<p>And some of those with pre-existing conditions were covered by the states’ high risk pools. </p>
<p>You can’t have it both ways, Goldenpooch. You are objecting that the people in the individual insurance poll now have to pay for the people in the individual insurance pool with pre-existing conditions, whereas previously, the people in the individual insurance pool didn’t have to pay for those expensive people with pre-existing conditions. This is true.</p>
<p>But then, you point out that people with pre-existing conditions who are in the group pool have always been able to get their group insurance. This is also true. But if those pre-existing condition people are getting insurance, then the other people in the group pool must have been paying for the pre-existing conditions of the unhealthy people in group pools all along. </p>
<p>So, if healthy people in the group pool have been subsidizing unhealthy people in the group pool all along, why do you think that healthy people in the individual pool should be entitled to shirk their part? Why should people in the group pool have to pay for the unhealthy people in the group pool, but people in the individual pool get cheap rates because they don’t have to pay for unhealthy people? </p>
<p>Why would that make sense to someone in the group pool? You’re saying that I have to pay for premature babies and cancers of my husband’s co-workers because I’m paying for the company’s insurance, but I should also pay for the premature babies and cancers of people in the individual pool because you don’t want to? Yeah, no. That doesn’t work.</p>
<p><a href=“Doctors Say Obamacare Rule Will Stick Them With Unpaid Bills : Shots - Health News : NPR”>Doctors Say Obamacare Rule Will Stick Them With Unpaid Bills : Shots - Health News : NPR;
<p>This is just getting noticed in the mainstream press, although I posted about this months ago. People with subsidized insurance will get a 90 day grace period for non-payment of premiums. However, the insurance company will only reimburse the doctor for treatment during the first 30 days of non-payment. For the next 60 days, the doctor will not be paid. So the doctor takes a patient thinking they have insurance. The patient doesn’t pay the premium. The doctor isn’t notified by the insurance company (they don’t have to be by the law). The insurance company says, “Well, doc, you visited that patient every day, you did a 12 hour operation, but hey, the guy didn’t pay the premiums, we knew it, but you are stuck. Tough nuts”. </p>
<p>Another reason why doctors are not rushing to sign up ACA patients. </p>
<p>CF, okay, you are saying I have to pay for people with preexisting conditions which is debatable, but does that also mean I have to lose my plan, network and doctors. It would be one thing If I was given some choice about whether I wanted to forgo the plan I was perfectly happy with, but I don’t appreciate it when it is done by coercion or the usual method of the do-gooders and bleeding heart believers who routinely attempt to force their vision of utopia upon everyone else.</p>
<p>That’s one of the issues that need to be tweaked, TatinG.</p>
<p>It’s a minor issue that needs ‘tweaking’ if you aren’t the one not being paid. This is basically the government expecting doctors to work for nothing if they see subsidized ACA patients. This is on top of the poor reimbursements from Medicaid and Medicare. </p>
<p>So now picture yourself as a young doctor. You graduated at the top of your class after studying like a madman during college instead of having fun. Then you went to medical school again studying, working hard, having sleepless nights on call. Another 4 years go by. You are now 26 and have yet to earn a living. Instead you are now $360,000 in debt. But you aren’t done yet. Now you do a three, four, five or six year residency. You are now in your early 30’s and are just getting started earning a living. You have to make a $2500 payment on your medical school loans every month and then have some left over for living expenses. </p>
<p>Maybe for every subsidized ACA patient a doctor sees, the government would forgive a few thousand on the loans. </p>
<p>TatinG is wrong about the high risk pools. We have gone thru this already.
GP, you are comparing apples and oranges. </p>
<p>We are talking the individual market.
