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mastershakeman posted:Signing up for PPACA for the first time, and last minute double checking showed that the healthcare.gov site listed one (cheaper) insurance plan as covering the nearby hospital/med group my family uses. Upon further checking to make sure, the insurance co/hospital both confirm they don't take that plan. I imagine you could of claimed a change in life circumstance...
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Dec 12, 2016 22:34
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Incorrect information listed on healthcare.gov is considered a qualifying life event so you'd be able to change plans.
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Dec 12, 2016 23:03
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Reik posted:To be fair, the insurance policy would be usable, just not at the doctors you would prefer to go to. Usable, assuming the accepted doctors are within a reasonable distance and are accepting new patients.
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Dec 13, 2016 16:18
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PerniciousKnid posted:Usable, assuming the accepted doctors are within a reasonable distance and are accepting new patients. Correct, which if that is not the case you would call the NAIC and report the network on your policy as being inadequate. You could probably call your state department of insurance too.
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Dec 13, 2016 16:32
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So I started a new job that offers insurance. Great, right? Well, the plan that costs me $40/month somehow qualifies as coverage under the ACA despite it covering nearly nothing, if I'm reading this paperwork right. It's a "limited benefit indemnity plan" and says it's not basic health insurance or major medical coverage right on the faq sheet. About all the use I'll get out if it, from what I can tell, is a yearly physical, yearly gyno exam, and free birth control. Now, my employer also offers a real medical plan from Humana, but it's like $300 a month, which I sure as hell can't afford on minimum wage. But because of this lovely plan being offered, I can't go on the exchange and get something subsidized.
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Dec 13, 2016 19:04
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skull mask mcgee posted:Incorrect information listed on healthcare.gov is considered a qualifying life event so you'd be able to change plans. Interesting. I would've lied regardless once I found out what was happening. That being said I'm now getting emails saying the application is incomplete, and logging in shows it to be completed. This is my first year doing it, I can't imagine people on their 3rd? 4th? year of this crap
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Dec 13, 2016 19:42
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taiyoko posted:So I started a new job that offers insurance. Great, right? Well, the plan that costs me $40/month somehow qualifies as coverage under the ACA despite it covering nearly nothing, if I'm reading this paperwork right. It's a "limited benefit indemnity plan" and says it's not basic health insurance or major medical coverage right on the faq sheet. About all the use I'll get out if it, from what I can tell, is a yearly physical, yearly gyno exam, and free birth control. If they have told you that if disqualifies you from subsidies, your employer's HR department might not understand the regulations. Notice 2014-69 says that plans must substantially cover in-patient hospitalization services and physician services to be considered Minimum Value (MV) . Without knowing the details, the skinny plan seems to constitute Minimum Essential Coverage (MEC) but would not satisfy the Minimum Value (MV) requirement. MEC and MV are two different requirements on healthplans, and plans that have one will not necessarily have the other. Since it has MEC, it would be enough for you to avoid paying the individual mandate penalty. However, since it is not MV, its availability does not disqualify you from receiving a subsidy on the exchange. If I were in your position I would discuss the issue with HR and tell them I intend to get a subsidized plan on the exchange. None of this is tax or legal advice.
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Dec 13, 2016 19:44
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esquilax posted:If they have told you that if disqualifies you from subsidies, your employer's HR department might not understand the regulations. Notice 2014-69 says that plans must substantially cover in-patient hospitalization services and physician services to be considered Minimum Value (MV) . The Minimum Essential Coverage plan probably exists so they don't have the pay the penalty for not offering an "affordable" coverage options (9.5% or less of income).
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Dec 13, 2016 19:59
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Reik posted:The Minimum Essential Coverage plan probably exists so they don't have the pay the penalty for not offering an "affordable" coverage options (9.5% or less of income). Well the employees wouldn't pay a penalty, but the employer would still pay a penalty for each employee that gets a subsidy on the exchange. Offering a plan that is MEC but not MV isn't a safe harbor from paying employer shared responsibility penalties.
