<p>He’s a complete and total non-drinker. It’s Superbowl Sunday and he’s at work alone. Workaholic yes, drinker no. But, I did talk to him this afternoon and he says he’s feeling better. Now he’s calling it a possible panic attack and has taken some kind of mood pill. He did sound relaxed. But, he had hives and nausea yesterday and said he didn’t think he could make it to the phone and didn’t want to go to the ER or even bother anyone calling for help figuring it would pass. And, it was hours. He also said he had a physical and the numbers were all fine so … </p>
<p>Last night, he said he had a headache and took one pill followed by this reasonably dramatic reaction but now he’s not even sure those two things are connected. Nerves are an ongoing problem. Thanks for looking that up. I’ll probably see him tomorrow . </p>
<p>Geez, it is never boring around here that’s for sure.</p>
<p>This isn’t just a CA thread, tho CA offers the weirdest examples.<br>
ER on our plan is $200.<br>
Texas, I think you got caught in one of our swirls. It’s not the defined plans that address length of stay. There are other forces for that. But yes, there were former plans with low payouts or certain conditions that made those policies ineffective if one had charges beyond those bounds. Used to advertise on tv- wow, we’ll pay up to $100/day for hospital.</p>
<p>OK then, maybe unconnected. My understanding is that people can accidentally OD on tylenol because they assume that it is safe to take more than the prescribed dose – so for example, someone takes 2 pills, and then when they still have a headache, they take 2 more an hour later. But if he only took one pill and doesn’t drink… then it doesn’t really sound like a drug reaction. </p>
<p>I just raised it because its one of those areas where people assume that the OTC drug is safe and innocuous, and they get careless. Or they forget that they’ve taken the pills and take some more. </p>
<p>As to going to the emergency room: yes there is a cost, no matter what. But it costs LESS if you are insured – and it’s there for a reason. </p>
<p>Some people do choose to have high deductible co-insurance policies, where nothing is paid until the deductible is met. I have had a policy like that for years, along with an HSA, and am very happy – but I fully fund the HSA and I like the control that gives me. But it isn’t just the reimbursement aspect of insurance – it’s also the benefit of the negotiated rate. So if I go to the emergency room – I’ll be seen. A bill will get sent to my insurance company – let’s say that the bill is $2000. Then the insurance company will determine what is allowed under their contract rate. If I haven’t met my deductible, I’ll end up paying whatever the allowance is, but it could very well be that the insurance only “allows” $500 of that $2000 - so even though I am out $500, I have also gotten a $1500 benefit, or thereabouts.</p>
<p>Re: the “average” deductibles: specifics depend on anyone’s actual insurance plan. You need to know which sorts of medical care may have no fee, a flat fee, or a %, after deductible is met, per that plan. And the Maximum Out of Pocket. On our Silver plan, ER is a flat $200. In contrast, hospitalization is 10% after the deductible is met. And the deductible is $2600/5200 individual/family. </p>
<p>For hospitalization, even that deductible wouldn’t be easy for a person living close to the edge. But when you go to the exchange calculators and enter your own details, it may not be $2600. For those at low income levels, it may/will be lower, depending on the plan. It’s also confusing to look at “individual” plans insurers sell versus what is done via the exchange, depending on the plan. </p>
<p>I hate change in our health care as we have to relearn the rules each time we make it. This is going to be the case for many who sign on for ACA plans. It happens with non ACA insurance too. I was caught by surprise a couple of years ago when I found out that the major hospital that serves our area was dropped by the Blues. The doctors so associated, many of them still covered by the Blues were campaiging to get the hospital reinstated. The drop was due to an inability to reach financial terms agreement, not due to any healthcare issues. And all hospitals run into the situation that children’s hospital in Seattle has. Long before ASA, I was seeing this. In Pittsburgh, in fact, CHOP was dropped by major carriers and was only reinstated because the pediatric physicians took a unified stand. </p>
<p>I had Aetna at the time when my son was dxed with cancer, and it was a major pain in the tush. I had to go through a lot of hoops at a time when I was particularly stressed, to get a special administrator assigned to my account and that was the only reason a lot of things went smoothly thereafter for his treatment. I saw a lot of denials of treatment, entry, etc of a lot of very sick kids. It’s not just ACA, believe me, it happens all of the time with any number of insurances. I expect this year will be a tough one in getting things interfaced with the medical providers. My son is working practically round the clock in getting systems in place for the providers, top medical centers in the country, in fact, and he says the systems in place at those are antiquated to the point that he is horrified looking at the as he is. A change was definitely needed. </p>
<p>I don’t think anyone expected this to go easy, especially as there are so many involved fighting the process every step of the way. It’s appalling how some providers are deliberately making it difficult, but, yes, this is the case too.</p>
<p>What cptofthehouse said. Insurers have always made the decisions on whether adequate care is available in-network, and their definitions of adequate don’t always match ours. That’s why there are appeals, but there isn’t now (and wasn’t pre-Obamacare) any guarantee that the appeal would be resolved in your favor. </p>
<p>GP, you can be relied on to post all the Obamacare hit pieces. </p>
<p>With regard to the Pittsburgh (actually Mckeesport) auto body shop, though, you forgot to tell us the rest of the story. As is common in such cases, the employees could have done a lot better by going to the exchanges. The boss of that auto body shop is not contributing anything to his employee’s premiums. The insurance broker, an outspoken opponent of the ACA, negligently failed to inform the employees that many of them would be eligible for subsidies.</p>
<p>If you want to be as informed as possible, then I don’t see why you’d have any interest in lying hit pieces designed to misinform you. In the Mckeesport auto body shop, we see Judy almost in tears, facing a $1316 monthly insurance payment. That’s awful for a worker at an auto body shop. We don’t see Judy going to the exchange, like she ought to, and finding out what subsidy she is entitled to.</p>
<p>Since I am stuck at Kaiser in Santa Rosa waiting for my dad to get his check up, I thought i would read where the doctors were educated. </p>
<p>There are 15 family care doctors posted where I am. 7 are women.
