Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
14081

<p>My point with the acupuncture is simply this…if is often used as a modality INSTEAD of other modalities. It is used in an attempt to avoid back and neck surgery. It is used to manage menopausal issues. It is used to postpone hip replacements. Patients who seek this type of therapy very often avoid the traditional approach. And, because of this they will not be paying towards their deductible prior to the self selected acupuncture treatments. </p>

<p>

Exactly. Assuming the patient had already met the deductible, they would have exactly two weeks of covered pain treatment - for a modality that is not expensive when compared to traditional physical therapy. </p>

<p>Also, since there are no ‘in network’ acupuncturists (not last time I check), the provider will most likely issue a super bill and it’s up to the patient to file with their own insurance. This is a feel good add on. </p>

<p>And yes, I know of what I speak.</p>

14082

<p>An example of how crummy and deceitful Anthem is:
<a href=“Recording seems to refute claims made by Anthem”>http://www.latimes.com/business/la-fi-lazarus-20140516-column.html&lt;/a&gt;&lt;/p&gt;

<p>Customer says that Anthem rep assured them their surgery would be covered and the doctor was in-network. Customer has the surgery. Anthem denies the claim, saying that it was never pre-authorized. Customer produces recording of the phone call. Anthem continues to deny that their rep said what he (according to the recording) said.</p>

14083

<p>Ugh…the worst part of any health insurance battle is that it is usually undertaken when one is vulnerable and scared.</p>

14084

<p>Anthem may be crummy and deceitful but in my region it is the only realistic choice in the individual market. The other insurer, Blue Shield, has a pathetic network. I can’t find a decent doctor who belongs to it.</p>

14085

<p>CF, in my brain, one of the important questions is: is there anything else I need to do, to have this procedure approved? [Not just, sure, it’s covered.] It also escapes me why these articles hint people only check with the insurer. If I had a procedure in mind with a doc I had not yet visited on my new insurance, I would ask his/her folks, too. But I do hope the couple wins. Btw, afaik, recording a call is regulated. </p>

<p>Tricky, is that BCBS told me they have an initial quick approval and then it’s reviewed. Forewarned is forearmed. You want approvals in writing or done direct by your doc. </p>

<p>Out of curiosity, GP, what do you think makes “a decent doc?”</p>

14086

<p>If I were sitting on the jury and Anthem was trying to defend itself on rejecting that claim after their rep said it was covered, I’d throw the book at them. The customer is justified in relying on the statement by their representative. This is Swedish Made P---- Enlarger territory. </p>

<p>-- We didn’t authorize it!</p>

<p>-- One phone recording, Anthem representative authorizing coverage.</p>

<p>-- It’s not our bag, baby!</p>

<p>-- One phone recording, Varicocele surgery by Dr. Werthman, W-e-r-t-h-m-a-n, It’s Our Bag Baby, by Anthem.</p>

14087

<p>I hope they get nailed to the wall!!! EVERY SINGLE customer service agent should be responsible for the information they provide. This includes the public and the private sectors.</p>

14088

<p>"Out of curiosity, GP, what do you think makes “a decent doc?” </p>

<p>Recommendations from trusted doctors and friends.</p>

14089

<p>

I don’t know about the EPO in your county, but the BS PPO in mine has in-network acupuncturists. There are 8 listed within 5 miles of my home.</p>

14090

<p>Totally different topic, sort of related, but kind of funny to remember. Way back when I first found out I had facet joint syndrome after a severe lockup, I’d been getting pain relief from a talented acupuncturist who had also been a doctor when living in China. I was living in Canada, where you didn’t really give much thought to financial implications of an illness, except being able to work.</p>

<p>The acupuncturist had written a note for me to give to my fancy, deeply-experienced, Harvard-trained, osteo-surgeon specialist. After diagnostic tests, (bone scans, mri, etc.) he told me she was 100% correct in her dx and had pinpointed precisely the five locations where there was evidence of trouble. </p>

<p>He also told me to keep going to her, and said it was too bad she wasn’t covered under our national health system, because her treatment plan was likely more effective, and substantially cheaper to the govt than the physio, TENS, and painkillers combined, and definitely cheaper and less risky than the surgery he might have to resort to but preferred to avoid given that I was the single parent of a young child without help to care for him ;)</p>

<p>I pursued a combo of western medicine plus her therapy and eventually recovered and learned some ways to avoid aggravating the condition. I was also, after a year of therapy, able to avoid a high-risk and expensive (and iffy in terms of efficacy) surgery. At the time, my compatriots were amazed that I’d spend $600 a month pursuing alternative therapy.</p>

<p>These are the same folks who can’t actually comprehend that mch and I now pay $979 a mo. for individual coverage that still has a $2800 deductible ;)</p>

<p>Two things come to mind from this experience. One is that even in single payer systems where “everything” is covered, most alternative therapies traditionally aren’t covered, so its to e kinda crazy to expect private insurers to do so.</p>