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Dec 13, 2016 20:14
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It's seriously amazing how much these discussions resemble something I'd associate with Dungeons and Dragons more than anything I'd recognize as the provision of healthcare.
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Dec 13, 2016 20:26
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PT6A posted:It's seriously amazing how much these discussions resemble something I'd associate with Dungeons and Dragons more than anything I'd recognize as the provision of healthcare. I found my D&D minmaxing skills very useful when selecting a plan. Useful tip for families with only children: 3 individual plans are cheaper than a family plan, by quite a lot.
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Dec 13, 2016 20:27
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PT6A posted:It's seriously amazing how much these discussions resemble something I'd associate with Dungeons and Dragons more than anything I'd recognize as the provision of healthcare. Think of all the different regulations and FAQs as splat books and you are not far off
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Dec 13, 2016 20:33
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If you want to learn how local government works, try out LARP.
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Dec 13, 2016 21:15
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Oh, for posterity: two of my coworkers (30 year old woman, 39 year old man) today said they're straight up not having health insurance next year and either paying the fine or just re-upping when the grace period ends, they'd rather go without for january than pay the premium. We make like 3x the minimum wage
mastershakeman fucked around with this message at 23:02 on Dec 13, 2016 |
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Dec 13, 2016 21:46
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esquilax posted:Well the employees wouldn't pay a penalty, but the employer would still pay a penalty for each employee that gets a subsidy on the exchange. Offering a plan that is MEC but not MV isn't a safe harbor from paying employer shared responsibility penalties. But they'd only pay the penalty if the employee sought MV coverage from an exchange? If the employee was okay with the MEC indemnity plan they would be in the clear.
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Dec 13, 2016 23:19
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Reik posted:But they'd only pay the penalty if the employee sought MV coverage from an exchange? If the employee was okay with the MEC indemnity plan they would be in the clear. Yep. The $300 Humana plan is enough by itself to avoid the $2,000/all penalty, and the $3,000/each penalty is only on employees getting a subsidy.
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Dec 13, 2016 23:33
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Wasn't UnitedHealth supposed to move out of washington state? I just got my apple health renewed automatically, which is odd because they used to want me to manually review before approval and I figured I would use that to make the switch to someone not leaving the state.
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Dec 14, 2016 20:49
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I'm getting married next year and so will lose all my subsidies (wife makes more than twice what I do), going from paying $50 a month for an Essential plan on New York's exchange, to $400 a month, the cheapest plan available on the NY state exchange. Her employer offers me health insurance, with a higher deductible and higher co-pays, for $600/month cool
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Dec 14, 2016 23:28
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Don't get married and make sure you write your senators and congressman to tell them why. Especially if they're Republican.
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Dec 15, 2016 07:04
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The family glitch sucks poo poo too, but there is no hope of that getting fixed with trump.
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Dec 15, 2016 07:31
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Have you seen my apex seals? I seem to have lost them.
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Aeka 2.0 posted:The family glitch sucks poo poo too, but there is no hope of that getting fixed with trump. Man, it is a right-wing coup that they managed to get everyone calling that poo poo a "glitch". It sounds so benign when you phrase it that way.
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Dec 15, 2016 16:39
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Oracle posted:Don't get married and make sure you write your senators and congressman to tell them why. Especially if they're Republican. This sort of "perverse incentive" is pretty common with every level of "welfare" so much that people have constructed liberal conspiracy theories about it being responsible for the destruction of poor people's family life (particularly poor Black family life.) Marriage often disqualifies you from any benefits, which can be a big issue if you have kids. Republicans, of course, see it as evidence of the depravity of the poor. BarbarianElephant fucked around with this message at 19:53 on Dec 15, 2016 |
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Dec 15, 2016 17:08
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There is an alternative calculation to make in the year of marriage that just might address the problem.
