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And where will the money for those subsidies come from?</p>
<p>Part of the problem with moving back the employer mandate is the fact that it was intended to be the vehicle for income verification.</p>
<p>After being on the phone with our insurance agency and talking more with husband, I have him actually considering the higher deductible plan with the addition of an HSA (which will be used to meet the deductible). The plan we are looking at now has a $5800/single and $11,500/family deductible. Once that is reached, everything (including prescriptions) are covered 100%. </p>
<p>I got a little confused talking with the insurance broker. She said that the deductible works like this-----If the hospital bills the insurance $3000 for blood work and the insurance company agrees to only pay $350 for the work, then the $350 is the amount used toward meeting the deductible. Can someone who has a high deductible plan clear this up?<br>
Does this mean we would get a bill from the hospital for the $350 agreed upon by the insurance company or would we get a bill from the hospital for the $3500 that they wanted to charge the insurance company? So confusing.</p>
<p>^I think your broker explained it backwards – if the hospital bills $3000 for blood work and insurance company agrees to cover $350, you’re responsible for the rest ($2650). Assuming you then write a check for $2650, that out of pocket expense goes toward your deductible. And make sure to ask or confirm that the deductible is indeed a “family” deductible (vs a per patient deductible). So if you incur non-reimbursed expenses of $11,500, the Smile Family’s deductible has been met. Some policies say that each individual has their own deductible.</p>
<p>^this is what confused me because our current insurance is set up in a way that supports what the insurance agent told us. My last blood work (routine) was billed to our current insurance for $3200. The insurance company only paid $350 to the hospital. The hospital accepts the lesser payment of $350 as paid in full as per their agreement with the specific insurance company.</p>
<p>Huh…maybe I’m wrong then. If you’ve had claims processed this way, then that must be how it works.</p>
<p>NYSmile, you have to understand this before you agree to a policy.</p>
<p>The hospital sends a bill to the insurance company for 3000. The insurance company negotiates the 3000 down to 350. You have to pay
100 percent of the negotiated rate until your deductible is reached. In your case 350.</p>
<p>That is what it sounds like to me. Ask your agent again. </p>
<p>The way it works is the hospital bills…
Insurance company negotiates the costs down…
Insurance company pays a percentage of the negotiated rate. Could be zero all the say up to 100 percent depending on your policy.
Policy holder pays her share of the negotiated rate that the insurance company doesnt pay.</p>
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As if you can believe anything a health insurer says!</p>
<p>You might do better with individual coverage for the family and giving your employees cash to go seek their own insurance. Obamacare will give them a lot of options.</p>
<p>A $40 co-pay is not a lot for an office visit that would probably run $150 otherwise. One of the points of co-pays is to discourage frivolous use of medical care.</p>
<p>You definitely need to figure that one out, nysmile. We get these bills all the time saying, for example, that the cost of something is 3K, but the insurance agreed upon rate is $850, so that’s what the provider/hospital gets. You’d need to make sure you get the insurance rate, not have to cover the bogus inflated rate. I don’t know what I’m talking about, really, but I’d know that I want to get the discount rate!</p>
<p>If I rememeber correctly blue cross has catastrophic plans where the rates are not negotiated down. I would be wary of taking one of those plans because the negotiated rate can be so much lower than the initial bill.</p>
<p>I understand. Either way, we would have to pay up to the family deductible of $11,500 then everything after that is covered 100%. It’s so darned confusing. It’s almost worth paying the outrageous $40,000 and stick with what we have now.</p>
<p>I can’t take anymore right now. I’m tired of trying to figure this all out—mostly confused. Stepping away from the computer and telephone for a while.</p>
<p>No…</p>
<p>You need to look at the different plans.</p>
<p>If premiums are 10,000 and the maximum you have to pay is another 11500 that is cheaper than 24,000 in premiums. I am just throwing an example out there. </p>
<p>You have to compare. I dont like the super high premium plans because my health care costs are usually low. You may have different needs.</p>
<p>Your agent should give you a few different kinds of plans to play with so you can compare. </p>
<p>The agent should help cut the choices down for you. </p>
<p>Ok.</p>
<p>^ welcome, dstark, but it’s been a googlefest. I just went through a policy change. I hope this ACA works.</p>
<p>NY, aiui, the key is “usual and customary charges,” which insurance admins and (I believe) docs/hospitals have access to. That is the first level of ongoing negotiations (separate from you and me) that docs, hospitals and carriers do.</p>
