I had a delightful conversation with a health Insurance company rep this morning

Quote

Originally posted by: Chilcoot
How could you pay $27,000 in out of pocket? As you've read here many times, the annual family limit for out-of-pocket is $12,700. How could you still not know that?

Again, I'm glad you signed up. But you really are clueless about how this works.


Quote

Originally posted by: Chilcoot
As for prescription drugs, it's true they have their own cap for 2014.


Quote

Originally posted by: forkushV
Quote

Originally posted by: Can you name one single issue with Obamacare that your physician had? I mean just ONE


Physicians are not obligated to detail business decisions to patients. You can believe, though, that it is not usually "one single issue" but the piling on of issues.

My brother closed his private primary care practice 17 years ago (obviously before the ACA). He didn't want to, he loved his patients. But the straw was the ever increasing complexity of filing, denials, re-filing, etc. with the various payers including HMOs, insurances companies, Medicare, Medicaid, etc. Suddenly some long-time patients are not covered for this or that treatment, or at all. No person not in the business of running a medical practice can comprehend this. Part of what we are charged is to pay the salaries of people (and the electronic systems required) who's job is to do this battle. Womb to tomb practices where "everybody knows your name" (like my brother's) are at risk when yet another new wrinkle in the insurance madness, another new regulation, more documentation requirements come down.
Quote

Originally posted by: O2bnVegas
Quote

Originally posted by: forkushV
Quote

Originally posted by: Can you name one single issue with Obamacare that your physician had? I mean just ONE


Physicians are not obligated to detail business decisions to patients. You can believe, though, that it is not usually "one single issue" but the piling on of issues...
True! Which is why anyone who says that their "family physician quit his practice because of Obamacare" is being dishonest.
If you look closely I believe you will see I said my income. My wife has made some income this year (she worked three weeks) and disability won't kick in until July 20, at the soonest but it will still be 2014 household income.

Quote

Originally posted by: Chilcoot
At a $65,000 income, which you described as a "high side" estimate for your family this year, your family's monthly premium subsidy will by almost $500 a month for a plan that covers a family of four. No way will your premiums his "roughly 10k" a year on an unsubsidized policy with the $756 unsubsidized monthly premium amount when the government is paying over half the premium. ($756 monthly premium - $450 monthly subsidy) X 12 months = $3672 a year in premiums, not $10,000.

As for prescription drugs, it's true they have their own cap for 2014. Next year, they'll be folded into the general out-of-pocket cap.

However, for a typical silver plan in Indiana like this one from Anthem, the copays and coinsurance are tiny for the vast majority of people.



Now, if your family consumes over $127,000 a year in specialty drugs, yes you will be subject to two $12,700 out-of-pockets this one year, it's true. But what's the alternative? You pay $12,700, and insurance pays the remaining $114,300, plus another $6,000 in premium subsidies, plus who knows how many tens or hundreds of thousands for your primary care physicians, specialists, emergency room care, and inpatient facilities and physicians.

Is Obamacare perfect? Definitely not. Is it an unbelievable godsend for very, very sick people like you and your wife? Without question.



It looks like Vermont's single payer system is in trouble even though it doesn't launch for another 3 years

Vermont Watchdog reported, an independent report by the Washington, D.C.-based consulting firm Avalere Health concluded that the costs of Green Mountain Care would require Vermont to raise tax revenue roughly equal to the state's tax collections from all sources today.

Condon, a Democrat from Colchester, said he thinks a single-payer system in Vermont would "cost more" than a couple of previous estimates. Those estimates pegged the cost for single-payer at anywhere from $1.6 billion to $2.2 billion annually.

"It's a government program [so] I think it's going to cost more than that. Given that, I think it would be in the best interest of Vermonters to redirect our energies away from single-payer health care to trying to improve the system we're in now," Condon added.
A front page story in my local paper 'The Fresno Bee' recently pointed out a major flaw in Obamcare and it's California implementation 'Covered California'. Local Doctors are just not accepting those plans.

https://insurancenewsnet.com/oarticle/2014/03/16/some-calif-doctors-rejecting-aca-plans-a-475154.html#.Uyg3sy3n99A

"Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low."

"The 160-doctor Central California Faculty Medical Group -- one of the largest private physician groups in Fresno -- decided not to accept patients with PPO plans through Covered California.

"We would be paying to see patients, and we just couldn't afford to do that," said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group, which is affiliated with the University of California at San Francisco-Fresno Medical Education Program."

So, although these particular doctors are not leaving the profession, I can see why many doctors might conclude that physicians 'paying to see patients' is not a sustainable business model.
Quote

Originally posted by: alanleroyII
A front page story in my local paper 'The Fresno Bee' recently pointed out a major flaw in Obamcare and it's California implementation 'Covered California'. Local Doctors are just not accepting those plans.

https://insurancenewsnet.com/oarticle/2014/03/16/some-calif-doctors-rejecting-aca-plans-a-475154.html#.Uyg3sy3n99A

"Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low."

"The 160-doctor Central California Faculty Medical Group -- one of the largest private physician groups in Fresno -- decided not to accept patients with PPO plans through Covered California.

"We would be paying to see patients, and we just couldn't afford to do that," said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group, which is affiliated with the University of California at San Francisco-Fresno Medical Education Program."

So, although these particular doctors are not leaving the profession, I can see why many doctors might conclude that physicians 'paying to see patients' is not a sustainable business model.