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Dec 15, 2016 19:27
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Timing health care expenses is good with money, but that we have strong incentives to do it is just sad. https://thefinancebuff.com/health-care-expenses-bunching.html
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Dec 20, 2016 16:21
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baquerd posted:Timing health care expenses is good with money, but that we have strong incentives to do it is just sad. Doesn't this just pass the expense onto other people?
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Dec 20, 2016 17:32
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Dr. Arbitrary posted:Doesn't this just pass the expense onto other people? It passes the expense back to everyone, including yourself, through premium increases. Stacking your expenses to get the most from your insurance is the optimal strategy, but insurance companies have to account for this in the premiums or else they don't have enough in premiums to cover the liabilities and go under. This is pretty standard though, and I wouldn't say doing this is bad for everyone in the long run. What is bad for everyone in the long run is the fact that a more expensive facility does not necessarily make it a better facility, and once people have hit their out-of-pocket maximums they receive a higher perceived value from going to the most expensive facility possible as long as it is in network. Education is the only real solution to this, since it's still very difficult to quantify one facility being just as good as another facility. Getting that MRI at the standalone imaging place that charges $400 as opposed to the "non-profit" hospital system that charges $2,400 might seem silly when you pay $0 for both MRIs, but you end up paying the price in premiums next year. Reik fucked around with this message at 18:00 on Dec 20, 2016 |
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Dec 20, 2016 17:57
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Reik posted:What is bad for everyone in the long run is the fact that a more expensive facility does not necessarily make it a better facility, and once people have hit their out-of-pocket maximums they receive a higher perceived value from going to the most expensive facility possible as long as it is in network. Education is the only real solution to this, since it's still very difficult to quantify one facility being just as good as another facility. Getting that MRI at the standalone imaging place that charges $400 as opposed to the "non-profit" hospital system that charges $2,400 might seem silly when you pay $0 for both MRIs, but you end up paying the price in premiums next year. I read somewhere ages ago that price controls in Japan had led to the creation of a domestic medical imaging industry to make lower-cost MRIs and such, which didn't necessarily perform like the top-of-the-line machines from elsewhere, but worked well enough for a fraction of the cost.
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Dec 21, 2016 07:02
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VideoTapir posted:I read somewhere ages ago that price controls in Japan had led to the creation of a domestic medical imaging industry to make lower-cost MRIs and such, which didn't necessarily perform like the top-of-the-line machines from elsewhere, but worked well enough for a fraction of the cost. I have no medical degree so I have no idea what the difference is between a top of the line MRI and a regular MRI. I do know that the machines are expensive though, and I understand the finance behind getting a good return on investing in additional capital. Took my wife to a freestanding ER (big issue down here in Texas) and they had a CT scanner, their only advanced imaging machine. Of course they wanted to do a CT scan on my wife to make sure it wasn't anything severe, but fortunately I knew enough about the industry to make sure to go to one of the few freestanding ERs that actually contracts with our insurer, which is different from being paid "in network" because it's an Emergency Room. The amount they billed for the CT scan was $5,000, but the contracted amount with the insurer was only $800. They make a pretty penny on people that come in there thinking all ERs are "in network" and tagging them with a $5,000 CT scan.