<p>Right now, if my doc bills 200 and I have not met deductible, that’s my bill. There is some negotiating that can go on, between you and your doc. I have no experience with that.</p>
<p>If it is 200 and is for a service that qualifies to go toward deductible, it does. Except when the charge is beyond usual and customary. In your example, the charge may be 3000 but U&C is 350, so that’s all the carrier credits you for. aiui.</p>
<p>This o-o-p stuff is only what the carrier agrees to- eg, you can spend 6k on a nose job and they don’t care.</p>
<p>What the carrier considers a U&C charge or qualified toward deductible can depend on how the doc codes it. </p>
<p>My last sane link for now is this one: <a href=“Healthcare Bluebook – Your Guide to Fair Pricing for Healthcare Services”>Healthcare Bluebook – Your Guide to Fair Pricing for Healthcare Services;
It is not perfect, but it beats the mind fog of not knowing anything, imagining yourself having to ask about pricing in the midst of a crisis.</p>
<p>“I can’t take anymore right now. I’m tired of trying to figure this all out—mostly confused. Stepping away from the computer and telephone for a while.”</p>
<p>I like this. This idea that people are going to sit down and make great economic decisions so just leave everything to the marketplace is such bs. </p>
<p>People dont have the time. Dont have the knowledge. The demand supply playing field tilts towards the pros. The pros have the advantage. The consumer is screwed. </p>
<p>My dad was in the hospital. He needed an operation. I guess that would have been the perfect time to start cold calling to find the cheapest rates for the operation. Let’s see…he was 85 and all drugged up.</p>
<p>"Heeeeeeloooooo. Is this UCSF? I need my gall bladder taken out. I would prefer the operation to occur in an hour. How much would it cost? Is that the negotiated rate or the rack rate? Is there a senior discount? I was a veteran too. Oh… This is the front desk? You want me to hold. Look I am not feeling too good. My stomach hurts. Will you take $5,000?</p>
<p>Betty… Will you take the phone? I am not feeling good and I am on hold."</p>
<p>Perhaps I read this incorrectly, but I thought under the ACA, we wouldn’t be allowed to purchase just catastrophic coverage, but would be required to purchase much more coverage. So purchasing catastrophic coverage would be just a short term solution.</p>
<p>The whole point of agreed-to “usual & customary” is to avoid bargain hunting.</p>
<p>"…some individuals will be able to purchase catastrophic plans with an even lower actuarial value. Catastrophic plans will cover essential health benefits but have high deductibles. Only young adults under 30 and individuals exempted from the individual mandate because they cannot find affordable insurance are allowed to purchase catastrophic plans."</p>
<p>dstark…once again, the preferred rates…IE for healthy people are gone now because of new federal law. The 18% avg increase is for both pools…Pool A(for anyone) and pool B(for healthy). My family plan increase is 50%…has been less than 5% for past 4-5 years.</p>
<p>…so dstark, my comments were 100% correct…</p>
<p>.</p>
<p>As for NY’s question abut the discrepancy between the hosp charge and the U&C, she needs to cover that with the agent. I know sometimes a hosp will bill an excess or excessive amount and then cave when the ins co declines to go beyond U&C.</p>
<p>Geeps20, ok…</p>
<p>Because that 18 percent increase was not because of ACA…according to the insurance companies…some of your increase is not due to ACA.</p>
<p>You are very fortunate to be healthy enough to be insured under your old plan. Sorry your rates are going up. </p>
<p>You never know when an illness strikes or who is going to get ill. Sometimes healthy people become ill for no known reason. Sometimes a person is stricken with something that affects 30 people a year in the US. Who would believe it?</p>
<p>Insurance protects us all and if we dont get one of these illnesses all the better. I would rather lose on insurance than get sick.</p>
<p>I do understand your frustration. </p>
<p>I was gouged for over 8 years. Had an irregular heartbeat when I was about 47 years old. And I was screwed. Insurance wise. Didnt have an irregular heart beat again for those 8 years.</p>
<p>My resting heart rate is 48 when I wake up and I am 57 years old.</p>
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<p>you would pay the $350. HD plans are great for the healthy and the negotiated rates between your carrier and hospitals/doctors save you much more than if you didn’t have insurance. HD plan coulped with a HSA is the way to go…IMO I have a $10k deductible($11k out of pocket max) and my family plan is about $6k a year($9k next year) Stick $6k in a HSA, tax deductible saving me $1,800. So, after a few years of contributions and something major comes up, the money is there in the HSA. All I would need to pay is $11k max. Sure beats paying 15-20K in premiums a year for some fancy plan where you might not have anything major for years…lots of waste there IMO/ </p>
<p>Insurance(any type) should always be for the major stuff…not running little Johnny to the doctor every time he has runny nose or fever.</p>
<p>Before I had surgery, I tried to determine the costs of the surgery, etc. Basically, impossible, no one, not the doctor’s office, not the hospital, not the insurance company, no one could tell me the contracted amount, even with the billing codes.</p>