As expected under Obamacare: Insurance Exchange Premiums Through The Roof

[mp170.6]

Meaning they have much more power.

 

More power to do what?

 

They do seek lower costs!  Why do you think they have networks?  Our in network providers are all providers we have contracted lower rates with.

 

Also, competition not really?  Are you ****ing kidding me?  The competition is insane.  The sales process for a new company with say 500 lives takes months because the broker will negotiate with several insurance companies.  It is extremely competitive.

 

If they truly sought out lower costs, why do the premiums we pay keep increasing -- and not the other way around? 

 

The competition is insane?  Really?  I don't think you know the industry very well.  The top three players control 75% of the market.  And if you want an individual plan, it's even worse, because Blue Cross, Blue Shield, and Kaiser have a stranglehold on 87% of the market. 

 

http://www.chcf.org/publications/2013/03/data-viz-health-plans

 

 

Copays have everything to do with the plan you have picked.  They usually are around 20 dollars per office visit, 50 per urgent care and 100 per ER visit on the HIGH end.  They also only exist on managed care products, meaning plans with strict networks.  Those plans exist as low cost plans.  If you get your care done in network then the costs are covered by the copay.

 

Deductible is the amount of money you pay out of pocket in a plan year before your insurance coverage kicks in.  That is for things other than yearly checkups, etc.  If they charge $3k for a surgery and the deductible is 5000 then you pay out of pocket, if your deductible is 1500 then you only pay that, and the remaining percentage on the other 1500 not covered by the insurance.

 

I know what copays and deductibles are. 

 

The point I was making is that I can go to Oklahoma and pay $3,000 cash for the average surgery, but back home the same surgery costs $25,000 and I would have to pay a $5,000 deductible even with insurance that covers the same surgery. 

 

Our premiums ought to be peanuts since the deductibles are priced higher than the true costs for average surgeries. 

[Vegas Halo Fan]

I don't see how cutthroat the business can possibly be when, like most employees, I have exactly one choice of an insurance company - unless I go with the PPO, which covers less for a higher premium. United Healthcare has an essential monopoly with Nevada state employees. If we don't like them there is nowhere for us to go, and they know that. I also love it when (as they have done several times) they make fundamental changes in the conditions of the policy just after I'm locked in for the next 12 months. They also took a medication off their formulary when a family member was 60 days into a 90-day course of treatment. I got no notice, just found out when the pharmacy tried to charge me over $350 for a medication that was $50 the month before. The insurance company's response? "If her condition gets worse, we will cover the medication again." I told them to perform an impossible physical act and bought the medication from a pharmacy in Canada for about the cost of my previous deductible with UHC - and that was out of pocket with no insurance coverage.

 

Health insurance companies are scum. Period.

[Tank]

Will obamacare cover things like Michael Douglass' throat cancer?

[nate]

More power to do what?

 

 

If they truly sought out lower costs, why do the premiums we pay keep increasing -- and not the other way around? 

 

The competition is insane?  Really?  I don't think you know the industry very well.  The top three players control 75% of the market.  And if you want an individual plan, it's even worse, because Blue Cross, Blue Shield, and Kaiser have a stranglehold on 87% of the market. 

 

http://www.chcf.org/publications/2013/03/data-viz-health-plans

 

 

 

I know what copays and deductibles are. 

 

The point I was making is that I can go to Oklahoma and pay $3,000 cash for the average surgery, but back home the same surgery costs $25,000 and I would have to pay a $5,000 deductible even with insurance that covers the same surgery. 

 

Our premiums ought to be peanuts since the deductibles are priced higher than the true costs for average surgeries. 

 

Dude are you not paying attention, do you know what insurance is???  Our premiums go up because our costs go up.  As healthcare gets more expensive, our insurance gets more expensive.  Also, States and the Fed keep passing more and more coverage mandates that must be covered, which cost more money.

 

The surgery costs that because that is what the DOCTOR is charging, we are required to pay it.  Again, you have no ****ing clue what you are talking about.  Our premiums are what they are so we can pay all of your claims.  If the doctor charges 25k for that surgery and you have a 5k deductible, which by the way is extremely high.  Average deductible for a family is about 2500 and 1000 for a single plan.  If you have a 5k deductible you would have a much lower premium.  Anyway that still puts us on the hook for $20k.

 

This isn't car insurance where the longer you own the car the lower your premiums get because the car is older and less valuable.  Every year doctors are charging more and more for their care.

 

Insurance works two ways depending on what kind of plan you have.  If you have an individual plan, you are underwritten so your premiums match the risk of your plan.  If you are healthy and young your premiums will be very low, just to cover the cost of the occasional office visit.  If you are old and overweight your premiums will be much higher to cover the risk of a major health issue.

 

Group insurance plans for companies, the entire company is underwritten based on risk and the premium is the same for every member in the company.

 

VHF, the competition is huge, just because the company you work for only offers one carrier doesn't mean anything.  Every year on their anniversary they have the opportunity to change carriers.  They will go through the entire underwriting process again with their current carrier and several other carriers as they all jockey for that business.  They wont just offer lower rates but better coverage or more creative benefits.