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Dec 21, 2016 17:05
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I work in a pharmacy that's part of a community health center which helps provide medications and outpatient coverage to patients whose incomes aren't quite low enough to qualify them for Medicaid. All in all I love my program and what we do, but somehow the huge majority of my job has become trying to understand and help patients navigate the laybrinth of poo poo and despair that is our healthcare system so that they can actually get their stupid primary insurance to cover their meds, or enroll on manufacturer assistance programs if they qualify. As a note though I'm not criticizing the ACA directly, which while half-assed, was a huge improvement over what came before, and once the GOP guts it we are going to be in a world of hurt for disadvantaged groups. The problem isn't the ACA, it's the American healthcare system itself and its baffling array of Medicare A/B/Advantage+/-D, Limited Income Medicare programs, wildly different state Medicaid programs, assistance programs, commercial plans, marketplace plans and their bizarre rules that determine who qualifies for what and what will and won't be covered. This month however I got to experience a role reversal, since instead of waging war on behalf of my patients with bureaucratic assholes at the insurance company, I got to try to get one of my own medications covered by my poo poo stain insurance. What makes this all the more mind blowing is that I am employed by a CHC that partners with a large nonprofit healthcare system. If I want affordable insurance, I need to purchase the insurance plan that is offered by my employer, which naturally is a sub-entity of the same healthcare system. This insurance only covers non-emergency medication fills if they are processed at the pharmacy...which is part of the healthcare system (which by itself is loving lovely when you work in the pharmacy, gee I wonder if my coworkers can figure out what I'm using this for). Also unless I want to pay a shitload more, I'm going to be visiting a doctor who is employed by the same healthcare system. Recently my system doctor wrote me a prescription which I tried to fill at our system pharmacy, only to find out the claim had been rejected by our system insurance. Their explanation was that I was not using the medication for an FDA-approved indication. This naturally is an insurance bullshit-ese way to say "gently caress you, we don't want to pay for your mildly expensive medication". Medications are used for off-label indications all the time in the real world, the insurances only pretend to give a crap when it's a more costly medication they might need to pony up for. Thankfully I have a doctorate in pharmacy, a solid knowledge of insurance rules, and my understudied disease actually has a pretty decent body of evidence that the medication I'm trying to fill works very well for it, so this should be a breeze to get covered, right? Today it is a week and half later. A formal written appeal by myself full of data and primary medical journal articles, along with supporting evidence by my doctor, along with a half dozen web messages, emails and phone calls have yielded one response total from the insurance company more or less just saying "your appeal will be reviewed". I've also learned that after failing to meet the initial criteria, the determination of my coverage is no longer decided by the pharmacy services department at my insurer (which actually has pharmacists and people who understand medications on staff), but instead now goes to a mysterious "appeals committee", which apparently has one medical doctor and a bunch of mysterious shadow-forms who will use a criteria known only to them to decide whether my medication will be covered. Again this must be stressed: myself, my provider, my pharmacy and my insurer are all employed/part of the same healthcare system. Even if they approve my claim, money largely just flows from one part of the system to a different part of the system. All this process really accomplishes is wasting an enormous amount of time of multiple parties, each one of whom is employed by the same monstrous web of a healthcare system. It's a zero sum system that just wastes time and generates misery. Kind of like the American health system in general.
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Dec 21, 2016 20:15
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Subvisual Haze posted:I work in a pharmacy that's part of a community health center which helps provide medications and outpatient coverage to patients whose incomes aren't quite low enough to qualify them for Medicaid. All in all I love my program and what we do, but somehow the huge majority of my job has become trying to understand and help patients navigate the laybrinth of poo poo and despair that is our healthcare system so that they can actually get their stupid primary insurance to cover their meds, or enroll on manufacturer assistance programs if they qualify. As a note though I'm not criticizing the ACA directly, which while half-assed, was a huge improvement over what came before, and once the GOP guts it we are going to be in a world of hurt for disadvantaged groups. The problem isn't the ACA, it's the American healthcare system itself and its baffling array of Medicare A/B/Advantage+/-D, Limited Income Medicare programs, wildly different state Medicaid programs, assistance programs, commercial plans, marketplace plans and their bizarre rules that determine who qualifies for what and what will and won't be covered. If they approve your claim doesn't money go from the insurer (your system) to the pharmacy (your system) to the manufacturer (not your system)? Not saying this BS is right but just pointing out that it's not just moving money from one department to another. They don't want to pay the manufacturer. I hope they approve your claim.
