<p>Without insurance you are generally billed MUCH less for most services. MUCH.</p>
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<p>This is good! You should be happy!</p>
<p>I WANT to pay more in insurance than I get back in benefits. I insure against bad things, and I don’t want bad things to happen to me. If a bad thing happens, like my house burning down, I’ll be glad to have the insurance. But I’d rather buy insurance and have no fire.</p>
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<p>I’ve heard that if you move into a new state that you are allowed to enroll at any time. If you have a long running treatment (like at Cleveland clinic) it might be worth doing. </p>
<p>Since calmom is the only person who actually read the ACA I wonder if she knows if this is true?</p>
<p>actingmt:</p>
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<p>Do you have a source for that? Everything I’ve read says the opposite.</p>
<p>Yes. it would be true – so you’ve spotted one possible loophole – although there is still a delay of 3-6 weeks between signup and coverage. But I think in most cases it works the other way: the unexpected injury or illness renders the person less mobile, and the task of relocating more daunting.</p>
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<p>You should become an Evil Navigator- helping people exploit ACA loop holes. Just like Evil HR Lady.</p>
<p>I wonder about the Federal government’s power to make it illegal to sell certain types of health plans. Thats seems bizarre. What if I offered a Brass Plan- isnt that regulated by state licensing boards not the Feds?</p>
<p>The catastrophic-insurance-by-relocation plan works better for some catastrophes than others. If my son is bleeding in the emergency room in Philadelphia, I’m not so fond of the plan that says he should go to Cleveland and wait a month.</p>
<p>CF - My husband’s insurance was cancelled by his work mid-treatment for some relatively minor medical stuff. The bill for the last procedure was $2000+ but when the physician’s office billed insurance the final time they didn’t pay because the policy was terminated two weeks earlier. It was a small business with financial problems. Anyway, when the docs office learned we would be cash pay he charged $200.00. </p>
<p>It also happened with my kid at the dentist. He fell at school and knocked out a tooth. Coincidentally, also $2000 until they found out we don’t have dental coverage. Then, suddenly it’s $200.00. While I was grateful and all, it has always made we wonder what the heck this stuff really costs.</p>
<p>actingmt, It’s well known that the bill the hospital/doctor sends out has prices that don’t have much correspondence to cost. If you are uninsured, you may be able to bargain with your health care provider for a lower cost. But you may not; they have no obligation to bargain with you.</p>
<p>If you are insured, take a look at a bill for a procedure. It will have some outlandish price, and then the much lower price that the insurance company actually has agreed to pay for this procedure. Insurance companies don’t pay the sticker price. They have deals with doctors and hospitals so they pay much less than sticker price.</p>
<p>Yes, I do know that. But it surely seems that most of our healthcare costs are not in fact going to healthcare.</p>
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<p>I don’t think this is a good way to look at the situation. Let’s take the example you cited: A dentist charges $2000 for a minor procedure. We may conclude that $2000 is ridiculously high for this minor procedure, but if you had paid it, that money would, in fact, be going to health care. You would have just paid a dentist, a health care provider, for providing health care.</p>
<p>A better way to view the system is to examine whether some providers charge too much. The dentist isn’t a good example here, because nobody is paying the $2000 sticker price. But look at expensive hospitals-- why is Cedars Sinai getting twice the going rate for an uncomplicated gall bladder operation? Why are American specialists getting such whopping compensation, much higher than similarly qualified specialists in other countries? Outpatient surgery centers are enormously profitable-- why are we paying their huge rates?</p>
<p>Well I think when we talk about providers and compare them to other countries, it’s slightly off. The cost and time investment in the US for that training tends to be wayyyy higher than in those other places. </p>
<p>This is going to need to be addressed imho</p>
<p>Part of this is because the cost control in the system is so crude. </p>
<p>If you just peel off $20 and pay the doc then you are in agreement about what your necessary services are. You are a self regulating system.</p>
