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 Shelter Dog Lover
Posts: 10277
  
| I sent your post to my daughter. Her response:
Could be true. There are several brand new carriers that entered the market b/c of obamacare and Lockton has told HR to warn EEs from these new companies for this reason. You don’t know anything about level of service, network coverage, etc. and there is no way for the consumer to know what they’re getting.
Under the affordable care act, ER services must be covered at the same level as in-network services so what that company is doing is illegal under HCR if it was truly an emergency and she was processed through the ER. They must have processed it as an in-patient stay and that would be out of network and the OOP maxes set under HCR don’t apply then.
It honestly sounds like this lady bought a plan that she really didn’t understand (narrow network) from a company that is turning out to be less-than reputable. That’s one of the major flaws with HCR. It assumes that consumers can make educated decisions on what kind of health insurance that they need but in reality, insurance is extremely complicated and the average consumer just hasn’t been educated enough on the intricacies of the legislation and insurance in general. Also, there is a lack of transparency on the part of insurance companies and this makes it difficult for consumers to make good choices even if they know exactly what they want/need.
From:
Sent: Wednesday, May 28, 2014 1:23 PM
To: Murphy, Ryan
Subject: your thoughts?/
a post on barrel horse world
My "Friend" had to have emergency surgery just after she was dropped from United Health Care and forced onto Obamacare. She wansn't worried and hasn't seen a bill until two days ago. Nothing is covered. Why? Because the company providing coverage under the mandate nobody has heard of. When she contacts them all she gets is the reply that her surgeon is "out of network"
It was an emergency...she didn't have time to pick a surgeon or the anesthesiologist or any of the other charges.
She tries to get past the robot on the phone and there is NO live person to explain anything to.
Had she not been dropped all she would have had to pay is her deductible of 500.00 Now she is out for more than ten thousand thanks to this new federal mandate.
Question is; Where is the money going that is pouring into Obama care.
I really want to know. Signed, confirmed tin foil hat wearer.
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  The Original Cyber Bartender
 
Location: Washington | RidenFly - 2014-05-28 11:01 AM My "Friend" had to have emergency surgery just after she was dropped from United Health Care and forced onto Obamacare. She wansn't worried and hasn't seen a bill until two days ago. Nothing is covered. Why? Because the company providing coverage under the mandate nobody has heard of. When she contacts them all she gets is the reply that her surgeon is "out of network"
It was an emergency...she didn't have time to pick a surgeon or the anesthesiologist or any of the other charges.
She tries to get past the robot on the phone and there is NO live person to explain anything to.
Had she not been dropped all she would have had to pay is her deductible of 500.00 Now she is out for more than ten thousand thanks to this new federal mandate.
Question is; Where is the money going that is pouring into Obama care.
I really want to know. Signed, confirmed tin foil hat wearer.
So before the emergency surgery there wasn't someone with her or herself signing paperwork? The hospital by allowing the surgery to take place had agree to her insurance plan, the medical team is also bound to this agreement. BUT they will charge her for her aftercare if they are out of network, they should be making her aware of that. Tell her to call the hospital, or better yet go down and talk to them. | |
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 Famous for Not Complaining
Posts: 8848
Location: Broxton, Ga | Nevertooold - 2014-05-27 2:30 PM I no longer have healthcare that I pay $500.00 a month for...I now have catastrophic insurance. Sucks! My deductible is $6,000. I wish I had the money we have paid into healthcare just since the DickTator has taken office.
Same boat.........December our premium will increase to $1200.00 monthly..........$12,000.00 deductible..... | |
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 Over Informed
Posts: 5372
Location: West Tennessee | fatchance - 2014-05-28 3:00 PM RidenFly - 2014-05-28 11:01 AM My "Friend" had to have emergency surgery just after she was dropped from United Health Care and forced onto Obamacare. She wansn't worried and hasn't seen a bill until two days ago. Nothing is covered. Why? Because the company providing coverage under the mandate nobody has heard of. When she contacts them all she gets is the reply that her surgeon is "out of network"
It was an emergency...she didn't have time to pick a surgeon or the anesthesiologist or any of the other charges.
She tries to get past the robot on the phone and there is NO live person to explain anything to.
Had she not been dropped all she would have had to pay is her deductible of 500.00 Now she is out for more than ten thousand thanks to this new federal mandate.
Question is; Where is the money going that is pouring into Obama care.