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Dec 21, 2016 20:36
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Vladimir Putin posted:If they approve your claim doesn't money go from the insurer (your system) to the pharmacy (your system) to the manufacturer (not your system)? Not saying this BS is right but just pointing out that it's not just moving money from one department to another. They don't want to pay the manufacturer. This is true, but one can't forget the hidden
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Dec 21, 2016 20:55
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i emigrated to france a couple of years back, and last year i developed an abcess in my tonsils that required hospitalization. i just showed up, gave my carte vitale to the hospital, and spent the next 5 days lazing about. i have never once seen a bill for my time there (technically, i can go see the bill if I want, but it was 100% covered by the public healthcare and my $250 a year supplementary private insurance). even before I had gotten fully signed up for france's social security system i was able to purchase medication for far less in the US and go see a doctor for $24 without the help of insurance. hearing about the issues people have just getting medications filled i am terrified of being kicked back to the US and having to deal with any sickness. it also just blows my mind that the richest country on earth refuses to meet even a fraction of the quality of care of german or french systems, and that people lie to themselves that it's the best care in the world.
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Dec 21, 2016 20:59
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Condiv posted:i emigrated to france a couple of years back, and last year i developed an abcess in my tonsils that required hospitalization. i just showed up, gave my carte vitale to the hospital, and spent the next 5 days lazing about. i have never once seen a bill for my time there (technically, i can go see the bill if I want, but it was 100% covered by the public healthcare and my $250 a year supplementary private insurance). even before I had gotten fully signed up for france's social security system i was able to purchase medication for far less in the US and go see a doctor for $24 without the help of insurance. hearing about the issues people have just getting medications filled i am terrified of being kicked back to the US and having to deal with any sickness. it also just blows my mind that the richest country on earth refuses to meet even a fraction of the quality of care of german or french systems, and that people lie to themselves that it's the best care in the world. From what I've seen in studies the quality of care in the US is about average or slightly above. The problem is that we pay the most per capita. Canada has about average or slightly below average but they pay way less per capita so they get a good value. I think the best care/price ratio is the Scandinavian countries.
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Dec 21, 2016 21:20
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Vladimir Putin posted:From what I've seen in studies the quality of care in the US is about average or slightly above. The problem is that we pay the most per capita. Canada has about average or slightly below average but they pay way less per capita so they get a good value. I think the best care/price ratio is the Scandinavian countries. It's really quite remarkable when you look at the cost breakdowns. We spend as much per capita on public healthcare expenditures (Medicare/Medicaid/etc.) as most nations spend on their entire universal healthcare system, then we pay the same amount again in individual/private expenses. The system is a gigantic Frankenstein's monster that I have very little hope can get sorted out to provide actual efficient healthcare short of burning it all down and starting over with universal public coverage (which realistically will never happen). Now it's just an endless game of kick the (cost) can. Drug manufacturers and healthcare providers/labs/etc. jack up prices to insane amounts, insurers do everything they can to avoid paying, Medicare/Medicaid have insane rules on what they will and won't cover, state governments gleefully gut and limit services offered by Medicaid, and pharmacists/doctors juggle it all to make sure our professions get paid much more than what we'd make in other UHC countries (while simultaneously causing every doctor/pharmacist to hate their career but feel stuck in it due to mountains of student debt). In the end it's always going to be the patient who is denied services and stuck holding the bag for prices with no basis in reality.
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Dec 21, 2016 21:38
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Reik posted:I have no medical degree so I have no idea what the difference is between a top of the line MRI and a regular MRI. I do know that the machines are expensive though, and I understand the finance behind getting a good return on investing in additional capital. On the plus side, since we're venting all the available helium to space with no attempt at recovery nobody will have to worry about MRIs after this generation anyway. I'm trying to figure out if I win or lose with ACA repeal. I'm in a non-expansion state, so my family all falls into the abyss of GOP obstructionism. Kids are poor enough to be covered by the state, but my wife's insurance plan falls under "don't get sick. Ever.". I've got a grandfathered pre-ACA plan through work that sucks but sucks less than the ACA-compliant plans the insurers keep trying to foist on us - same things covered but costs more and with a higher deductable/max OOP. Worst case, $750/month and I can pull them all into my plan through my company. That's 1/3 my income, give or take. I wonder if any first world countries need embedded programmers.
