My insurance company is pulling out of TX. This will be the 3rd yr in a row, where they can't make enough money in the market and cannot justify losses to investors.

I get it, I'm an investor.

Now I'm just trying to find the least expensive plan since the last 3 years, not one Dr. accepted my insurance plans, even though those Dr.s were on the list to accept the insurance.

It happens every year. The government website crashes during open enrollment. One would think after 3 years someone would have the foresight to realize the problem and take care of it proactively.

Right now I'm only going to enroll for the least expensive option (Mod note: political reference removed)

ACA is a great idea. Too bad it works better on paper than in real life.

I thought this was a politics-free forum?

@Jay C wrote:

I thought this was a politics-free forum?

It is and I screwed up by ignoring the rules. Thanks for calling me out!

Big KUDOS to MA for her gracious response. How wonderful would our forum be if everyone who received a reminder or a correction of wrong information thought before replying and agreed rather than turning the forum into World War III with defensiveness and arguments.

MA, you made my day.



edited to correct spelling - Spell Checker is not my friend.

Edited 1 time(s). Last edit at 11/27/2016 11:53PM by AustinMom.

@MA Smith wrote:

My insurance company is pulling out of TX. This will be the 3rd yr in a row, where they can't make enough money in the market and cannot justify losses to investors.

I was listening to a non-political discussion the other day and there was an interesting comment that the insurance companies were losing money because those who had previously not had insurance and were waiting for employer insurance or Medicare (or the Tooth Fairy) to get non-critical surgeries done signed up for ACA where pre-existing conditions must be covered, got their non-critical surgeries done and promptly dropped their insurance, finding it cheaper to pay the penalty than the premium. This was abusive behavior, but is not illegal.

In the 'normal' sequence of things an individual or family does not face a major surgery annually, so ongoing insurance from somewhere means that some years the insurance company will make a profit on a particular family and some years it won't. Of course there are exceptions and historically insurance cut off individuals from further insurance coverage once they hit the million dollars spent on them mark. That is no longer allowed.

There has to be some 'sweet spot' out there where universal health care works. In the coverage of Castro's death one of the points mentioned was that Cuba offers free medical care and has about 3X as many doctors per thousand of population as the US. So I see the doc for 15 minutes, the first 5 are her nurse getting weight, blood pressure and pulse. The doc uses her stethoscope for a minute and spends the rest of the time on her keyboard asking me questions and typing in her 'findings'. The bill for $150 for the visit gets chopped down to $36 by insurance and paid. A bill in the mail today for $102.26 for an x-ray got chopped to 22.76. A bill a few years ago for a hip replacement came in at about $86,000 and was chopped down and paid at around $13,000. You can't afford NOT to have health insurance because you as an individual won't get the negotiated rates the insurance companies get. So we are paying the insurance company to negotiate prices and process paper and payments rather than having fair and reasonable pricing to start with.

I didn't have insurance at the time but I went to the hospital emergency room because I hurt my wrist(It's a small hospital with 1 other patient waiting for care). The doctor took some x-rays and said it's only a sprained wrist. The bill came in the mail and it was $2,000 In the bill it included a sling, but I never was given one. I was a minor at the time so my mother wrote a letter to the hospital. Never heard of the bill ever again.

Rather than having insurance, I would just write a strongly worded letter to the hospital and threaten media exposure.

Technically if an adult did not sign to be financially responsible for your care it might indeed be able to walk away from costs incurred by the minor though paying nothing towards services rendered is abusive IMHO. You would not appreciate having your shops unpaid because the owner of the MSC did not personally contract with you but rather had an outside scheduler do it.

I'm amazed that people would have insurance for their cars, but not for their bodies.

I'm blessed to have very good insurance through my union. I'm also blessed to only need it once a year for my physicals.

Charging me for a sling that I didn't receive is fraud. A lot of restaurants would comp a whole meal if they messed up. It's all about customer service.

@HonnyBrown wrote:

I'm amazed that people would have insurance for their cars, but not for their bodies.

I'm blessed to have very good insurance through my union. I'm also blessed to only need it once a year for my physicals.

Having car insurance is a waste of money too. We need universal car care.

I would not categorize a RANT on health insurance as political. It seems that to those of us who are self-employed discussing or RANTING about frustration with government services is relevant. Blaming it on a particular politician or politicians would seem to veer into political commentary and discussion.

