care. If I knew it would cost me $100 to see the dr for something, I could then decide if my issue was worth $100 to get advice. I went for an upper GI last April because I thought I had an ulcer. Turned out I was fine and it was food intolerances. My cost of the 10 minute procedure was $1400. ![](http://images.proboards.com/new/shocked.gif) Had I known that in advance, I would have waited/researched other factors before getting the test. I get moles removed every year as part of cancer screening. I know this will cost me $600ish because I've done it enough times now I know the average. Because of the cost, I do the removals every year instead of every 6 months like they want me to. I guess you could argue I'm being penny wise pound foolish, but cost should always factor into decisions on health care. Everyone (including doctors) act like cost isn't an issue and they run test after test do all these appointments as if it's all free. Cost should be front and center on medical decisions, and the fact that people don't know the cost until they get their EOB weeks after the test/appointment is asinine.
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movingforward
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Post by movingforward on Nov 5, 2014 10:34:18 GMT -5
Dr's are not dumb and they do not have to treat you. A lot of people with the new high deductibles are going to find out that they will be required to prepay. A Dr is not going to take the risk of collecting. When I had surgery recently I had to prepay for the Dr charges before they would do the surgery. Those people on their new ACA policies are going to be very shocked when they are asked to pay upfront to get treated. Honestly, I'd be THRILLED if doctors posted their fees upfront. The most frustrating thing about health care (and ACA didn't address this at all ![](http://images.proboards.com/new/angry.png) ) is the cost of care. If I knew it would cost me $100 to see the dr for something, I could then decide if my issue was worth $100 to get advice. I went for an upper GI last April because I thought I had an ulcer. Turned out I was fine and it was food intolerances. My cost of the 10 minute procedure was $1400. ![](http://images.proboards.com/new/shocked.gif) Had I known that in advance, I would have waited/researched other factors before getting the test. I get moles removed every year as part of cancer screening. I know this will cost me $600ish because I've done it enough times now I know the average. Because of the cost, I do the removals every year instead of every 6 months like they want me to. I guess you could argue I'm being penny wise pound foolish, but cost should always factor into decisions on health care. Everyone (including doctors) act like cost isn't an issue and they run test after test do all these appointments as if it's all free. Cost should be front and center on medical decisions, and the fact that people don't know the cost until they get their EOB weeks after the test/appointment is asinine. This is one of the biggest reasons why health cost are completely out of control
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billisonboard
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Post by billisonboard on Nov 5, 2014 10:34:31 GMT -5
I want a Lexus to get me to work but all I can afford is a bus pass. I want chemo to cure my cancer but all I can afford is an aspirin. And your point is? I'm not sure if you are mocking me or not... At some point everyone who is born will die. A significant portion of medical spending is not in "curing" cancer, but merely prolonging the life of those who develop it, or other end of life care. Tell me, if you knew for a fact that your kids and grandkids would have to personally pay off your medical bill of $400K or more just so you could have a few more years on the planet would you take the treatment? I think most folks would not burden their family with that kind of debt. But let's make it a cost to "society" and then it suddenly becomes more palatable? Yes, medical advances are amazing - but I think we've advanced beyond the point where equal access to those expensive advances is feasible for all. Not mocking you. If the cost would credit debt and be a "burden", I won't. If the cost would be a smaller donation to the Opera this year, I would. I support a frank conversation: "Whether you live or die will be based on your financial resources. If you have the money, you will receive excellent care. Down the scale to the potential that you might die on the street in excursiating pain." If that is what we are going to have, let's say it.
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billisonboard
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Post by billisonboard on Nov 5, 2014 10:39:31 GMT -5
Not sure what the point is? If I can afford a Lexus and I want one, I am going to buy one. And you will be arriving at work in style. If you can't afford one, you will be arriving at work at the bus stop with the rest of us. If you can afford the chemo, you stand a chance of continuing to live, If all you can afford is the aspirin, you will die in extreme pain. The point was to point out that difference without drawing the picture. Guess I should have gotten out the crayons to start.