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Dec 21, 2016 21:50
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Subvisual Haze posted:It's really quite remarkable when you look at the cost breakdowns. We spend as much per capita on public healthcare expenditures (Medicare/Medicaid/etc.) as most nations spend on their entire universal healthcare system, then we pay the same amount again in individual/private expenses. The system is a gigantic Frankenstein's monster that I have very little hope can get sorted out to provide actual efficient healthcare short of burning it all down and starting over with universal public coverage (which realistically will never happen). What do you feel about the debates in drug costs going on right now? I personally don't get it. Many drugs cost $100,000 per year. I think there was a huge controversy over a hep c drug that was $90,000 per year. There's a huge controversy over this right now but I don't see how this impacts the average person. Let's say for that hep C drug you get them to cut the cost by 50%, which is a huge discount. Is the average person going to be able to afford a $45,000 drug? Let's say you go apeshit and get them to cut the cost of the drug by an order of magnitude (10x). Now the drug costs $9,000. Nobody is going to want to pay for that either and 99.9% of people still can't afford it. Even when you get down to a 100x discount and the drug is about $1000, most people still won't want to pay that much for it. So why are we getting mad at these imaginary numbers that nobody pays and nobody can pay? The people getting impacted by this is the insurance industry who are the ones that do pay the cost of this and would benefit from a discount anywhere from 2x to 100x. Is the public discourse being disproportionality driven to benefit these people?
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Dec 21, 2016 21:51
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Vladimir Putin posted:From what I've seen in studies the quality of care in the US is about average or slightly above. The problem is that we pay the most per capita. Canada has about average or slightly below average but they pay way less per capita so they get a good value. I think the best care/price ratio is the Scandinavian countries. imo QoC should entail availability (including economic availability)
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Dec 21, 2016 21:52
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Vladimir Putin posted:What do you feel about the debates in drug costs going on right now? I personally don't get it. Many drugs cost $100,000 per year. I think there was a huge controversy over a hep c drug that was $90,000 per year. There's a huge controversy over this right now but I don't see how this impacts the average person. despite all appearances the insurance companies are not Santa Claus figures pulling that money from nowhere to dispense free drugs to all the good little girls and boys, they take that money from you and skim a percentage off the top (and, per the ACA, their profits are a fixed percentage of expenses, so any attempt to negotiate prices down would be money out of their own pockets) A Wizard of Goatse fucked around with this message at 22:03 on Dec 21, 2016 |
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Dec 21, 2016 21:55
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A Wizard of Goatse posted:despite all appearances the insurance companies are not Santa Claus figures pulling that money from nowhere to dispense free drugs to all the good little girls and boys, they take that money from you and skim a percentage off the top (and, per the ACA, their profits are a fixed percentage of expenses, so any attempt to negotiate prices down would be money out of their own pockets) Yeah but do most people who are arguing this really understand that? I mean if that were the case won't most people argue that premiums are too high and not indirectly helping themselves by saying that drug prices are too high? I mean I agree premiums are too high and frankly I don't give a gently caress how they are lowered whether it's drug prices or hospital reform or whatever. I guess my question is why is the drug price debate so intense when the only people it directly impacts is mostly the insurance companies? Why isn't every other cost driver so intensely debated?
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Dec 21, 2016 22:07
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Vladimir Putin posted:I guess my question is why is the drug price debate so intense when the only people it directly impacts is mostly the insurance companies? Why isn't every other cost driver so intensely debated? Because it's easy to look at a pill, or an IV bag, and go "they're charging HOW MUCH for that?" But an MRI machine looks impressive and expensive and very fiddly, so it "makes sense" why it's so expensive.
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Dec 21, 2016 22:18
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