[Adam]

So basically, the point of this thread is to make sure you never get AIDS, unless you're in Oklahoma.

[DowningRules]

F THIS!  Just called my insurance broker because my health insurance was raised by $30/month.  She told me to stick it out and that I'm actually on the cheapest plan she can find for what I need.  And this is WITH a $6800 deductible.

She told me she'd be calling in six months when the 'affordable health care act' goes into effect.  I said, "You mean 'Obamacare?'

 

There was a short silence and I got the message:  She doesn't want to/can't call it that.

 

But she did tell me no matter what, my rates will be going up in six months. 

 

This f'ing program is going to cost me a grip of cash that I could spend on small businesses and porn.  And this is BEFORE it even goes into practice.  The broker told me she is taking seminars, webinars, etc. to figure out Obamacare (my term not hers) and she's very puzzled.  She's been in the business for decades so it's not like she doesn't speak the lingo.

 

We are in for a terribly rude awakening since I have already decided that I'm not going to pay for insurance when the time comes.  And if I'm going to bail on paying for insurance, I can only guess how many other of my 300 million fellow legal countrymen will not pay for the scheme in the form of an insurance bill.  Put me in the penalty box and let every one else pay for me.  I can't afford affordable health care.

[Jay]

You think this is bad, just wait until Congress figures out that Obamacare is broken and tries to fix it. The result will be single-payer, which is what they wanted all along.

Feed the beast!

[halobob]

F THIS!  Just called my insurance broker because my health insurance was raised by $30/month.  She told me to stick it out and that I'm actually on the cheapest plan she can find for what I need.  And this is WITH a $6800 deductible.

She told me she'd be calling in six months when the 'affordable health care act' goes into effect.  I said, "You mean 'Obamacare?'

 

There was a short silence and I got the message:  She doesn't want to/can't call it that.

 

But she did tell me no matter what, my rates will be going up in six months. 

 

This f'ing program is going to cost me a grip of cash that I could spend on small businesses and porn.  And this is BEFORE it even goes into practice.  The broker told me she is taking seminars, webinars, etc. to figure out Obamacare (my term not hers) and she's very puzzled.  She's been in the business for decades so it's not like she doesn't speak the lingo.

 

We are in for a terribly rude awakening since I have already decided that I'm not going to pay for insurance when the time comes.  And if I'm going to bail on paying for insurance, I can only guess how many other of my 300 million fellow legal countrymen will not pay for the scheme in the form of an insurance bill.  Put me in the penalty box and let every one else pay for me.  I can't afford affordable health care.

Come on DR, we both know that it's only the small businesses that will suffer...your porn budget will remain the same.

[saangels]

This has proven to be an informative thread.  Thanks Nate and MP.  (And I'm not being sarcastic.)

[Vegas Halo Fan]

Will obamacare cover things like Michael Douglass' throat cancer?

 

Jay Leno talked about this in his monologue a couple of nights ago. He said that "Obamacare might not cover Michael Douglas' throat cancer, but Clintoncare certainly would have."

[Vegas Halo Fan]

Group insurance plans for companies, the entire company is underwritten based on risk and the premium is the same for every member in the company.

 

VHF, the competition is huge, just because the company you work for only offers one carrier doesn't mean anything.  Every year on their anniversary they have the opportunity to change carriers.  They will go through the entire underwriting process again with their current carrier and several other carriers as they all jockey for that business.  They wont just offer lower rates but better coverage or more creative benefits.

 

I might buy this if I hadn't had to spend so much time and effort trying to get my insurance carrier to cover things that they should definitely pay. At times they seem to be deliberately trying to inconvenience me, hoping that I will get frustrated enough to just give up and pay the bill. I have hand carried documentation to their office only to have them later claim that they never received it. One time I had to leave work early to pick up records at one of their clinics and hand carry them to another, because they claimed that they had no mechanism to send them between two of their own offices before my appointment (they told me this two hours before I was supposed to be there). On another occasion my wife and I went to a quick care owned and operated by the insurance company, The doctor recommended that my wife have surgery immediately. The insurance company then denied the claim, saying that their own doctor did not have the authority to authorize surgery - despite the fact that he handed us a written referral before we left the office, certified that it was a medical emergency, and the referral was to the insurance company's own surgery center. Only when I had an attorney friend call them did they pull their heads out of their collective posteriors and begin to do something.

 

I could go on, but it would just bore people to death.

 

My opinion stands. If the business was as competitive as you say it is, insurance companies wouldn't spend as much time and effort as they do trying to deliberately screw over their own policyholders.

[arch stanton]

Is the possibility of being bored to death going to be covered?

[Vegas Halo Fan]

Is the possibility of being bored to death going to be covered?

 

They will tell you it is, until you submit a claim.

