<p>Bay… You must be missing something. Why did that family from an earlier link have to go out and raise money when they exceeded the cap?</p>
<p>bluebayou,</p>
<p>How did you know the details of those employees’ medical care? I always thought one’s care was confidential, and that the employer only knew the numbers, not the diagnoses.</p>
<p>dstark,</p>
<p>Sorry, I don’t know what you are referring to.</p>
<p>Not sure if lifetime cap is the same as what I can find on my current policy, but I have a lifetime cap of $500k per illness with my current insurance here in CA. Always felt that seemed kinda low, but then again 1/3 of the students here come from countries where they could always just go home for cheaper health care if the poo hits the fan. Or, I guess, just rack up as much as they want in bills and return to their home country, never to return.</p>
<p>RacinReaver, is this student health insurance?</p>
<p>Graduate student, so most of us aren’t still covered by any sort of parental insurance (even with that extension in age which you can be covered up to).</p>
<p>bay</p>
<p>Even in a company of thousands of employees, when someone’s gut gets shot full of holes on accident, word gets out pretty quick. (And this was before the Internet was invented by you-know-who!) But beyond word of mouth, the ee in question had to get all kinds of approvals for extended leave. Local offices would put on fund-raisers to assist. It is hard not to ‘know’.</p>
<p>To be clear, we only had access to medical claims data at corporate, with no personal identifiers, other than basic demographics (age range, sex, etc.). And yes, we absolutely had Dx (ICD-9 and DRG, back when those were used). There was a sw company that sold a nifty program that would allow us to slice and dice the data, including costs.</p>
<p>btw: in our current, small company, with a fully insured plan, I still get info on large claims, including treatments. (I just demand them from the carrier to justify their annual increase.)</p>
<p>I just want bluebayou to know I didnt pull the $75 out of thin air…</p>
<p>This was Bclintonk’s link.</p>
<p><a href=“http://www.hemophilia.org/docs/LifetimeLimitsReport.pdf[/url]”>http://www.hemophilia.org/docs/LifetimeLimitsReport.pdf</a></p>
<p>Bay, maybe the story I saw was not about premature babies…</p>
<p>I am not sure why you are addressing the premature babies to me.</p>
<p>^^never assumed that you did pull the number out of thin air, stark. (While we may frequently disagree on interpretation, I have always found your numbers credible.)</p>
<p>:)…</p>
<p>dstark,</p>
<p>My mistake, I thought you were asking bluebayou about what kind of costs s/he saw for the cap-hitters (which she said were mostly preemies). That is why I provided info about what happens with preemies’ care.</p>
<p>
</p>
<p>No one “pulled the rug out” – if you didn’t know what “grandfathered” meant you could have asked. </p>
<p>It was your decision, your responsibility to do whatever research or ask whatever questions could impact that decision.</p>
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</p>
<p>Most people expected larger average premium increases. I certainly knew, long before the law passed, that coverage for everyone without regard to medical history would mean significantly higher rates for me. Pretty simple math: I was getting the most favorable rate available in a pool that excluded people with chronic health problems or pre-existing conditions. If everybody had insurance and payed a uniform rate, my personal rates would have to go up – there was no other rational possibility. </p>
<p>What I didn’t anticipate was the generosity of the subsidies. I had no idea that there was any potential that I could qualify for any sort of government benefit.</p>
<p>“When I changed plans in 2012, nobody knew (and I mean nobody) that there would be significant premium increases or the severe narrowing of the networks.”</p>
<p>In 2012, BEFORE the ACA implementation, there were significant premium increases and narrowing of networks. (Was that why you changed plans?) I don;'t know where you live, but where I live, you’d have to be pretty blind not to see that.</p>
<p>Actually, in 2012 many people warned that all of this and so much more was coming with the ACA, but I think GP is referring to the official sales pitch which was somewhat unrealistic.</p>
<p>Yes he is, but GP also posted this:</p>
<p>
</p>
<p>So basically it seems he is a proponent of individual responsibility and bearing the consequences of one’s choices, except when it impacts him and he doesn’t like the results. </p>
<p>I think that, at least among educated people, the concept that some plans were “grandfathered” and others weren’t was pretty widely understood. The “keep your plan” promise hasn’t been breached for anyone who held onto their grandfathered status.</p>
