<p>Frankly, so are the kids at the grocery store. Anyone who sees your driver’s lic when you write a check. Lady at the bank took a whole lot of info from me, today. Fafsa did. Since CA wouldn’t disclose more detail about the supposed ex-cons, I doubt we know enough. For all we know they are working within the ex-con community that needs navigation help. </p>
<p>Insurance brokers require licencing to be insurance brokers.
The feds set a minimum and states can increase the training required for certification. Is it Md that calls for 120 hours? You need to look at the actual source info.</p>
<p>I’m going to go all conservative here and say that there are already too many jobs requiring licensing. Instead of creating more, we should get rid of some of those unnecessary regulations. A license to be a hair braider? Come on. </p>
<p>There was a list of the organizations that got navigator grants, initially. But it has disappeared from the HHS website. Basically, they were community activist petition signature gathering groups and the like. </p>
<p>So I needed a medical test today and, as I always I do, I gave them my insurance card, and the receptionist unlike past times asked for an estimated upfront payment since my plan has a deductible and copay. I told them since the provider was in-network they could only bill me after I received the claim statement from BS stating how much BS paid and what I owed the provider. She said their policy is to require an estimated payment now and they would refund it if the estimated amount is incorrect. Although I think they were wrong, I didn’t argue it.</p>
<p>Later, I spoke to supervisor who confided in me that since Obamacare they feel they have no other choice but to get the deductible or copay upfront before any treatment or test is administered.</p>
<p>When I mentioned that I had the same experience-- having to pay a copay at the time of the visit-- others in the thread said that has always been the practice at their doctors’ office. I don’t think such a practice is prohibited. </p>
<p>ETA: Nor do I think the doctors office “has no choice” but to require a payment, no matter what they may be telling you. One location where I saw a doctor recently required the payment, but another location didn’t.</p>
<p>Maybe the rules have changed but I know for a fact that pursuant to the contract with the insurance company, the provider is prohibited from asking for any payment from the subscriber at the time of service if they are in your plan’s network. The reason for this is because the rate they can charge has been negotiated with the plan and the insurance company doesn’t want the subscriber to pay until they sent the explanation of benefits to them and the patient. I am not sure they are allowed to mandate payment at the time of service (unless they were out-of-network) but I definitely understand why they want to do it this way.</p>
<p>Here is how Anthem describes the process of paying an in-network medical provider.</p>
<p>Question: Do I pay upfront for a doctor’s visit, or does the physician’s office bill the insurance company first, then bill me once the network adjustments are applied? Does emergency, hospital, etc.work the same?</p>
<p>Answer: Those who enroll in CDHP will receive an insurance card from Anthem and present it to healthcare providers as services are needed – just as they have been doing through the current healthcare plans. Since the insurance card lists no co-pay, the patient should walk out of the doctor’s office/ER/urgent care facility without paying anything at the time of the visit. The health care provider submits the bill to Anthem for network discounts to be applied. When Anthem sends out the Explanation of Benefits (EOB) to the health care provider and the patient, the discounted dollar amount is on the EOB. The EOB is the trigger for the patient to pay the dollar amount listed to the health care provider since your provider may or may not send an invoice. </p>
<p>Here is what Blue Shield of Illinois says about upfront payments:</p>
<p>"When members receive care from a contracting PPO doctor or hospital, there are:</p>
<pre><code>no claim forms to complete
no up front payments
no balance billing because PPO doctors and hospitals have agreed to accept Blue Cross and Blue Shield of Illinois’ payment"
</code></pre>
<p>Ironically, the bill that was supposed to make healthcare more equitable among the SES classes seems to be solidifying the class differential. Those that can pay for the greater access/networks will do so. Those that can’t are more solidly relegated to smaller networks and practitioners with long waits.</p>
<p>Dietz, what do you think the lower SES people had before? They are going from zilch to a wide array of choices, which you (and others) see as “limited” because you were able to obtain and afford insurance that offered broader coverage in the past. </p>
<p>If anything… you and your friends are simply getting a relatively small exposure to the types of frustrations that have been “normal” for those who have been essentially shut out of the private insurance market in the past. </p>
<p>Calmom is comingling poor people who had zilch with those people who were purchasing insurance on the independent market. The buyers are getting less now. The employer insurance crowd is are next.</p>
<p>I’ve been putting together my spreadsheet comparing group offerings (for 50 and under) and individual policies. Between what I am seeing and the conversations with the brokers - the offerings foreshadow a closing of the small group market and a forcing of those clients into the individual market. If the individual market continues to shrink networks ( for 2 out of 3 offerings)…it will be an interesting decade. Fasten you seat belts.</p>
<p>I could see the development of a level of care between where the standard insured individual goes and the high end concierge member goes. Perhaps a blended insurance/concierge level. This type of practice would accept your insurance. But, those with standard insurance get the 4 week wait and perhaps limited access to practitioners, those on the concierge side get the 2 day wait and access to whomever they wish.</p>
<p>Hmmmm…that’s not a bad idea…</p>
<p>H just called me a SME - subject matter expert. oh dear…</p>