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giramomma
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Post by giramomma on Nov 5, 2014 10:41:27 GMT -5
Honestly, I'd be THRILLED if doctors posted their fees upfront. The most frustrating thing about health care (and ACA didn't address this at all ![](http://images.proboards.com/new/angry.png) ) is the cost of care. If I knew it would cost me $100 to see the dr for something, I could then decide if my issue was worth $100 to get advice. I went for an upper GI last April because I thought I had an ulcer. Turned out I was fine and it was food intolerances. My cost of the 10 minute procedure was $1400. ![](http://images.proboards.com/new/shocked.gif) Had I known that in advance, I would have waited/researched other factors before getting the test. I get moles removed every year as part of cancer screening. I know this will cost me $600ish because I've done it enough times now I know the average. Because of the cost, I do the removals every year instead of every 6 months like they want me to. I guess you could argue I'm being penny wise pound foolish, but cost should always factor into decisions on health care. Everyone (including doctors) act like cost isn't an issue and they run test after test do all these appointments as if it's all free. Cost should be front and center on medical decisions, and the fact that people don't know the cost until they get their EOB weeks after the test/appointment is asinine. While it's not quite the same, my health insurance has a phone line you can call to get the prices on the 25 most common procedures. They have a sign about this posted in the reception area of every office I've been in. Our Drs office doesn't push seeing PA. I went to see one recently because I knew what I wanted (quick thryoid test and a metformin script). I didn't need a dr (who apparently doesn't take note that I have PCOS), to do these things, and I didn't want to wait a few months to see one. So, I asked what else could be done. The nurse I talked to said "Well, you can see a PA yet today or tomorrow." Boom. Done. When ever the kids are sick and I think it might be hinky, I just talk to a nurse and double check what I need to look out for. (I forgot everything between #2 and #3). Actually, I'm kinda of annoyed at that now. You used to be able to just talk to them. Now they have to run through a whole check list, and then based on that checklist, then they tell you what to do.
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bean29
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Post by bean29 on Nov 5, 2014 10:52:28 GMT -5
I have heard people recently who were VERY upset about being booted off medicaid/chip plans and onto the exchanges. They said the coverage wasn't even close to the same and they had less choices of Dr's. I thought from what they were saying the lack of choice was because the exchange HMO's weren't as good as the medicaid ones. Why a Dr would choose to be on the medicaid HMO but not the exchange one is a good question. With most Medicaid plans, the patient has either $0 to pay as their share or some very nominal amount.
With the new exchange plans, most of the least expensive plans have low monthly insurance premiums, but there is a large deductible. So the patient has to pay 100% of the doc visits until the deductible is reached. For a doc's office, that means instead of collecting their payment from the state Medicaid plan, they're trying to collect from hundreds of individuals who don't really understand how their insurance works and don't have the money to pay the doc even if they do.
While this is true, I say so? My employer paid plan is exactly the same. I have to pay the first $2500. I have had this plan for at least 6 years, so it predates Obamacare by quite a while. I agree that low income people will have difficulty ever paying the deductibles...but hope that is a growing pains kind of thing. I would guess that it just does not make sense to tell someone at poverty level we are giving you "Health Insurance" but you have to pay the first $2500. You can choose between medical care and food. BTW, I have a friend who works as support staff for a large local school district who can no longer afford medical care b/c of the high deductible plan she is in. She considers Republican Govenor Scott Walker the one who eliminated her access to health care, not Obama.
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gooddecisions
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Post by gooddecisions on Nov 5, 2014 11:00:14 GMT -5
I'm totally confused by the prepayment as well. Early this year, I called the hospital to set up a "just in case induction." They told me I had to pay $900. Instead of giving them my credit card number over the phone, I said I would pay when I get there. I have an expensive comprehensive plan and I wasn't required to pay up front in 2011 when I had my baby at the same hospital with the same comprehensive plan. I didn't pay when I got there, I was too busy ripping my clothes off before the baby fell out of me. So, they sent me the bill. I feel a lot more comfortable paying charges when I see the bill. They would have charged me for 2 nights and I only stayed one night had I paid upfront. And, what if I didn't make it to the hospital at all and had my baby at home.
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Deleted
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Post by Deleted on Nov 5, 2014 11:01:26 GMT -5
I went for an upper GI last April because I thought I had an ulcer. Turned out I was fine and it was food intolerances. My cost of the 10 minute procedure was $1400. ![](http://images.proboards.com/new/shocked.gif) Had I known that in advance, I would have waited/researched other factors before getting the test. But doctors are complicit here. They recommend testing before other, less expensive options.
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emma1420
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Post by emma1420 on Nov 5, 2014 11:07:20 GMT -5
There has been a two tiered system for years depending on where you live and your health insurance provider. I have had to wait months for specialist appointments (long before ACA) and to get treatment. I have had treatment reviewed and denied by health insurance companies long before the ACA.
