<p>NJRes, I’d ask the potential 2014 insurer how basal cells would be covered. It may be treated as a “preventative care.” I was also told some things depend on how the docs code the visit or service. Colonoscopies are also preventative.</p>
<p>It depends. Colonoscopies are not always considered preventative if you have had one previously and had even the teeniest issue. Maybe, it depends on the doctor but there are gray areas in what’s preventative.</p>
<p>I think we have covered this before. If they identify something and they want to retest or do followups, the activities coming after the screen impact your deductible?</p>
<p>Yes. Also, if they ID something during a screening test, that screen becomes diagnostic and you have to pay in the future. </p>
<p>For me, all mammograms are diagnostic. Not covered. There are pre existing prices built in to the new compliant plans, they just aren’t called that anymore.</p>
<p>I’ve never had an illness, but mammograms in my case always require a diagnostic reading. Even though it’s preventative in my case, it’s not covered as such. I’m fine with this.</p>
<p>It doesn’t have to be a retest or a followup. Once you have a bad reading, it is kicked off from preventable and affects deductibles. I believe it stays that way for a long time even if you get good readings following a single bad one.</p>
<p>I’ve never had a bad reading, I just have a complicated reading. Therefore I pay. That never goes away.</p>
<p>I don’t really care about this personally, but a lot if ppl will find this turns out to be expensive.</p>
<p>What is bad is that it is not what it seems to be. it got fancy words and sounds good but under the hood, there are surprises. Over the course of life time, people are going to get a bad reading from time to time. If that pushes it to diagnostic permanently, what will be left to be preventable?</p>
<p>Igloo, the law was written by the insurance lobby. Most laws are written that way now, but it is particularly bad in this case. This is how they are factoring in pre existing. They can’t lose the way they wrote it.</p>
<p>ACA is not in effect yet. I am assuming the deductible works the same way now as well as future since it is a standard insurance practice. </p>
<p>Is that not the case here?</p>
<p>Tearing my hair out right now! I went back to the app today and clicked through each page and was able to change the filing 2014 taxes question to a yes. I was able to then click all the way through to the review page, confirmed it was correct, agreed to the boilerplate questions, and then hit submit.</p>
<p>The Eligibility Notice that came back says that D may be eligible for IL Medicaid and she will receive a final decision from them. Arrgh! No plans shown. </p>
<p>Good grief. Her 2014 estimated income was $23,000. I thought the cutoff was $15,850. Of course, the Notice doesn’t say when she will get their determination. The “system” obviously ignored the 2014 estimated income and is using her current part time income that is under the Medicaid threshold. Why do they ask for a 2014 estimate if they are just going to ignore it?</p>
<p>Who knows when IL Medicaid will get back to us. Two weeks left to sign up and we are caught up in bureaucratic mess. They had better not sign her up automatically. At this point, H & I are ready to sign her up off the exchange and forget about the subsidy. Using the Kaiser estimator, it looks like the subsidy is only going to be about $50 a month anyway.</p>
<p>Any ideas, anyone?</p>
<p>I would pay 50-dollars not to have my kid on Medicaid in a heartbeat.</p>
<p>poet, I know. But don’t blame lobbyists. They were doing their job. Blame politicians. They were the ones neglecting their job; take info from lobbyists and apply it for the good of the nation not the industry lobbying.</p>
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<p>Or it is split. For example, today I go to the dermatologist for a skin exam. She finds nothing, I pay my $40 copay (specialist), and she balance bills the insurance company for her negotiated fee. No impact on deductible.</p>
<p>But if I go for a skin exam, and she finds something and scrapes it off, I still pay the $40 for the exam, and she balance bills for the exam, but she also then bills for a surgical fee (and lab). Since it is one visit, the second fee receives some sort of discount.</p>
<p>I pay the $40 against preventive AND the surgical and lab fees (for scraping) since they hit the deductible (which in my case is $500).</p>
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<p>My wife’s are covered as preventive even tho she had a breast ca. (PPO with national carrier offered through employer, but it is my understanding that we have the ‘standard’ mid-sized business package offered in Calif.)</p>
<p>^Interesting. IMO, the lesson here is that the industry can wiggle their way in and out as they see it fit, make it diagnostic or preventive, narrow the network or broaden it. We consumers have to take what’s given. We don’t even have a choice to opt out it all.</p>
<p>^^In our case, it also might be a Calif. state law (too lazy to look it up).</p>
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<p>Catching up from a few pages back, but wow, do those numbers seem high to anyone else? I assume this means <em>after</em> the deductible and co-pay and also adjusted per contract, so that means the average employee is incurring more than $4K (a possibly a lot more if they have a high deductible) in medical care, every year. </p>
<p>I don’t think H has used our insurance in years. He has scheduled a physical several times, but the wait is about 3 months or more to get one, and he always ended up having to cancel due to something coming up. I wonder what all the expensive treatment is that everyone who works is getting.</p>
<p>Bay, I don’t know… if those averages are means (not medians) then the average will be skewed to the high side by pregancies/births and possibly a few serious very expensive illnesses.</p>
<p>“I wonder what all the expensive treatment is that everyone who works is getting.”</p>
<p>The company insurances typically have just 5% or less using up the budget. So if I were to make up a number, 10-20% of the total insurance budget is used by 90+ percent of people while the rest 10%would consume 80-90%. </p>
<p>I work in a company with over 100k employees within US. Just based on our group of 20-30 people, I can say there are about 3 people who might have spent most of our contributions while the rest probably went to doctors pretty much for routine care. Think of one person having multiple heartcare procedures running into 100k or more and you have our typical profile for this year. It could be someone else next year.</p>
<p>Texaspg, does your company self insure?</p>
<p>I am certain they do. :p</p>