[nate]

I might buy this if I hadn't had to spend so much time and effort trying to get my insurance carrier to cover things that they should definitely pay. At times they seem to be deliberately trying to inconvenience me, hoping that I will get frustrated enough to just give up and pay the bill. I have hand carried documentation to their office only to have them later claim that they never received it. One time I had to leave work early to pick up records at one of their clinics and hand carry them to another, because they claimed that they had no mechanism to send them between two of their own offices before my appointment (they told me this two hours before I was supposed to be there). On another occasion my wife and I went to a quick care owned and operated by the insurance company, The doctor recommended that my wife have surgery immediately. The insurance company then denied the claim, saying that their own doctor did not have the authority to authorize surgery - despite the fact that he handed us a written referral before we left the office, certified that it was a medical emergency, and the referral was to the insurance company's own surgery center. Only when I had an attorney friend call them did they pull their heads out of their collective posteriors and begin to do something.

 

I could go on, but it would just bore people to death.

 

My opinion stands. If the business was as competitive as you say it is, insurance companies wouldn't spend as much time and effort as they do trying to deliberately screw over their own policyholders.

 

I can't address your specific situation without knowing all the facts.  I would assume you have a HMO.  That is the narrowest network plan you can have.  Insurance companies have to protect themselves from fraud and excess so they will scrutinize claims that they do not believe to be under the contract of the plan you are enrolled in.  Because it is so competitive and profit margins are so slim, they cannot afford excess spending.  They should however always pay claims they are obligated to.  My guess is your doctors improperly got pre cert/referral.

 

I would suggest against HMO plans.  They are cheap but they severely limit your options and open you up for large out of pocket expenses.

[HaloMagic]

They should scrutinize claims in house and not pull the customer along for the ride. If the claim is legit and is going to be paid then they shouldn't inconvenience the customer while they play their little yes-no bipolar coverage game.

[nate]

They should scrutinize claims in house and not pull the customer along for the ride. If the claim is legit and is going to be paid then they shouldn't inconvenience the customer while they play their little yes-no bipolar coverage game.

 

They do scrutinize in house.  That is how they determined the claim should be rejected.

[mtangelsfan]

I do believe that many insurance companies will deny coverage at first with the hope that the patient will just accept that answer.  We know this has been done in the past due to court cases.

 

Everybody's hands are dirty in this.  Insurance companies, doctors, hospitals, lawyers, the general public and fraud.

[nate]

I do believe that many insurance companies will deny coverage at first with the hope that the patient will just accept that answer.  We know this has been done in the past due to court cases.

 

Everybody's hands are dirty in this.  Insurance companies, doctors, hospitals, lawyers, the general public and fraud.

 

Maybe it happened years ago but regulations and audits make this a very expensive practice.  The fines we face for this would cripple the company.

[mtangelsfan]

Maybe?

[HaloMagic]

They do scrutinize in house. That is how they determined the claim should be rejected.

But then they reject it and people fight it and they then backtrack and end up paying sometimes. They need to get it right the first time instead of making their customers fight with them.

[nate]

But then they reject it and people fight it and they then backtrack and end up paying sometimes. They need to get it right the first time instead of making their customers fight with them.

 

We usually do.  Again, health insurance companies lose billions every year due to fraud.  Most of the time claims get rejected it is because they are filed incorrectly.  More than 90% of all claims are automatically approved without any intervention.  Of the remaining 10%, 6% are approved after review from claim consultants, the other 4% are pended or denied.

 

Because health insurance companies are always made out to be the enemy all you ever hear about is how us evil health insurance companies are wrongly denying claims to everyone.  In reality it is a very small issue.

 

Also, studies have concluded that less than 25% of Americans understand their health insurance coverage.  We have spent millions communicating in simple terms how the coverage works, what is covered at what percentages and what isn't covered at all.  Including toll free numbers to call and confirm before getting care.  I realize that doesn't work in emergency situations but that isn't usually when these issues happen since almost all coverages include emergency care.  Since those communications have gone out the level of understanding has increased but still most people ignore those communications.

[HaloMagic]

Because health insurance companies are always made out to be the enemy all you ever hear about is how us evil health insurance companies are wrongly denying claims to everyone. In reality it is a very small issue.

I'm not concerned with what I hear about. I'm concerned with what I've experienced. And judging from my own experience the reason "all [we] ever hear about is how evil health insurance companies are wrongly denying claims" is because many other people have had experiences that match my own.

[floplag]

yeah.. calling bullshit on this as nothing more than an attempt to deflect it.. i do not know one person who can say their rates have dropped under this.. and if they have its becaseu their hours have also dropped making it moot or worse on the net income

[Vegas Halo Fan]

They do scrutinize in house.  That is how they determined the claim should be rejected.

 

One of my nursing colleagues once worked for the insurance company we are stuck with. She said that their appeals process is a complete sham. They rule against themselves just often enough so that it isn't 0% of the time. She said that even the so-called independent arbitrator is beholden to them. She said "Think about it. If he had a history of ruling against them, would they keep paying him to do it?" When this so-called arbitrator ruled on my claim, I was not allowed to be present or to know what documents he was or was not reviewing. The insurance company took care of all of that. For all I know, they may have withheld the letter I had from an emergency physician stating that the proper level of care was used and that the ER visit was medically necessary.

[gotbeer]

IRS scandals threaten funding for health care law