What Forbes is bringing up really isn't any different than what many people have been dealing with for decades. The healthcare system in this country has for years been two tiers. The version for the haves and the version for the have nots.
I do agree that the ACA has issues. While no healthcare system is perfect, the ACA is completely inadequate. It didn't go nearly far enough.
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movingforward
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Post by movingforward on Nov 5, 2014 11:09:26 GMT -5
I'm totally confused by the prepayment as well. Early this year, I called the hospital to set up a "just in case induction." They told me I had to pay $900. Instead of giving them my credit card number over the phone, I said I would pay when I get there. I have an expensive comprehensive plan and I wasn't required to pay up front in 2011 when I had my baby at the same hospital with the same comprehensive plan. I didn't pay when I got there, I was too busy ripping my clothes off before the baby fell out of me. So, they sent me the bill. I feel a lot more comfortable paying charges when I see the bill. They would have charged me for 2 nights and I only stayed one night had I paid upfront. And, what if I didn't make it to the hospital at all and had my baby at home. I have always paid the day of services. The surgeon's office has already called the insurance company and knows the deductible and what I owe. When I say prepay I mean the day I check into the hospital. No, I have never paid for services prior to that day. The office lets me know what to expect though. I know when I show up I will be paying X amount of out of pocket. It has been this way for eons. People either choose to have the surgery and pay X out of pocket or they don't.
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Shooby
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Post by Shooby on Nov 5, 2014 11:10:53 GMT -5
Not sure what the point is? If I can afford a Lexus and I want one, I am going to buy one. And you will be arriving at work in style. If you can't afford one, you will be arriving at work at the bus stop with the rest of us. If you can afford the chemo, you stand a chance of continuing to live, If all you can afford is the aspirin, you will die in extreme pain. The point was to point out that difference without drawing the picture. Guess I should have gotten out the crayons to start. Ok, well snark on. But, there are always people who can afford more. Doesn't matter what the system is.
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billisonboard
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Post by billisonboard on Nov 5, 2014 11:15:26 GMT -5
... Ok, well snark on. But, there are always people who can afford more. Doesn't matter what the system is. True. A question is "Do we subsidize a bus system to help people get to work or not?"
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Post by The Walk of the Penguin Mich on Nov 5, 2014 11:33:25 GMT -5
No I don't know any Dr's offices that manipulate their wait times for appointments. I do know that every Dr's office around here will only have a certain percentage of patients from plans like medicaid, chip and medicare. If the payments are the same on the exchanges as medicaid I would think they would also limit them as well. It is all a numbers game for the Dr's. They need X amount of revenue coming in every month. They also need X number of patients to be fully booked. The Dr's I know also genuinely like helping people. The key is to keep a patient mix in the practice that allows them to both make enough money every month while helping people. ![](http://images.proboards.com/new/wink.png) I have heard people recently who were VERY upset about being booted off medicaid/chip plans and onto the exchanges. They said the coverage wasn't even close to the same and they had less choices of Dr's. I thought from what they were saying the lack of choice was because the exchange HMO's weren't as good as the medicaid ones. Why a Dr would choose to be on the medicaid HMO but not the exchange one is a good question. My first thought is they think the person with medicaid/chip is more needy. My experience says that is sometimes true but in many cases the person working a job for low wages can often times be even more vulnerable.I don't think it's the wait to see a doctor but the wait for the insurance company to approve an MRI or physical therapy or if you need a referral for an orthopedist getting your PCP to give you one. That may be part of it, but I have read some papers that have shown that those on Medicaid are 3x more likely to cancel their appointment. If half your practice is Medicaid patients, even that small stipend that they give the physicians can have a huge impact on their bottom line.
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Lizard Queen
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Post by Lizard Queen on Nov 5, 2014 11:34:27 GMT -5
Going back to the OP, I've always had trouble getting in to see my Dr. It's often taken over a month to schedule a physical. When I'm sick, I normally have to see a PA or NP. That was true for a decade before the ACA came into being. I was on a BCBS silver plan for a total of 6 months. We chose a more expensive option so that we wouldn't have a limited network. I never used it, and DS1 never used it. DS2 had a well visit and a sick visit. DH had more--a couple visits and an MRI. The deductible was pretty much the same as what we had through his prior employer. I don't know if the reason he had to wait so long to see a specialist was due to the insurance, but I really doubt it. It has ALWAYS taken me a long time to get in to see specialists.