Obama

Always the pot-stirrer. And an immature little boy.

Yeah, head to Cuba for your next surgery and let me know how that goes. If you read any Spanish-language sources or other than Huffington Boast/MSNBC, your thinking about Cuba's healthcare will likely do a 180.

If you are not a fan of ACA for whatever reason, and you keep practice of a particular religion (Christian, Moslem, Orthodox Jew, probably others), there are health-sharing organizations that don't require participation in ACA or the penalty. The ones I have looked at require participants to refrain from lifestyle choices that are medically higher risk.

ETA: Typo



Edited 1 time(s). Last edit at 11/29/2016 07:47AM by PasswordNotFound.

Very true. I went to Urgent Care for runners' knee (strained ligament). I was given a Motrin for the swelling. It was the same one I kept in my purse.

NINE dollars for one pill!

@DavePi wrote:

Charging me for a sling that I didn't receive is fraud. A lot of restaurants would comp a whole meal if they messed up. It's all about customer service.

@HonnyBrown wrote:

Very true. I went to Urgent Care for runners' knee (strained ligament). I was given a Motrin for the swelling. It was the same one I kept in my purse.

NINE dollars for one pill!

@DavePi wrote:

Charging me for a sling that I didn't receive is fraud. A lot of restaurants would comp a whole meal if they messed up. It's all about customer service.

Yes, they overcharge for everything. If you need extensive surgery, you're fecked. My mother has dual citizenship so she moved back to Taiwan for a little bit to remove her large cysts in her uterus, removing the uterus altogether(hysterectomy). Guess what she paid? $0. I'd probably move to Taiwan if I need to get anything major done.

Edit: My mother is doing great.



Edited 1 time(s). Last edit at 11/29/2016 06:00PM by DavePi.

Oh how I regret my original post. It stirred up a hornet's nest.
I should not have posted my frustrations. I will admit I knew better. It rates up there with me acknowledging the military/border patrol dogs. Not supposed to tell them they're pretty and good babies, but I have a tendency to do it anyways, The dogs amaze me. I know I can't behave well in obnoxious weather and obnoxious people.

@MA Smith wrote:

It rates up there with me acknowledging the military/border patrol dogs. Not supposed to tell them they're pretty and good babies, but I have a tendency to do it anyways, The dogs amaze me.

They certainly are amazing! I've watched them on their agility runs and it's a spectacular sight. I don't think I'd want one coming after me ;-). As for the not petting, it's because they're on the job, and it could be a distraction. Our local military base has a vet who will see non-military dogs on a space-a basis, so we have occasionally been able to chat with the trainers/operators. Serious business. German shepherds can be intimidating, but Ovcharkas are downright scary.

When I have time, i stop the car and watch when the dogs are being worked at the Lackland annex. It's the back way to my Dad's place. Lackland trains quite a few of the dogs used in K-9 situations.

Every once in awhile, puppies are brought over to the BX, so they learn how to socialize with children, crowds and massive noise.

I have a lot of respect for these dogs, because I grew up with them. I know what can happen.

But my favorite memory on one of my trips was a dog that wasn't up to specs. She was still a pup. Her handler took her to the potty area. She wouldn't do it. Had to sniff forever. Her handler did something with his body that said...BITE ME! Right after his body movement, the dog did business and then pulled the guy that was a solid 180lbs so she could go back to sniffing vehicles. He didn't expect it. Then the dog had an issue with sniffing the caddy trunk in front of me. She knew she was going to be praised but didn't get that she wasn't supposed to hang there forever.

It was hysterical. Even professionals can't get pups do it without repetition and they get just as frustrated as we mere mortals.

@DavePi wrote:

Yes, they overcharge for everything. If you need extensive surgery, you're fecked. My mother has dual citizenship so she moved back to Taiwan for a little bit to remove her large cysts in her uterus, removing the uterus altogether(hysterectomy). Guess what she paid? $0. I'd probably move to Taiwan if I need to get anything major done.

Edit: My mother is doing great.

I'm glad your Mom is doing well!

My friend's parents were traveling in a socialist country. Her Dad got really sick and was hospitalized for 3 weeks. Their bill totaled $150.

