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Poor Melania
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octopus




 
 
    
 

Post Wed, Sep 20 2017, 4:36 pm
okay if we are all complaining about healthcare, I'm going to put in my 2 cents even though it really has nothing to do with the original post.

I don't know any other business that you don't know the cost of the service until after the fact. I never know what the dr's office is going to bill my insurance, and my insurance won't tell me how much they cover until after it's processed. Something is rotten somewhere. In what other industry do you blindly "buy" a product (in this case healthcare) and not know the cost until after the fact.
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MagentaYenta




 
 
    
 

Post Wed, Sep 20 2017, 6:03 pm
octopus wrote:
okay if we are all complaining about healthcare, I'm going to put in my 2 cents even though it really has nothing to do with the original post.

I don't know any other business that you don't know the cost of the service until after the fact. I never know what the dr's office is going to bill my insurance, and my insurance won't tell me how much they cover until after it's processed. Something is rotten somewhere. In what other industry do you blindly "buy" a product (in this case healthcare) and not know the cost until after the fact.


Healthcare is a service. You should be asking your medical provider and your ins. company why you don't know this. When my medical monopoly went online they also created an ins. interface. I can login to my patient data, see the next apt I have what my deductible will be and how much it cost and how much will be paid. I've had that ability for about 7 years. Other states have it as well. It requires a slight amount of effort on my part, some info needs to be input but that's about it.

But even before the interface I got a statement of charges on every visit and I could always ask my ins carrier prior to a visit how much would be covered. (Or just learn your policy.)
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RebekahsMom




 
 
    
 

Post Thu, Sep 21 2017, 4:53 pm
octopus wrote:
okay if we are all complaining about healthcare, I'm going to put in my 2 cents even though it really has nothing to do with the original post.

I don't know any other business that you don't know the cost of the service until after the fact.


The gov’t didn’t know what was written into the ACA bill until they signed it. Why should we have better treatment?

That being said... Obama lied (really was clueless more than lied) about keeping services, prices skyrocketed. Thank g-d my husband has good insurance- I waived my coverage at work, because they can charge no more than 9.5% of salary for an employee, but no limit on family. I need a good plan- special needs kids. It would cost me something like $1150/ month, plus at least $25 per copay (figure 4-5 co-pays/ week, plus sickness), and meds.

I have friends whose kids were forced onto Medicaid, and the backlog to get them added was 6-9 mos without any coverage. Friends that previously paid less than half of their premium, with better service, for their entire family.

A step-niece pays over $300/ month and has almost nothing for coverage.
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Mommyg8




 
 
    
 

Post Sat, Sep 23 2017, 8:36 pm
MagentaYenta wrote:
Healthcare is a service. You should be asking your medical provider and your ins. company why you don't know this. When my medical monopoly went online they also created an ins. interface. I can login to my patient data, see the next apt I have what my deductible will be and how much it cost and how much will be paid. I've had that ability for about 7 years. Other states have it as well. It requires a slight amount of effort on my part, some info needs to be input but that's about it.

But even before the interface I got a statement of charges on every visit and I could always ask my ins carrier prior to a visit how much would be covered. (Or just learn your policy.)


It doesn't always work that way. I remember that when I had a baby (this was more than ten years ago), I pre-registered with the hospital, I filled out all the forms, and I was obviously using my own doctor. I double checked and triple checked that everything would be covered. Two weeks after my baby, I got a bill in the mail for about $3500. Reason? This was the bill for the anesthesiologist for the epidural - I was under GHI, so the hospital was completely covered, but the anesthesiologist did not accept GHI. This bill was completely my responsibility.

So no, you don't always get the info. in advance. Even when you ask for it.
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octopus




 
 
    
 

Post Sat, Sep 23 2017, 9:01 pm
magentayenta, you should just know my dh is so on top of the insurance. We are on the phone with them all the time. They do not have an app etc. It's a private insurance crafted by the company, and it is not a typical insurance. And it is not obamacare. I would say 70% of the time they are helpful but there is a 30% chunk that even the insurance company cannot tell us until after the bill is processed. Believe me, if we could find out everything in advance, we would! Again, I'm on the phone with the insurance all the time before I ever do anything. But they themselves do not know how something will be billed, etc. Your insurance sounds wonderful that you can do this. If we could, we would. Believe me.
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octopus




 
 
    
 

Post Sat, Sep 23 2017, 9:06 pm
Mommyg8 wrote:
It doesn't always work that way. I remember that when I had a baby (this was more than ten years ago), I pre-registered with the hospital, I filled out all the forms, and I was obviously using my own doctor. I double checked and triple checked that everything would be covered. Two weeks after my baby, I got a bill in the mail for about $3500. Reason? This was the bill for the anesthesiologist for the epidural - I was under GHI, so the hospital was completely covered, but the anesthesiologist did not accept GHI. This bill was completely my responsibility.