I was happy to have the option to get the ACA plan for that period between employer coverages. It saved my family over $9000 over COBRA. Now we're on DH's new employer's insurance, which was a little confusing switching mid-year again. BCBS again.
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Angel!
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Post by Angel! on Nov 5, 2014 11:46:26 GMT -5
We have always had a tiered system, the tiers are just changing a bit. Before the working poor had no insurance & basically were told to use the ER for issues. Now they have insurance & have long wait times for annual exams (so do I), but at least they can see a doctor or visit urgent care now.
I still believe we are better off than we were before. It is absolutely not where we should be & the system still sucks.
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readergirl
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Post by readergirl on Nov 5, 2014 12:13:36 GMT -5
Obamacare is great for people who couldn't afford health insurance before, but are now getting it paid for them. BUT, we were just managing to pay ours on our own before Obamacare. I just got my new rate for 2015. Our rate is going from $1179.37 to $1788.61 for 2 people, 60 years old. I go to the doctor once a year for an annual and take a generic Imitrex. My husband hasn't seen a doctor in years. Over a 50% increase! We make just enough too much for premium credit, but now not enough to pay for our current policy as of January 1. I am frantically searching for a new plan. We will definitely have to downgrade and give up prescription coverage. We couldn't afford to cover another person we don't know. Want to guess my opinion of Obamacare?
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zibazinski
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Post by zibazinski on Nov 5, 2014 12:23:46 GMT -5
Of course it was always going to be the middle class that pays, and pays, and pays, for those who won't. Nothing has changed in that regard.
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Mardi Gras Audrey
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Post by Mardi Gras Audrey on Nov 5, 2014 12:32:22 GMT -5
We have always had a tiered system, the tiers are just changing a bit. Before the working poor had no insurance & basically were told to use the ER for issues. Now they have insurance & have long wait times for annual exams (so do I), but at least they can see a doctor or visit urgent care now. I still believe we are better off than we were before. It is absolutely not where we should be & the system still sucks. ![](http://syonidv.hodginsmedia.com/vsmileys/yeahthat.gif)
Which is why I will continue to advocate for single payer universal coverage. Some day we will join the civilized world in this regard.
I don't see how you think a single payer system would work economically. Right now, private insurers (United Health, Aetna, HealthNet, Coventry, BCBS, etc) are propping the system up by paying higher reimbursements than public payers (Medicare, Medicaid). The private insurers are, therefore, subsidizing the public payers. Medicare/Medicaid don't really negotiate, they just set the rate they are going to pay and tell the doctors/hospitals to suck it up. Right now the doctors can suck it up because they get extra from the private payers. You make it a single payer system (I guess that would be the govt? Medicare?), there is no negotiating anymore. One side of the equation has all the power and just dictates the price, regardless of what that price is based on. What do you think is going to happen to the number of doctors/hospitals if we go that route? Simple economics shows that your supply will drop, as the prices drop. Is a limited supply of providers what we want in healthcare? Especially as our population ages? The alternative is for the single payer to hire the doctors for a fixed rate (a la the VA or Kaiser). We have all seen how VA care is (You want an appointment? Wait 6 months.. maybe we will call you before you die). From my experience with Kaiser, they can be better but the flexibility to get the care you need is non-existent (I think of Kaiser healthcare as going to Costco for paper towels... they have 2 versions available. They are great and cheap if you just need any paper towels. If you need blue ones with little ducks, you might not want to look there first... they don't have the options you need).
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chiver78
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Post by chiver78 on Nov 5, 2014 12:41:19 GMT -5
Obamacare is great for people who couldn't afford health insurance before, but are now getting it paid for them. BUT, we were just managing to pay ours on our own before Obamacare. I just got my new rate for 2015. Our rate is going from $1179.37 to $1788.61 for 2 people, 60 years old. I go to the doctor once a year for an annual and take a generic Imitrex. My husband hasn't seen a doctor in years. Over a 50% increase! We make just enough too much for premium credit, but now not enough to pay for our current policy as of January 1. I am frantically searching for a new plan. We will definitely have to downgrade and give up prescription coverage. We couldn't afford to cover another person we don't know. Want to guess my opinion of Obamacare?
but are you actually downgrading? in all honesty, if your premiums are going up that much, you very likely had one of the policies that the ACA deemed substandard. in placing you in the minimum standard plan, you're seeing increased premiums to match the increased coverages between the two policies. have you compared apples to apples as far as your coverages go?