<p>When we introduce extra parties, then they have to try to cost control from a distance. Now they need to hire reviewers and the doctor needs to hire billing and code people, etc etc. </p>
<p>As a small example my wife needed a Upper GI endoscopy. The insurance company wouldnt pay for it unless other tests were done first including a capsule endoscopy which cost 40% less. </p>
<p>Well the capsule endoscopy showed nothing, which meant they paid for both the camera endoscopy and the up GI. So essentially they paid 60% more than they needed to. </p>
<p>The physician thought it unlikely based on my wife’s symptoms that a camera endoscopy wouldn’t reveal anything. So if I had been paying out of pocket, even paying the same rates, it would have cost me less. </p>
<p>Even if it is true in 100 cases a rote medical coding that procedure 811 cant be authorized without procedure 805 ends up saving money, the rule will be wrong enough of the time that a lot of money is being wasted.</p>
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<p>The goal of ACA is to provide coverage for everyone, so it’s not really a “loophole” if a small number of people are able to sign up outside the enrollment period.</p>
<p>It’s also really easy under ACA to qualify for Medicaid if you simply quit your job. </p>
<p>But in most cases the costs to an individual of relocating or foregoing their income would far exceed the cost of paying insurance premiums.</p>
<p>The non-doctor cost of outpatient surgery (the hospital cost, as it were) is way more than what the same procedure costs in other countries. That cannot be explained by doctor training.</p>
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It comes under the Constitutional goal to “promote the general welfare”, Congress’ power to regulate interstate commerce clause, and the Supremacy clause. That is the federal government can regulate all sorts of things that involved commerce between and among the states, and federal law takes precedence over state law within the same domain. </p>
<p>It’s not really different from a legal perspective than the government telling car manufacturers that they need to put seat belts and air bags. or meet certain gas mileage targets for all vehicles made and sold in the US. </p>
<p>I think that other types of insurance can still be sold, but they cannot be labeled as health insurance. For example, insurance companies can still sell policies for accidental death and disability – the types of policies that give you a set benefit for the loss of a limb, etc. – and they can still sell those policies that pay you $100 a day while you are in a hospital (which are meant to compensate you, not pay the hospital bill). I’m sure there is potential for supplemental plans that pay for things not typically included within ACA compliant policies.</p>
<p>The law is just telling insurance companies that if they market something and call it health insurance, it needs to cover a certain minimum list of items – and they are telling citizens that they need to be covered by insurance that meets those standards.</p>
<p>Yeah, I wonder if this has been litigated. Yes, Interstate Commerce now means Intrastate Commerce and there is wide latitude to what Commerce means (but not including the Individual Mandate). But banning the sale of a perfectly safe product is interesting…</p>
<p>Has anyone heard of any cases out there where companies are still offering non-grandfathered plans? Or offering to grandfather people?</p>
<p>argybargy, The individual mandate has been litigated: the federal government may impose a tax on people who don’t buy health insurance that satisfies the requirements of the ACA.</p>
<p>So what lawsuit are you proposing: Acme Insurance Company should be allowed to sell an insurance policy that they label “Health Insurance” but that doesn’t satisfy the ACA? That seems unlikely to succeed; I think it’d fall afoul of statutes that require truth in labeling.</p>
<p>Yeah- thats what I am wondering- why doesnt ACME offer an inexpensive insurance product that is a Brass plan?</p>
<p>Maybe it would be pointless since you’d technically be due the tax. Or is not economical since you cant get a subsidy on it. Or maybe with all the preexisting condition limitations it couldnt be cost effectively be done. </p>
<p>But would it actually be illegal for a company to offer such a policy? Or for that matter, maybe they could say ‘sure , you are grandfathered’. Is that going on?</p>
<p>I think it would be considered fraud for Acme to offer a health insurance policy that didn’t satisfy the ACA. </p>
<p>It’d be illegal for Acme to grandfather someone who wasn’t entitled. Maybe Acme would try it anyway, but I suspect the small reward wouldn’t be worth the risk of being caught violating the law.</p>