<p>Come on Flossy, you didn’t buy the, “If you like your plan you can keep it,” or the, “if you like your doctor, you can keep your doctor,” or that people were going to save $2500 on their policies? Maybe you read the fine print, or realized that all politicians are liars. Look at the positive, if your company cuts your hours down or lays you off, you might be able to get a subsidy. And you might even get to join the growing millions of those on food stamps. Think positive!</p>
<p>In March of 2012, nobody knew what was going to happen in Jan of 2014. People can say they knew there were going to be huge premium increases or a major change in the networks, but I don’t know anyone, including insurance agents or other experts, who were saying this. Find me a few articles in the media (NYT, Washington Post, La Times, etc) from that time that spoke about this. I doubt if you can. </p>
<p>The only person who seemed to know anything was our President, who was proudly boasting about lower premiums and keeping your plans and doctors. Even Peter Lee, the head of Covered Ca, was trumpeting lower premiums for exchange plans in July of this year. I don’t remember him saying anything about higher premiums. The way I figured it out was by playing with the Covered Ca calculator in July. I concluded the calculator must be broken because how could I be getting results so different from what I was being told.</p>
<p>I don’t want to be inflammatory but there were a lot of people lying back then about what was going to happen. I will live with my decisions, but no way I am going to take responsibility for this fiasco.</p>
<p>Can anyone show me any threads from this site in early 2012 predicting much higher premiums and a change in networks? As a matter of fact, find me any CC threads or articles in the popular media from 6 months ago anticipating any of this stuff.</p>
<p>(Same time post, coincidental, not responding to GP.)
One of the things that struck me, oh, maybe back in middle school, was the concept that “ignorance of the law is no excuse.” We all have situations in which we trust, or times when we take a wait-and-see attitude. But we aren’t just responsible for our choices, but also for our ignorance. It helps to sweat out a little research, sometimes. And that means a little analysis, too. Then, at least you know you made the best, informed choices you could, at the time. Not just that you had freedom of choice.</p>
<p>What’s hanging over our heads isn’t just the monthly costs. It’s that if we do run into high needs, it can be mighty expensive. To me, it’s not whether I keep our docs or prefer one hospital over another. It’s whether I can make the best choices that protect my family, in case. And, in light of all of our needs. Not even about getting “the absolute best” care, but about getting the right sort of highly competent care. And being reasonably assured we can afford our share. So we can make those informed choices.</p>
<p>It feels like a sidetrack to go back to promises or glitches or get mired in certain details. The time is coming to make the choices.</p>
<p>Now, to GP: no one was sure. It was our refrain on the parent thread to this one, pre-Oct 1. I asked everyone, no one could answer what would come, not admins, nurses/docs, not my doc’s office staff, not Google, not my financial guy who knows insurance, not even my insurance reps, when I had to replace our former plan. It was obvious, to me, that this was a wait-and-see. </p>
<p>So what? I knew we were about to move a darned big boat. Lots of folks would have liked to start researching 6+ months ago, but couldn’t. But, here we are, on 11/26- have you done it now? That’s what matters. Have we looked more deeply than media reports about dissatisfaction, factoids about bankruptcies in MA, fretting over whether it’s big pharm that drives up costs for Tier 4 Rx? Are we ready to make our best decisions, now?</p>
<p>If you can’t get a straight answer from an insurer, that’s a problem. If the calculators weren’t consistent before their official release, that’s different. But nothing should stop you from asking, making the call to your exchange or insurer, running your numbers, projecting and weighing. Now.</p>
<p>GP, the point is that your excuses about ACA are inconsistent with your “allowed to make choices” with no guarantees or do-overs post. You seem to be opposed to the idea of the government coming up with a set of rules that requires that all insurance cover a certain set of benefits or have no out-of-pocket caps – (because people should be able to choose less coverage if they want, and risk the consequences) – but when it comes to your own choice – you are upset that the government didn’t take more steps to protect from your own mistakes. </p>
<p>Anyway, I’m done. I’ve made my point; if you don’t get it, so be it.</p>
<p>No, I don’t get it.</p>
<p>Edit: If I made any mistakes I have plenty of company (5 million people). I never said I was unhappy the govt didn’t take more steps to protect me from my mistakes but it would have been nice if it hadn’t lied to me and everyone else. My main point is no one else knew what was coming, despite hearing some posters claiming otherwise. It’s pretty hard to make an informed decision (early 2012) when you have zero, nada information about what was going to happen.</p>