13 percent of individuals who applied for individual coverage were denied coverage. </p>
<p>It is 13 percent of 13 or 15 million or a little more. They did not get any coverage at all according to the health insurance industry. Zero coverage. </p>
<p>GP, Did you buy a hsa plan or a ppo plan?</p>
<p>These numbers mean there is a surge going on…</p>
<p>The numbers are running a little higher than last week When the surge started…</p>
<p>“More than 845k visits to HealthCare.gov and 196k calls to call center yesterday. 11 Days left for consumers to #GetCoveredNow
6:11 p.m. Thu, Mar 20”</p>
<p>dstark, are you getting paid by the administration, with all those federal grants they are doling out like candy, to huckster this junk to the public?</p>
<p>What premiums are you paying? I am talking to my daughter right now! ;)</p>
<p>What is your plan…she deals with Blue Shield group plans…her groups are larger though. </p>
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</p>
<p>That is preposterous hyperbole. You’re talking as if no one who walks into a doctor’s office with subsidized insurance is going to pay. That is light years away from the truth.</p>
<p>The vast majority of people who get subsidies are going to keep their insurance and not let it lapse. They want insurance! The problem you talk about is real, but it is a small problem. A tiny minority of patients will let their insurance lapse and then go see the doctor. Some people will do that. But not many. </p>
<p>So, there will be some bad debts. But doctors have always had to deal with bad debts from some deadbeat patients. I’m not even convinced that the total number of bad debts will increase. It might-- but then again, it might not.</p>
<p>I belong to a large group plan. It’s a PPO but not a HSA.</p>
<p>CF, will heavily subsidized subscribers pay their bills that don’t exceed their high deductibles. Not so sure they will.</p>
<p>Heavily subsidized people don’t have high deductibles. They have low deductibles like $1000 or $2000. That’s pretty manageable for a lot of people.</p>
<p>GP, then my daughter deals with your plans. Does the employer have a HRA? Or do you have a FSA?</p>
<p>The fact that such a provision would even be written into the law shows that the insurers had better lobbyists than the doctors. How are the doctors supposed to know who are the subsidized ACA people and who are unsubsidized? </p>
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</p>
<p>Why would they need to? </p>
<p>The article only spoke to subsidized plans. Perhaps there is no 90 day grace period for unsubsidized plans? </p>
<p>I dunno, TatinG. Maybe you could use Google and find out for us.</p>
<p>TatinG – when my daughter was in college, she had a minor medical procedure done on an outpatient basis that cost $800. It was a planned procedure that was supposed to be fully covered by her college health plan, and the procedure was pre-authorized. Yet after the procedure was done, the insurance company (UHC) wouldn’t pay. First they denied the claim because it hadn’t been submitted to my daughter’s other insurance ( a high deductible policy we had to supplement the college plan); then after we submitted it to the other insurance and they denied the claim, UHC claimed they didn’t cover it at all, and we had to appeal; when I submitted an appeal for my daughter pointing out the specific provision in the policy that provided coverage, they claimed that the procedure code showed that it was excluded by another policy provision --but I checked the procedure code and the codes were correct- the person to UHC was lying to me about what the code stood for. The matter was eventually resolved by getting the benefits coordinator from the college involved. </p>
<p>I don’t think our experience was unique – I’ve heard many accounts of people getting similar runarounds from their insurers.</p>
<p>So I have a hard time thinking that the 90 day grace period is going to cause a bigger problem for doctors than the old system did – I think it’s been fairly common for doctors to submit bills that insurance companies don’t pay for various reasons. But with ACA, there could be no argument that the procedure my daughter had would be covered by insurance – it’s now an essential benefit that all insurers have to pay. So doctors can be a lot more confident about coverage of all sorts of procedures, and I assume that will result in more resolution of many claims.</p>
<p>Before ACA, there were millions of dollars of unpaid expenses incurred by doctors and hospitals provided to uninsured and uninsurable patients who entered the hospitals by way of the emergency room with life-threatening conditions. Now, a large and growing portion of those patients will have insurance, and/or be eligible for retroactive coverage via Medicaid. The hospitals and surgeons and anesthesiologists will get paid in 2014 for the type of services that were left unpaid in 2013.</p>
<p>Will there be some circumstances where doctors will accept a patient with an insurance card only to find out later that the insurance coverage is denied because the patient’s insurance bill had not been paid? Yes. </p>
<p>Will the doctors be losing money as compared to the old system? I don’t think so – I think they will find that the claims that are now paid more promptly are going to outweigh the fairly rare situations when an individual has let their insurance coverage lapse. </p>