I really want to know. Signed, confirmed tin foil hat wearer. So before the emergency surgery there wasn't someone with her or herself signing paperwork? The hospital by allowing the surgery to take place had agree to her insurance plan, the medical team is also bound to this agreement. BUT they will charge her for her aftercare if they are out of network, they should be making her aware of that. Tell her to call the hospital, or better yet go down and talk to them.
In addition, the one thing I'm learning at my new job is that when a Dr's office verifies coverage the insurance companies also give themselves an out that on every EOB (estimate of benefits) -- that reads something to the effect of this doesn't gaurantee coverage it just shows that our system at the moment says the person has X insurance in place.
editied to attempt to make that clearer: When I verify coverage, I request a fax from the insurance company. In small print on every fax it states that this only verifies that coverage is in existence at the moment but does not guarantee coverage at the time a claim is filed.
The insurance portion of my new job is beyond scarey -- it is so incredibly confusing & I'm just dealing with orthodonic coverage only! I can't imagine medical or denistry!!!
Edited by dme0324 2014-05-28 6:46 PM
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"Heck's Coming With Me"
Posts: 10797
Location: Kansas | Riden, a month or so ago a fellow in 50's or 60's had something similar happen. He was forced onto Obamacare and had been paying his premiums as required. Then he had a heart attack. Turned out no "confirmation" that he was indeed on this specific policy was in place. Looked as if he was going to be stuck with all the hospital bills. | |
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 Ima Fickle Fan
Posts: 3547
Location: Texas | I personally see cases like this becoming a lawsuit. We have friends in Wyoming who got dropped from their insurance. Before they could sign up for Obamacare, the wife had a stroke and was careflighted to Denver. She was in the nuero ICU for a week or so. Due to the astronomical hospital bills, they may lose their ranch and business.
The whole Obamacare thing to me is a huge scam and royal mess. | |
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 Baby Blue's
Posts: 7306
Location: Texas | rodeomom3 - 2014-05-28 2:58 PM I sent your post to my daughter. Her response:
Could be true. There are several brand new carriers that entered the market b/c of obamacare and Lockton has told HR to warn EEs from these new companies for this reason. You don’t know anything about level of service, network coverage, etc. and there is no way for the consumer to know what they’re getting.
Under the affordable care act, ER services must be covered at the same level as in-network services so what that company is doing is illegal under HCR if it was truly an emergency and she was processed through the ER. They must have processed it as an in-patient stay and that would be out of network and the OOP maxes set under HCR don’t apply then.
It honestly sounds like this lady bought a plan that she really didn’t understand (narrow network) from a company that is turning out to be less-than reputable. That’s one of the major flaws with HCR. It assumes that consumers can make educated decisions on what kind of health insurance that they need but in reality, insurance is extremely complicated and the average consumer just hasn’t been educated enough on the intricacies of the legislation and insurance in general. Also, there is a lack of transparency on the part of insurance companies and this makes it difficult for consumers to make good choices even if they know exactly what they want/need.
From:
Sent: Wednesday, May 28, 2014 1:23 PM
To: Murphy, Ryan
Subject: your thoughts?/
a post on barrel horse world
My "Friend" had to have emergency surgery just after she was dropped from United Health Care and forced onto Obamacare. She wansn't worried and hasn't seen a bill until two days ago. Nothing is covered. Why? Because the company providing coverage under the mandate nobody has heard of. When she contacts them all she gets is the reply that her surgeon is "out of network"
It was an emergency...she didn't have time to pick a surgeon or the anesthesiologist or any of the other charges.
She tries to get past the robot on the phone and there is NO live person to explain anything to.
Had she not been dropped all she would have had to pay is her deductible of 500.00 Now she is out for more than ten thousand thanks to this new federal mandate.
Question is; Where is the money going that is pouring into Obama care.
I really want to know. Signed, confirmed tin foil hat wearer.