Is there something in Obamacare that tells insurance companies how much they pay doctors for their services? I dont believe there is. Feel free to correct me by posting that aspect of the law below.

...Oh wait...from AlanLeroy's link....
" Doctors who are not participating in plans through the exchange also are not participating in comparable plans sold in the private, individual marketplace.

But it's been a struggle getting word out to consumers that there is no difference in the providers for a private PPO plan and the equivalent plan through Covered California. "
Quote

Originally posted by: alanleroyII
A front page story in my local paper 'The Fresno Bee' recently pointed out a major flaw in Obamcare and it's California implementation 'Covered California'. Local Doctors are just not accepting those plans.

https://insurancenewsnet.com/oarticle/2014/03/16/some-calif-doctors-rejecting-aca-plans-a-475154.html#.Uyg3sy3n99A

"Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low."

"The 160-doctor Central California Faculty Medical Group -- one of the largest private physician groups in Fresno -- decided not to accept patients with PPO plans through Covered California.

"We would be paying to see patients, and we just couldn't afford to do that," said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group, which is affiliated with the University of California at San Francisco-Fresno Medical Education Program."

So, although these particular doctors are not leaving the profession, I can see why many doctors might conclude that physicians 'paying to see patients' is not a sustainable business model.
Doctors have decided to accept certain insurance and refuse others. This has never happened before in history.

From your link:


Quote

Originally posted by: pjstroh
Quote

Originally posted by: alanleroyII
A front page story in my local paper 'The Fresno Bee' recently pointed out a major flaw in Obamcare and it's California implementation 'Covered California'. Local Doctors are just not accepting those plans.

https://insurancenewsnet.com/oarticle/2014/03/16/some-calif-doctors-rejecting-aca-plans-a-475154.html#.Uyg3sy3n99A

"Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low."

"The 160-doctor Central California Faculty Medical Group -- one of the largest private physician groups in Fresno -- decided not to accept patients with PPO plans through Covered California.

"We would be paying to see patients, and we just couldn't afford to do that," said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group, which is affiliated with the University of California at San Francisco-Fresno Medical Education Program."

So, although these particular doctors are not leaving the profession, I can see why many doctors might conclude that physicians 'paying to see patients' is not a sustainable business model.


Is there something in Obamacare that tells insurance companies how much they pay doctors for their services? I dont believe there is. Feel free to correct me by posting that aspect of the law below.

...Oh wait...from AlanLeroy's link....
" Doctors who are not participating in plans through the exchange also are not participating in comparable plans sold in the private, individual marketplace.

But it's been a struggle getting word out to consumers that there is no difference in the providers for a private PPO plan and the equivalent plan through Covered California. "

Ah..but riddle me this..You go to all the time and money and effort to create a massive state run insurance exchange and then the plans that are offered are not being accepted by a very large percentage of physicians (at least in my city). Remind me what good that is....remind me how funneling a whole lot of new patients to a very few low end providers is going to improve medical care. I guess that may work until it bankrupts them.

I also wonder when this whole thing was 'designed' what the physician participation rate was estimated to be and how that syncs up with today's reality...because that's a pretty important statistic to know...don't you think? Maybe it's all working according to the master plan. Somehow I doubt that.

Quote

Originally posted by: alanleroyII
Quote

Originally posted by: pjstroh
Quote

Originally posted by: alanleroyII
A front page story in my local paper 'The Fresno Bee' recently pointed out a major flaw in Obamcare and it's California implementation 'Covered California'. Local Doctors are just not accepting those plans.

https://insurancenewsnet.com/oarticle/2014/03/16/some-calif-doctors-rejecting-aca-plans-a-475154.html#.Uyg3sy3n99A

"Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low."

"The 160-doctor Central California Faculty Medical Group -- one of the largest private physician groups in Fresno -- decided not to accept patients with PPO plans through Covered California.

"We would be paying to see patients, and we just couldn't afford to do that," said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group, which is affiliated with the University of California at San Francisco-Fresno Medical Education Program."

So, although these particular doctors are not leaving the profession, I can see why many doctors might conclude that physicians 'paying to see patients' is not a sustainable business model.


Is there something in Obamacare that tells insurance companies how much they pay doctors for their services? I dont believe there is. Feel free to correct me by posting that aspect of the law below.

...Oh wait...from AlanLeroy's link....
" Doctors who are not participating in plans through the exchange also are not participating in comparable plans sold in the private, individual marketplace.

But it's been a struggle getting word out to consumers that there is no difference in the providers for a private PPO plan and the equivalent plan through Covered California. "

Ah..but riddle me this..You go to all the time and money and effort to create a massive state run insurance exchange and then the plans that are offered are not being accepted by the a very large percentage of physicians (at least in my city). Remind me what good that is....remind me how funneling a whole lot of new patients to a very few low end providers is going to improve medical care. I guess that may work until it bankrupts them.


Is the exchange the problem? No. Your own link says as much. The private insuance companies set their own prices..not the law, right? But then you blame the law.

Ypuir original post says there is a flaw in Obamacare but Obamacare has nothing to do with the flaw you cite. But thanks for stopping by.
Already a LVA subscriber?
To continue reading, choose an option below:
Diamond Membership
$3 per month
Unlimited access to LVA website
Exclusive subscriber-only content
Limited Member Rewards Online
Join Now
or
Platinum Membership
$50 per year
Unlimited access to LVA website
Exclusive subscriber-only content
Exclusive Member Rewards Book
Join Now