<p>But on the other hand, if all complementary practitioners were as skilled as my particular acupuncturist had been, covering these therapies could indeed save a lot in terms of medical costs over time…so it might make god sense to cover them :)</p>

14091

<p>Dietz, my D saw a counselor in HS for what you lightly call the “ain’t it awfuls.” It was awful, and she needed some help. Our punishment for doing the right thing for our daughter was that she became uninsurable. </p>

<p>She never saw an MD for her problem. I did see one for mine. When I was prescribed antidepressants, I too became uninsurable. So if you touched any part of the mental health system, it was all over. </p>

<p>This was a terrible problem before ACA. You had to decide if taking care of your mental health, or your child’s, was worth the price of never again having health insurance. No family should be put in that position. Like many other aspects of the law, this may need adjusting. But even so, it is ten thousand percent better than it used to be.</p>

14092

<p>Interesting. I never knew about this particular pre-ACA problem. One of my kids had the HS “ain’t it awfuls” but I was pretty sure based on past experience that a doctor wasn’t going to be much help. DIY all the way and it worked out for the best for a variety of reasons. But, I’m curious. How…if she never saw a physician…does that become a pre-existing condition. There is no diagnosed condition.</p>

14093

<p>Applications specifically asked about therapists and counselors. I went over this with a broker at one point, and the term he used was “automatic decline.”</p>

14094

<p>In retrospect, the whole thing with S case of the ‘ain’t it awfuls’ is more disconcerting that it was during the actual process. Had we been in a position of needing to save the out of pocket $$ I’m sure the psychiatrist would have slapped some sort of label on S. It is now clear - there was nothing clinically wrong with him that a few sessions of being able to lament and get validation couldn’t cure.</p>

<p>Several months after all of this it came out in casual conversation with S that he was one of the few in his group that didn’t have a ‘diagnosis’. The conversation went as follows - In the car the other night so and so jokingly said - he dude - your the only non-depressive in the group. (WHAAAATTTT) A large majority of these young men were on some sort of medication. </p>

<p>S is pursuing a particular activity which would have been severely limited if a mental health issue was part of his permanent record.</p>

<p>If I had to do it over again, I would not even run the few covered visits through the insurance system. I’d just pay out of pocket and negotiate a cash payment at time services are rendered.</p>

<p>Yes, getting rid of the stigma and the resulting insurability issues was/is necessary. </p>

14095

<p>I don’t mean to minimize your son’s problem, dietz, but is his situation something that ought to be included in mandated insurance benefits? I’m sure that visits to a helpful, experienced and caring counselor helped him, but we don’t pay for everything that is helpful. Yoga and massage are good for my health, but I don’t think that my insurance ought to pay for them. </p>

14096

<p>Dietz, we didn’t even try to run it through insurance. The fact that she had been seen at all was the kiss of death. I can’t remember exactly what the wording was but we would have had to commit fraud to answer No.</p>

14097

<p>CF: IMO, no …nothing was ‘really’ wrong with S. And, for that I am grateful, thankful, humbled, and blessed. My point is simply had we taken the next step and had him evaluated I have absolutely no doubt he would have been assigned a diagnosis. The whole thing started with the Patient Health Questionnaire (PHQ-9) which he filled out during the regularly scheduled physical. The questions are so open ended that even on the best of days one could inadvertently wind up being classified as ‘depressed’. And, then the PCP is pretty much required to push psychiatric evaluation and/or anti depressants.</p>

<p>The process is what was/is disconcerting.</p>

<p>LasMa: Many years ago I had trouble sleeping. My CNP thought it was due to anxiety. However, she was smart enough to write up the diagnosis as ‘insomnia’. This resulted in the visit being covered under heath care (instead of being forced into the Mental Health care area), and prevented any other negative consequences. Although an ACA detractor (I think that’s what someone call it), I’ve not been one to every imply the past system was acceptable. I am of the opinion that the given solution has caused more problems for more people than it solved. But as we all know YMMV.</p>

14098

<p>I mentioned earlier, my neighbor’s girl, after she hit 26, couldn’t get any sort of affordable policy, because she saw a counselor once every 3 weeks. </p>

<p>Yes, counselor visits should be covered. Who are we to minimize what may be going on? That doesn’t mean you run out for every life hangnail. But there comes a time when you know if DIY is all it takes- or not. Hindsight isn’t always reliable. I;ve answered the question about counseling truthfully: yes, for some of life’s normal adjustments. When it became clear D2 might not have a healthy future without help, we sought it- same as we would for a medical condition that affected her.</p>

14099

<p>But, people do run out for every hangnail LF. Especially, if someone else is paying the bill. And, a therapist, counselor, doctor will find something to diagnose and something to write a prescription for because that’s what they do. it’s interesting when the undiagnosed kids are the oddities. And, probably not good.</p>

14100

<p>I found an old Anthem application, and one of the questions is “Within the last 5 years have you had counseling or treatment for symptoms of any mental, emotional, or behavioral disorder?” </p>