So no, you don't always get the info. in advance. Even when you ask for it.


I know which hospital this is. And, yes, we found out this fact based on others having this same experience. So we knew this already based on ppl who had a story like yours.So while I was in labor with one of my kids, the anesthesiologist walks in and dh is like, "hold it, do you take our insurance?" I had to wait an hour before I could get my epidural while the anesthesiologist had to figure out if we were covered or not (and this was after waiting hours for him to come in the first place). And, yes, the hospital took our insurance but each specialist charged separately. I think recently something was passed that this is illegal btw. So I don't think they do that anymore, but I could be wrong.
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Mommyg8




 
 
    
 

Post Sat, Sep 23 2017, 9:07 pm
octopus wrote:
I know which hospital this is. And, yes, we found out this fact based on others having this same experience. So we knew this already based on ppl who had a story like yours.So while I was in labor with one of my kids, the anesthesiologist walks in and dh is like, "hold it, do you take our insurance?" I had to wait an hour before I could get my epidural while the anesthesiologist had to figure out if we were covered or not (and this was after waiting hours for him to come in the first place). And, yes, the hospital took our insurance but each specialist charged separately. I think recently something was passed that this is illegal btw. So I don't think they do that anymore, but I could be wrong.


In Lakewood?
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octopus




 
 
    
 

Post Sat, Sep 23 2017, 9:12 pm
Mommyg8 wrote:
In Lakewood?


no! I'm in ny. I guess the hospital I used wasn't the only one with this terrible practice!
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Mommyg8




 
 
    
 

Post Sat, Sep 23 2017, 9:15 pm
octopus wrote:
no! I'm in ny. I guess the hospital I used wasn't the only one with this terrible practice!


Btw, I asked a million times if I was covered, even as they were calling the anesthesiologist! They kept saying, sure, you're covered! Until they sent me the bill.
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octopus




 
 
    
 

Post Sat, Sep 23 2017, 9:28 pm
Also, I'm going to a specialist with one of my kids. Just because the dr is covered doesn't mean all the tests she runs will be covered. I always run that risk. I once had that with a specialist with one of my other kids.
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BetsyTacy




 
 
    
 

Post Sat, Sep 23 2017, 9:37 pm
Is this still legal? I remember going to the hospital with the names of the covered anesthesiologists in my bag. I couldn't pronounce most of their names, but when the guy walked in to give my epidural I asked him if he could point out his name to me. At the time I think the practice was legal, but the insurance company was able to give me the list of covered docs. I remember thinking that this was a totally ludicrous practice, but then again the insurance I had through my work at the time only gave me 24 hours after birth in the hospital also.
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marina




 
 
    
 

Post Sat, Sep 23 2017, 9:55 pm
Mommyg8 wrote:
I wasn't going to get personal, but since everyone here is so on board with Obamacare...

I, personally, am going to lose my insurance in three months. That means that I will have either no insurance for me or my kids, or a very minimal insurance that will pay 25% of any doctor's fees - which is basically the same thing.

I am not eligible for Obamacare because my husband's employer offers insurance. The premiums in the insurance that I have had through my husband's employer have more than tripled in the last year (probably due to the new laws in the Obamacare legislation), making it pretty much unaffordable for us. We will have to simply go off the insurance.

Just wondering, why is my blood any less red than someone who's on Medicaid?


Have you explored this fully?

https://www.healthinsurance.or.....nges/

According to this link, you may have options. Even if your husband's insurance don't fit into the IRS's definition of "unaffordable," you may still be eligible for an ACA plan, just not with a subsidy. The cost of that would depend on the specific plan you choose.

Also, if the IRS basically decides what is an affordable vs unaffordable spousal insurance plan, I'm not sure you can place all the blame on Obama ...

Anyway, I wish you the best of luck. All our opinions on the ACA are affected by our own experiences and I hope yours get better and that you and your family get the healthcare you need.
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Mommyg8




 
 
    
 

Post Sat, Sep 23 2017, 10:48 pm
WhatFor wrote:

At the same time, what about all those people with preexisting conditions who could never afford such high premiums? Obama made it so that insurance companies were forced to take them. This may be a reason premiums went up?

At the end of the day everyone is entitled to affordable healthcare. How do we ensure that people who can afford healthcare pay for it? How about taking it out of their taxes? That's how a socialized healthcare system works and given that ours doesn't, maybe we should try it the working way.


I'm just going to answer one part of your post right now - as I'm busy with other things...

My insurance is based in New York. New York has had a law that forced insurance companies to take people with pre-existing conditions for some time, now. So that's not it.

In any case, since my husband has had insurance through his (large) employer, pre-existing conditions have never been a factor, and are still not a factor. Large companies never had an issue with affordable healthcare, as they would insure all their employees, they would have a large enough pool of healthy people to keep the premiums lowered. Obamacare was passed only to address the needs of people who were not offered insurance through their employer.