The statements about negotiated rates are not true. Medical providers don't negotiate rates with insurances. Insurance companies decide the reimbursement rates, and medical providers accept them. If a medical provider gets credentialed to bill an insurance company and chooses to be an in-network provider, the insurance company agrees to pay their claims with less hassle, more quickly, and at a different rate than out of network providers. That's the only negotiating going on there. One of my clients is a medical provider and he gives BETTER rates to his out of pocket patients (patients paying him without insurance) because he doesn't have to then pay me to file a claim, keep track of the claim's status, or wait 3-6 weeks for payment. Many other (but not all) providers will do this too, especially certain specialty providers (physical therapists, psychiatrists, etc) They often have to submit medical notes with every claim they file after the first few visits in order to get some insurance companies to keep paying claims. (FYI Cigna is the absolute worst in this regard.)
That doctor has to spend only 15 minutes per patient in order to see enough patients to afford to pay his/her staff, rent, operating costs, and themselves because of the "reasonable" reimbursement rates insurance companies pay.

@Flash wrote:

@MA Smith wrote:

I was listening to a non-political discussion the other day and there was an interesting comment that the insurance companies were losing money because those who had previously not had insurance and were waiting for employer insurance or Medicare (or the Tooth Fairy) to get non-critical surgeries done signed up for ACA where pre-existing conditions must be covered, got their non-critical surgeries done and promptly dropped their insurance, finding it cheaper to pay the penalty than the premium. This was abusive behavior, but is not illegal.

In the 'normal' sequence of things an individual or family does not face a major surgery annually, so ongoing insurance from somewhere means that some years the insurance company will make a profit on a particular family and some years it won't. Of course there are exceptions and historically insurance cut off individuals from further insurance coverage once they hit the million dollars spent on them mark. That is no longer allowed.

There has to be some 'sweet spot' out there where universal health care works. In the coverage of Castro's death one of the points mentioned was that Cuba offers free medical care and has about 3X as many doctors per thousand of population as the US. So I see the doc for 15 minutes, the first 5 are her nurse getting weight, blood pressure and pulse. The doc uses her stethoscope for a minute and spends the rest of the time on her keyboard asking me questions and typing in her 'findings'. The bill for $150 for the visit gets chopped down to $36 by insurance and paid. A bill in the mail today for $102.26 for an x-ray got chopped to 22.76. A bill a few years ago for a hip replacement came in at about $86,000 and was chopped down and paid at around $13,000. You can't afford NOT to have health insurance because you as an individual won't get the negotiated rates the insurance companies get. So we are paying the insurance company to negotiate prices and process paper and payments rather than having fair and reasonable pricing to start with.

My .2 cents....for you younger guys/girls the good thing about aging is Medicare and paying your $110.00 a month Ins. I get the best care, amazing Dr.'s many of which are switching from private practice, and went to the best Universities in the country. I recently had an eye drop prescribed for my condition of Glaucoma in the right eye, (blinding) and it is under control holding further damage back. I was unable to drive freeways as things got blurring (scary, yes). No pre-pay for appointments, cost of drop was $650.00. I told both Pharmacist and Dr., I just can't afford it, Dr. and Pharmacist took care of it, I pay 2.65. I asked no questions, but you have to speak up. I found this plan (United Healthcare on a job), and am so grateful for my care. Had paid (in the old days) $400.00 monthly for years, aging, bring it on.

@Irene_L.A. wrote:

My .2 cents....for you younger guys/girls the good thing about aging is Medicare and paying your $110.00 a month Ins. I get the best care, amazing Dr.'s many of which are switching from private practice, and went to the best Universities in the country. I recently had an eye drop prescribed for my condition of Glaucoma in the right eye, (blinding) and it is under control holding further damage back. I was unable to drive freeways as things got blurring (scary, yes). No pre-pay for appointments, cost of drop was $650.00. I told both Pharmacist and Dr., I just can't afford it, Dr. and Pharmacist took care of it, I pay 2.65. I asked no questions, but you have to speak up. I found this plan (United Healthcare on a job), and am so grateful for my care. Had paid (in the old days) $400.00 monthly for years, aging, bring it on.

But is medicare going to be around in 40+ years when I hit 65? I don't think we can sustain medicare with rising health costs and with the growing of the aging populace. Our debt to gdp ratio is already at a dangerous level and will probably get worse with the baby boomers retiring.