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Mardi Gras Audrey
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Post by Mardi Gras Audrey on Nov 5, 2014 12:44:21 GMT -5
Obamacare is great for people who couldn't afford health insurance before, but are now getting it paid for them. BUT, we were just managing to pay ours on our own before Obamacare. I just got my new rate for 2015. Our rate is going from $1179.37 to $1788.61 for 2 people, 60 years old. I go to the doctor once a year for an annual and take a generic Imitrex. My husband hasn't seen a doctor in years. Over a 50% increase! We make just enough too much for premium credit, but now not enough to pay for our current policy as of January 1. I am frantically searching for a new plan. We will definitely have to downgrade and give up prescription coverage. We couldn't afford to cover another person we don't know. Want to guess my opinion of Obamacare?
Reader, As a fellow generic imitrex user, I sympathize. Just wanted to let you know, if you end up dropping prescription coverage, look at Costco for your Imitrex. The cash price for these pills at the other pharmacies is ridiculous, even though it is generic (We are talking like $20 a pill vs $4 a pill at Costco). You don't need to be a member to use their pharmacy. I've also used pill splitting to reduce the number of pills I need. While the pills aren't scored (indicating the manufacturer is sure they can be split), I've been using cut in half ones for 4 years without problems. Get a prescription for the 100 or 50 and take 1/2 (based on what you are using now-50 or 25). You can always take the other half a little later if the first one doesn't do the job.
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shanendoah
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Post by shanendoah on Nov 5, 2014 12:46:19 GMT -5
Am I in favor as ACA? Unequivocally, yes. Is it perfect? No, so far from no that we don't even need to discuss it. Should we have waited until we had something perfect before putting it in place? That depends, did you actually want something done about healthcare in this country? If you did, then implementing the ACA was the best option. If you wanted things to continue on the status quo, then you wanted us to wait, because if you wait until you have something perfect, you will, in fact, be waiting for eternity.
The ACA has problems, big problems, but instead of trying to fix those problems, the argument has remained on an "all or nothing" level. There's no way to fix problems if all of the time is spent simply maintaining existence. If we could move past "let's get rid of it" and onto "let's make it better", life for all of us would be better.
All of that said, please remember that Medicare and the Military/VA systems are the only Federal/National healthcare in this country. All other healthcare, including Medicaid, is administered on a state level. The federal government does provide funds for Medicaid if the state is willing to follow some extra rules, but, as certain states have shown, each state really does have it's own choice whether or not to follow those rules (and get that money). Insurance plans through the ACA are no different. How it is handled depends 100% on what state you live in.
Everything I am about to say applies to WA state, and no other state. In WA, the doctor's office, hospital, etc, has no idea if I am on an exchange plan or not. They ask me my insurance company. I tell them. They ask me if I'm on a PPO or HMO. I tell them. (For the record, my insurance company and HMO status have all remained exactly the same regardless of whether my insurance was employer provided - both through the actual insurance company and the state - or purchased via the exchange - which I did this summer.) That is all they need to know to know if they are on my plan or not. From there, we book the appointment. When I arrive, they enter the group number on my card to know my co-pay. (I also happen to know my co-pay.) I pay my co-pay upfront. I see the doctor.
Does it work this way everywhere? Apparently not, but in WA, our state specifically said they would not let a company be on the exchange if health care providers could tell simply from the "plan name" that it was an exchange product. This rule was set up to combat the idea that providers would discriminate against people who got insurance via the exchange. You see, my employment status is none of my doctor's business (unless it actually factors into what's wrong with me). My income is none of my doctor's business. And here, of all places, we know that income is NOT actually a good way of knowing whether or not someone can pay their bills or will pay their bills. Whether I am buying my own insurance, getting it through my employer, or getting a credit to help me afford it- none of that is my doctor's business. (Mind you, I also live in a state with a LOT of highly paid individual contractors, with no employer provided insurance. The exchange has been fabulous for them, even if they aren't getting a subsidy.)
How long you wait for initial care has nothing to do with your insurance. It has to do with how busy the provider you are going to is. Back in the 1990s, I worked as a medical receptionist. When I started, I could get anyone in in about 2 weeks, 6 weeks max for my pediatric specialist. By the time I left, 3 years later, I couldn't get you in with anyone in less than 6 weeks, and for my pediatric specialist, a new patient appointment was minimum 3 months out, often closer to 6 months. When that next appointment was had absolutely nothing to do with what insurance you had.