So I'm still mystified as to why our premiums went up by such a huge amount.
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Mommyg8




 
 
    
 

Post Sun, Sep 24 2017, 12:16 am
marina wrote:
Have you explored this fully?

https://www.healthinsurance.or.....nges/

According to this link, you may have options. Even if your husband's insurance don't fit into the IRS's definition of "unaffordable," you may still be eligible for an ACA plan, just not with a subsidy. The cost of that would depend on the specific plan you choose.

Also, if the IRS basically decides what is an affordable vs unaffordable spousal insurance plan, I'm not sure you can place all the blame on Obama ...

Anyway, I wish you the best of luck. All our opinions on the ACA are affected by our own experiences and I hope yours get better and that you and your family get the healthcare you need.


thank you for concern, it's nice that somebody cares...

To answer your question:

First of all, my husband would still not be eligible for an ACA plan, as his employer does offer insurance. As for my kids... once I go off the insurance, I would probably be eligible for medicaid for them (based on my family size, the income eligibility for medicaid in my area is quite high), I am just not sure how to do this legally, and I would have to find out.

As for myself... I have the feeling that the premiums for an ACA plan would be unaffordable for me, as well.

Well, there's always that emergency room option...
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Mommyg8




 
 
    
 

Post Sun, Sep 24 2017, 12:40 am
MagentaYenta wrote:
It's interesting that no one here is complaining about the latest in Trumpcare.

Money previously given to states (to match) to fund medicaid expansion will turn into block grants. The amount of $$ received by each state will be determined by how much $$ they spent on medicaid expansion. The more money the state spent, the smaller their block grant will be. Red states who did not receive $ for medicaid expansion will receive more $$. States will also be determining if they will continue the PPACA position on pre existing conditions. These are just some of the highspots. Insurance companies will be given free rein in establishing how much money they spend on administrative costs (to include executive salaries).


Where did you find this information? I looked this up, but I only saw that they want to roll back the expansion of Medicaid that happened under Obama, and they are proposing giving the states block grants with greater flexibility in administrating Medicaid. This has the potential to be positive - as each individual state makes their own determination that works best for them, or, as the New York Times conjectures, this legislation has the potential to have negative consequences if the block grants do not keep up with the cost of healthcare.

Insurance companies, in a free market economy, have always had free reign to spend as much as they wish on administrative costs (including executive salary), as long as they turn a profit. This is where Obamacare's subsidies can have unintended negative consequences - subsidies interfere with free market price adjustments - making the insurance companies lose their incentives to keep their administrative costs under control - and therefore have the potential to raise the cost for everybody.
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MagentaYenta




 
 
    
 

Post Sun, Sep 24 2017, 12:43 pm
The AHCA is the blanket bill that the republicans fell short of votes on. Text is available online. The BCRA is the current proposed amendment to the AHCA that is up for a vote on Sept 25th.

The Wiki article on the AHCA is pretty comprehensive and includes a comparison chart comparing the AHCA and it's suggested amendment the BCRA. Your electeds should also be able to provide you with a comprehensive summary of the the Act and the proposed amendment. They may even have it posted on their web pages.

If you want to wade through the jargon of the AHCA and the BCRA just google asking for AHCA text or BCRA text. I'd post the links but I don't have access to my bookmarks.
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Mommyg8




 
 
    
 

Post Sun, Sep 24 2017, 1:04 pm
I am not finding any information that the proposed amendment is up for vote on Sept. 25. I understood that this amendment is dead. Please provide a link?

Also, when you read an article, you have to realize that the writers of the article have their own biases, and will present facts based on how they perceive the coverage to be.

Example: Headline: Medicaid coverage will be slashed under the BCRA amendment.

Fact: "Would still link aid to consumers’ income, though it would stop at 350% of poverty level, compared with 400% under the current law."

Source: http://www.latimes.com/project.....peal/

350% is still quite a high number.

In general, most of the numbers that are being bandied around are estimates, and estimates can be changed based on the information/bias of the people feeding in the numbers.
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Mommyg8




 
 
    
 

Post Sun, Sep 24 2017, 1:11 pm
And nobody has answered my yet as to why my insurance premiums went up by such a huge amount.
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MagentaYenta




 
 
    
 

Post Sun, Sep 24 2017, 1:34 pm
Mommyg8 wrote:
And nobody has answered my yet as to why my insurance premiums went up by such a huge amount.


Its likely your state doesn't regulate premium increases. Some states that regulate health ins. also cap annual premium increases. This is just a general reason. I know some people would like to blame the PPACA and it's proven to be the scapegoat of choice for 7 years. The other alternative is to call your provider and ask them. Your choice.
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Mommyg8




 
 
    
 

Post Sun, Sep 24 2017, 1:36 pm
New York doesn't regulate premium increases? I find that hard to believe.
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