-----
~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~
Interesting! My daughter broke her arm last month and we took her to the ER where she was sent via ambulance to the childrens hospital (we had to start off in the ER there). My company goes through an insurance "broker" which is great because I just send them all my bills and they tell me what to pay and answer any of my questions instead of me having to deal directly with BCBS. Anyways, before I got my first bill I sent an email giving them a heads up about what happened and right off the bat she let me know that emergency services (ambulance, care flight, etc) hardly are EVER covered (meaning the fees are 100% the patients and don't go towards your normal deductable) because they don't have to be. People don't shop around for emergency services when there's an ACTUAL EMERGENCY. Wonder if the ACA lumps that in with "ER services?" | |
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 Hawty & Nawty
Posts: 20424
| Isn't that lovely?  Stupid law. | |
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 Hugs to You
Posts: 7551
Location: In The Land of Cotton | Here are some info numbers for anyone with insurance problems - Your individual State Insurance Department, the US Department of Labor, Employee Benefits Security Administration at 866-444-3272 or www.dol.gov/ebsa, the US Department of Health and Human Services - 877-267-2323x61565 or www.cciio.cms.gov
More and more people are going to find out that their insurance plans and coverages are only going to meet the minimum esstential coverage and the minimum value standard for benefits.
The reason for "most" but not all bankruptcies in America a few years ago was a health catastrophy. I see the numbers balloning because of the new health care laws and plans. Most people do not have the knowledge and time to research all of the "fine" print involved and are going to really get screwed. | |
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Shelter Dog Lover
Posts: 10277
| bocephus's mama - 2014-05-29 9:29 AM rodeomom3 - 2014-05-28 2:58 PM I sent your post to my daughter. Her response:
Could be true. There are several brand new carriers that entered the market b/c of obamacare and Lockton has told HR to warn EEs from these new companies for this reason. You don’t know anything about level of service, network coverage, etc. and there is no way for the consumer to know what they’re getting.
Under the affordable care act, ER services must be covered at the same level as in-network services so what that company is doing is illegal under HCR if it was truly an emergency and she was processed through the ER. They must have processed it as an in-patient stay and that would be out of network and the OOP maxes set under HCR don’t apply then.
It honestly sounds like this lady bought a plan that she really didn’t understand (narrow network) from a company that is turning out to be less-than reputable. That’s one of the major flaws with HCR. It assumes that consumers can make educated decisions on what kind of health insurance that they need but in reality, insurance is extremely complicated and the average consumer just hasn’t been educated enough on the intricacies of the legislation and insurance in general. Also, there is a lack of transparency on the part of insurance companies and this makes it difficult for consumers to make good choices even if they know exactly what they want/need.
From:
Sent: Wednesday, May 28, 2014 1:23 PM
To: Murphy, Ryan
Subject: your thoughts?/
a post on barrel horse world
My "Friend" had to have emergency surgery just after she was dropped from United Health Care and forced onto Obamacare. She wansn't worried and hasn't seen a bill until two days ago. Nothing is covered. Why? Because the company providing coverage under the mandate nobody has heard of. When she contacts them all she gets is the reply that her surgeon is "out of network"
It was an emergency...she didn't have time to pick a surgeon or the anesthesiologist or any of the other charges.
She tries to get past the robot on the phone and there is NO live person to explain anything to.
Had she not been dropped all she would have had to pay is her deductible of 500.00 Now she is out for more than ten thousand thanks to this new federal mandate.
Question is; Where is the money going that is pouring into Obama care.
I really want to know. Signed, confirmed tin foil hat wearer.
-----
~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~~~~<>~
Interesting! My daughter broke her arm last month and we took her to the ER where she was sent via ambulance to the childrens hospital (we had to start off in the ER there). My company goes through an insurance "broker" which is great because I just send them all my bills and they tell me what to pay and answer any of my questions instead of me having to deal directly with BCBS. Anyways, before I got my first bill I sent an email giving them a heads up about what happened and right off the bat she let me know that emergency services (ambulance, care flight, etc) hardly are EVER covered (meaning the fees are 100% the patients and don't go towards your normal deductable) because they don't have to be. People don't shop around for emergency services when there's an ACTUAL EMERGENCY. Wonder if the ACA lumps that in with "ER services?"
My daughter's response:
The broker was 100% correct. Prior to 2014, there were no regulations around the cost share of out of network services. Beginning on Jan 2014 (or the plan’s ERISA contract date), all non-grandfathered plans have to cover out of network er services at the same level that they cover in-network services. The coverage of ambulances etc. does vary by plan but all EE out of pocket costs (except premium) must now accrue toward the OOP Max (where before most did not). As an aside, ER services are now considered an essential health benefit and thus cannot have any annual and lifetime limits. My understanding is that Ambulance, care flight, etc. now MUST be covered if it is considered a true emergency and if it is a non-emergency, it must be covered if taking another form of transportation would endanger the patient’s health.