How long you wait for an authorization for service is the fault of your insurance company. And there are laws regarding how long it can take them to authorize or not authorize. Again, these are set by the state, so find your state Insurance Commissioner's website and figure it out.
The demand for care has absolutely not changed since the ACA went into effect. One of the goals of the ACA, though, was to shift which suppliers felt that demand- ie move colds and the flu out of ERs and into PCP offices. But the demand, the number of people who need care, has not changed (except with population growth) since ACA was put into effect. It has, perhaps, increased the number of people who felt they had realistic access to healthcare.
Healthcare is a major problem. It is going to continue to be a major problem in this country until we make some big changes. But those changes aren't all about insurance plans or single payer systems, etc. A lot of it needs to start with medical education- the time and expense and mental cost.
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Mardi Gras Audrey
Senior Member
So well rounded, I'm pointless...
Joined: Dec 25, 2010 18:49:31 GMT -5
Posts: 2,082
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Post by Mardi Gras Audrey on Nov 5, 2014 12:58:12 GMT -5
I don't think this is true. Before the ACA, the demand for ER use for minor issues (colds, flus, etc) was usually Medicaid patients or patients who had plans with little or no copay. With the ACA dumping lots more people on Medicaid (where the copay for care is $0), people have no problems going to the dr or the ER for something small that they could stay home and self treat. I believe they had a study that showed this out of Oregon (showed increase use in ERs when Medicaid rolls were increased). Anytime you make it so someone has no skin the game (i.e. no copays), they have no incentive to conserve resources. I can say as someone who volunteered at a hospital urgent care center (and coordinated care with the ER), the people we saw at the Urgent care were those without insurance. The people at the ER (with the SAME MALADIES) were the medicaid patients who didn't care how much it would cost because they weren't paying it anyways. There were also a lot of drug seekers there to get prescriptions for Vicodin or Percocet (again, no copays) or people using the ambulance to the ER as a taxi ride into town (Once they got to the hospital, they were suddenly okay and would leave). Again, no incentive to conserve when you aren't paying the bill. ETA: I can say on the medicine side, there seem to be a lot more people getting medicines they may not need since the ACA kicked in. There are a lot more people on Medicaid and since it covers meds (even Over the counter meds!) with $0 copay, everyone wants all of them because they are "free". A good part of the time they will even say they don't know if they need them or what they are for but they "want them because they are free". These are the same people who didn't want the meds when covered by a commercial plan because the co-pay was $2 and the medicine "isn't worth that to me". But now, if it is $0, they are needed... ![](http://images.proboards.com/new/shocked.gif)
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readergirl
New Member
Joined: May 2, 2013 8:09:44 GMT -5
Posts: 33
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Post by readergirl on Nov 5, 2014 13:05:33 GMT -5
I do not have a substandard plan. It was grandfathered. My guess, this is Blue Cross's way of dumping the plan.
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chiver78
Administrator
Current Events Admin
Joined: Dec 20, 2010 13:04:45 GMT -5
Posts: 38,876
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Post by chiver78 on Nov 5, 2014 13:07:23 GMT -5
if it met the minimum requirements, why would it need to be grandfathered?
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Mardi Gras Audrey
Senior Member
So well rounded, I'm pointless...
Joined: Dec 25, 2010 18:49:31 GMT -5
Posts: 2,082
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Post by Mardi Gras Audrey on Nov 5, 2014 13:11:41 GMT -5
but are you actually downgrading? in all honesty, if your premiums are going up that much, you very likely had one of the policies that the ACA deemed substandard. in placing you in the minimum standard plan, you're seeing increased premiums to match the increased coverages between the two policies. have you compared apples to apples as far as your coverages go? If the plan provided the coverages she needed, it met her needs. While she may be getting "extra coverage" for that $$, it in't something she needs so why should she have to pay for it? That's one of the thing that angers me about the ACA (The bill... not you Chive ![](http://images.proboards.com/new/smiley.png) ). Where does the govt get off deciding what coverage you need? If I am an adult, I should be able to decide myself what coverage I need. How does any Washington politician know better than me what coverage I need? How can they decide it is "substandard" when I am happy with it I understand why they set minimums with car insurance (they set liability because that affects other people... not the insured). But they don't mandate collision or comp coverage.... we are smart enough to do that ourselves. Why not with medical?
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