Edited 1 time(s). Last edit at 12/03/2016 06:11PM by DavePi.

I have lived overseas under the single payer system (national health care) and frankly, I like it much better. I got to see a doctor right away (none of the long waits which the anti-single-payer folks threaten us with). I saw the doctor when I needed the doctor, got services that I needed (Pap smears, mammograms, x-rays, blood tests, etc.) when I needed them. Everybody pays into it, just as you pay into Social Security, and it WORKED much better than our system does. I know insurance companies don't like it. It means less profit for them. But for patients, it's a much better system.

@DavePi wrote:

@Irene_L.A. wrote:

My .2 cents....for you younger guys/girls the good thing about aging is Medicare and paying your $110.00 a month Ins. I get the best care, amazing Dr.'s many of which are switching from private practice, and went to the best Universities in the country. I recently had an eye drop prescribed for my condition of Glaucoma in the right eye, (blinding) and it is under control holding further damage back. I was unable to drive freeways as things got blurring (scary, yes). No pre-pay for appointments, cost of drop was $650.00. I told both Pharmacist and Dr., I just can't afford it, Dr. and Pharmacist took care of it, I pay 2.65. I asked no questions, but you have to speak up. I found this plan (United Healthcare on a job), and am so grateful for my care. Had paid (in the old days) $400.00 monthly for years, aging, bring it on.

But is medicare going to be around in 40+ years when I hit 65? I don't think we can sustain medicare with rising health costs and with the growing of the aging populace. Our debt to gdp ratio is already at a dangerous level and will probably get worse with the baby boomers retiring.

I understand your concerns, but we will have a plan for seniors and hopefully a better one for others than you have now. They are working on revising health care and will get it right....40 years, they will find a way.

@cordener wrote:

I have lived overseas under the single payer system (national health care) and frankly, I like it much better. I got to see a doctor right away (none of the long waits which the anti-single-payer folks threaten us with). I saw the doctor when I needed the doctor, got services that I needed (Pap smears, mammograms, x-rays, blood tests, etc.) when I needed them. Everybody pays into it, just as you pay into Social Security, and it WORKED much better than our system does. I know insurance companies don't like it. It means less profit for them. But for patients, it's a much better system.

In Taiwan, doctors can obtain a patient's whole medical history that are readily available. They don't have to go through lots of paper work to get it. The wait times are short, but the time with the doctor is shorter, however you can visit the doctor as many times as you want. In most cases, you don't need to make an appointment. Fee: $25 a month

In the US, the quality of care is excellent, however the system that it works in is extremely poor. The US ranks at the very bottom in terms of health care systems. It is hard to navigate through and access health care because of cost/not convenient and a good portion of Americans forgo seeking treatment because of it. In return, Americans as a whole are unhealthy in comparison to other developed countries. We spend $9,523(2014) per capita(per person) on health care and we have the worst returns.

[www.cms.gov]

@DavePi wrote:

@cordener wrote:

I have lived overseas under the single payer system (national health care) and frankly, I like it much better. I got to see a doctor right away (none of the long waits which the anti-single-payer folks threaten us with). I saw the doctor when I needed the doctor, got services that I needed (Pap smears, mammograms, x-rays, blood tests, etc.) when I needed them. Everybody pays into it, just as you pay into Social Security, and it WORKED much better than our system does. I know insurance companies don't like it. It means less profit for them. But for patients, it's a much better system.

In Taiwan, doctors can obtain a patient's whole medical history that are readily available. They don't have to go through lots of paper work to get it. The wait times are short, but the time with the doctor is shorter, however you can visit the doctor as many times as you want. In most cases, you don't need to make an appointment. Fee: $25 a month

In the US, the quality of care is excellent, however the system that it works in is extremely poor. The US ranks at the very bottom in terms of health care systems. It is hard to navigate through and access health care because of cost/not convenient and a good portion of Americans forgo seeking treatment because of it. In return, Americans as a whole are unhealthy in comparison to other developed countries. We spend $9,523(2014) per capita(per person) on health care and we have the worst returns.


[www.cms.gov][/quote
Most people work and get Ins. through their companies, what is it you expect? Maybe it's time to think about moving back to Taiwan....

Live consciously....

Yep, that's one of the benefits of dual citizenship, you get access to both social services.