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Shelter Dog Lover
Posts: 10277
| 3canstorun - 2014-05-29 10:14 AM Here are some info numbers for anyone with insurance problems - Your individual State Insurance Department, the US Department of Labor, Employee Benefits Security Administration at 866-444-3272 or www.dol.gov/ebsa, the US Department of Health and Human Services - 877-267-2323x61565 or www.cciio.cms.gov
More and more people are going to find out that their insurance plans and coverages are only going to meet the minimum esstential coverage and the minimum value standard for benefits.
The reason for "most" but not all bankruptcies in America a few years ago was a health catastrophy. I see the numbers balloning because of the new health care laws and plans. Most people do not have the knowledge and time to research all of the "fine" print involved and are going to really get screwed.
Exactly what my daughter is already seeing from the business side of it. | |
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Hungarian Midget Woman
Location: Midwest | rodeomom3 - 2014-05-29 10:24 AM 3canstorun - 2014-05-29 10:14 AM Here are some info numbers for anyone with insurance problems - Your individual State Insurance Department, the US Department of Labor, Employee Benefits Security Administration at 866-444-3272 or www.dol.gov/ebsa, the US Department of Health and Human Services - 877-267-2323x61565 or www.cciio.cms.gov
More and more people are going to find out that their insurance plans and coverages are only going to meet the minimum esstential coverage and the minimum value standard for benefits.
The reason for "most" but not all bankruptcies in America a few years ago was a health catastrophy. I see the numbers balloning because of the new health care laws and plans. Most people do not have the knowledge and time to research all of the "fine" print involved and are going to really get screwed.
Just wait till the poop really hits the fan in coming years
it will be interesting to say the least.... I'm hoping specialized care doesn't go down the toilet enough for me to lose my job (I work in a genetics medical lab). If I look at what I know of other european countries with universal healthcare, I will likely be okay because I work in a private University hospital setting.
Countries like Poland, India, and others right now have two main tiers of care: the government care, which is basically where you go to die, or private care, which is paid out of pocket completely. There is no "insurance" to buy. If you can't afford the surgery/meds/whatever, you die. Plain and simple. And yes, you pay up front. No financing. | |
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Hugs to You
Posts: 7551
Location: In The Land of Cotton | barrelracr131 - 2014-05-29 11:32 AM rodeomom3 - 2014-05-29 10:24 AM 3canstorun - 2014-05-29 10:14 AM Here are some info numbers for anyone with insurance problems - Your individual State Insurance Department, the US Department of Labor, Employee Benefits Security Administration at 866-444-3272 or www.dol.gov/ebsa, the US Department of Health and Human Services - 877-267-2323x61565 or www.cciio.cms.gov
More and more people are going to find out that their insurance plans and coverages are only going to meet the minimum esstential coverage and the minimum value standard for benefits.
The reason for "most" but not all bankruptcies in America a few years ago was a health catastrophy. I see the numbers balloning because of the new health care laws and plans. Most people do not have the knowledge and time to research all of the "fine" print involved and are going to really get screwed.
it will be interesting to say the least.... I'm hoping specialized care doesn't go down the toilet enough for me to lose my job (I work in a genetics medical lab). If I look at what I know of other european countries with universal healthcare, I will likely be okay because I work in a private University hospital setting.
Countries like Poland, India, and others right now have two main tiers of care: the government care, which is basically where you go to die, or private care, which is paid out of pocket completely. There is no "insurance" to buy. If you can't afford the surgery/meds/whatever, you die. Plain and simple. And yes, you pay up front. No financing.
Apparently though, the people in India must either: 1. Have lots of money to pay for medical care for child brith; or 2. Pop them out in their homes, because there sure are a lot of them. | |
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Hungarian Midget Woman
Location: Midwest | OT but yes, A lot of people in India are very very poor. I believe midwives are common in their culture. They do a lot of things differently there. Many people live in village-type locales. I work with a lady from India- she told me it is still somewhat common for the shieks to come to India and buy poor young Indian women as second and third wives and move them to Dubai. The women then travel back and forth and can give some money to their poor families back in the villages. ETA: I'm pretty sure birth control is against their culture in some cases. But I'm not sure. Back in the day, lots of the babies wouldn't make it, so they had a lot.
I know some areas are more urbanized though, with more wealth than others.
I know some oncologists who are in the US (originally from India) that opened a clinic there, and travel back and forth between countries. The clinics in India are quite lucrative, so she says.
Edited by barrelracr131 2014-05-29 11:51 AM
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