Two doctors were educated at UCSF. Two at UC Davis. Two at George Washington. Three in India. There is a Suny. A Georgetown. A Loyola. A medical college of Georgia graduate. UNC. Dartmouth. </p>
<p>Residencies… 4 were at UCs. There is a univ of Wash. Georgetown. Two Arizonas. Illinois. </p>
<p>There are. 3 neohrology doctors listed. Grads from Stanford. Harvard. Univ of Chicago. Residencies at UCSF. UCDavis. Wash U.</p>
<p>4 doctors that are IM or getiatrics ir pallitative care. Educated at Georgetown. Ross. Pakistan. UCDavis. Residencies at medical Center of Delaware. Kansas. UNLV. UCDavis.</p>
<p>There are 8 or 9 general surgeons on the wall. One graduated from Harvard. Ine from Rosalind Franklin. Baylor. One surgeon did his residency at the univ of Washington. Another at Cedars Sinai. </p>
<p>Ok… That’s it.</p>
<p>I think this is the nicest Kaiser i have ever visited.</p>
<p>Despite all the network talk, I may switch to Kaiser next year.</p>
<p>Same son? Just curious – but if so, it’s nice to know that your son is working now to fix some of the problems that caused you aggravation when he was young and so ill. It must have been a very rough time for you. </p>
<p>Yes, Calmom, same son now a college grad and working with health systems. He had considered medical school and would have been a strong candidate, but just didn’t want to do it. So he went the math/econ route with a double major in that. Now working in health services in systems. </p>
<p>It was a rough time, and I feel blessed. But I did see a lot holes in the insurance system back then, a lot. You literally got a tin cans to put a photo of your kid’s face to put in businesses to collect change, that and quarter holders if your kid needed a bone marrow transplant, which is first line treatment for most leukemia relapses and high risk cases, and if your insurance did not cover it. Many had to sue their insurance companies; they’d capitulate for leukemia most of the time, but still would not change the policies to cover it so that each person so affected would have to sue. </p>
<p>I’m no fan of a lot of the ACA provisions and non provisions, and what a mess in getting it in place, but it’s not like our system was a panacea and didn’t have some of the same holes in coverages before, as I too often saw first hand. Something had to change and at least this was a step and hopefully reforms and fixes will get things working better. There were so many patches in the old system that one could not even see the frame anymore. it was time for a change.</p>
<p>Many of the patients referenced in the article about Children’s Hospital in Seattle wouldn’t have insurance for all but for ACA. Before ACA, children were routinely denied insurance due to pre-existing conditions, or due to maxing out early on annual or lifetime limits.</p>
<p>It’s easy to spot the propaganda and hit pieces – they always leave out key information and are facile with language. We are told that the kids are being denied “specialist” care – but no information at all about what type of care they are being given, which insurers and what types of policies are involved int the denials. Which kids are signed up for HMO’s? Washington has a lot of choices offered on the exchange (as well as very liberal standards for children to qualify for medicaid via CHIP) – but how many parents opted to sign up for whichever policy offered the lowest premiums without considering network issues? We don’t know, the article doesn’t tell us. </p>
<p>I am sure that there are kids at Children’s who need specialized care and that their parents would prefer continuity with the same doctors. But we don’t know which ones have conditions that can be treated as well elsewhere – and we never will know, because that information is confidential. </p>
<p>Cptofthehouse, I think you should feel very proud of your son – I am, and I don’t even know him! >:D< (It’s just nice to know that a CC-kid is doing good work). </p>
<p>HIPAA limits how much Seattle Children’s can disclose about the conditions of the children denied. They canno say ‘a 5 year old with a rare type of disease’. If that kid is one of the few with it, that could be identifying information.</p>
<p>A CC grad success, how wonderful! Cptofthehouse, can you tell us more about exactly what your son is doing? Does he work for an insurer, a nonprofit, a health system, the government? Sounds like he is doing vitally needed work, whoever his employer is.</p>
<p>TatinG – that’s right – they can’t disclose details under HIPAA. That’s why I think it is also unethical for a doctor to be giving interviews to the press reporting specific anecdotes-- there’s enough info included in the report that I think the privacy issues have already been breached. But not enough to draw any real conclusions – for example, it was reported that the Children’s requested approval for 200 patients, had heard back on 20, of which 12 were approved and 8 were turned down. It’s implied that the other 180 were ignored, but far more likely that those requests are still in process, perhaps with more information being requested or a more extensive medical review taking place. </p>