<p>Great NYT article on different approaches to comparing ACA premiums year-to-year, and why so many different answers pop up: <a href=“How Much Did Health Insurance Rates Go Up? It’s Complicated - The New York Times”>How Much Did Health Insurance Rates Go Up? It’s Complicated - The New York Times;
<p>Interesting article: <a href=“Santa Cruz cancer survivor sells medical device to offset costs – Santa Cruz Sentinel”>PG&E boss says company wasn’t fully ready for California outages – Santa Cruz Sentinel;
<p>It never occurred to me that out of network charges could apply if your in network hospital and in network doctor sent a lab sample to an out of network lab. Ugh…</p>
<p>So instead of the expected OOP he’s left with an additional 9K. </p>
<p>The lesson I take away…the network is really really really important!</p>
<p>The lesson I take away is that legislation is necessary to mend this obvious hole in the safety net which we think we’re getting when we pay for insurance. Or that one network would fix this problem very nicely.</p>
<p>ETA – California has prohibited balance-billing in emergency room situations. Now they only need to take the next logical step to prohibit it in non-emergency situations where the patient has no practical choice, such as labs, surgical anthesthesiologists, etc. And note who the patient in the article holds responsible for his plight:</p>
<p>
</p>
<p>^^^ I think Varnaelli had quality care and care that might not have been available prior to ACA (although as a UCSC student it seems he would have had the option to join the UC plan). </p>
<p>It shouldn’t be on the insurance company. It should be the hospital. What are they doing using out-of-network labs for their in-network patients?</p>
<p>Someone upthread mentioned I might be eligible for an HSA account. Thank you for that suggestion. My plan is eligible and that is an idea I had not thought of. I don’t have an extra $3000 lying around, but it is definitely something to think about. I love learning things from all you smart people!</p>
<p>How do the hospital/docs/provider know who is in patient A’s network and who is in patient B’s network? Whose responsibility is it to determine who is in what network…the patient (who doesn’t even have clue, nor should they), as to what/if/where their lab work is sent? The facility? The Doctor? Really?..if someone with the weight of those who shall not be named, inserts itself into a supposedly broken system then the average Joe Plumber will assume that the FIX will protect them from this sort of crapage.</p>
<p>
</p>
<p>If it costs the hospital money, they’ll know. It is knowable, in principle, and the hospitals can certainly find out if it is in their financial advantage to do so. We can’t put in on the insurer because the insurer is not the one sending out the bloodwork. The hospital is making the decision of which ancillary provider to use, so the hospital is going to have to be the one that makes sure the providers are in-network.</p>
<p>In our plan, we have a $4000 family deductible, with a per person cap on out of pocket expenses (co-pays). But for the family plan the total out of pocket amount is less than the total per person amount. For example if you have four people in the family plan and the out of pocket amount is $1000 per person over the deductible amount, instead of $4000 out of pocket the family out of pocket would be $3000. (The out of pocket amounts are guesses, I can’t remember the actual amount). So, you get a discount by getting the family plan if you use the insurance a lot. That would be the benefit to getting family vs two single plans.</p>
<p>You have to give the hospital your insurance card…</p>
<p>My wife called the anesthesiologist office three times. Finally she received a call back, but she missed it. The voice mail said the anesthesiologists in the office take her plan. </p>
<p>Turned out after the cataract operation, the anesthesiologist doesn’t. Somebody involved in that practice knows what plans are taken. There are contracts.</p>
<p>More fun coming. My wife was charged the uninsured rate. We will see where this goes. :)</p>
<p>My wife’s plan says pathway. There are doctor’s offices that know they do or don’t take pathway plans. Some offices do get this right.</p>
<p>I haven’t read this whole thread, but it was wondering if any of you have run into the following problem. Our company has a high deductible plan. One of my co-workers had to have surgery to remove a tumor. She had not met her deductible and the hospital submitted a bill to the insurance company and required that she pay her portion of the deductible and the insurance pay upfront before they would do the surgery. According to the insurance rep she spoke to this was because so many people now have high deductibles and don’t have the money to pay for surgeries. If they don’t get the money up front, they have a hard time getting it at all.</p>
<p>I haven’t heard this anywhere else, but it seems like a big problem. I would think the majority of people don’t have the amount of their deductible saved.</p>
<p>^^ Providers will calculate a patients portion and require payment of this amount prior to proceeding. We are asked to pay our co-pay or calculated patient portion prior to services rendered. It has been common practice for a provider to ask for payment of the portion the insurance is not expected to pay. Why would they put themselves at risk? So, yes…your co-worker had not met the deductible/co-insurance limit…they will be and SHOULD be asked to pay up front. Providers are not charities, and as deductibles and co-pays increase…this will be an issue. Pay or don’t get service…same as at your grocery store, tire store, travel agency etc.</p>
<p>Getting a service is going to cost $$$$$$$$ unless we want to make a particular service ‘free’ in which case one gets what one pays for. So…all this isn’t ‘free’ oh shiver me timbers…who woulda guessed.</p>
<p>@dietz199. Thanks for the sarcasm. I wasn’t saying it should be free. We’ve had this type of insurance (high deductible) for 5 years. Nobody in my office ever had to pay upfront for any care. The doctor/facility bills the insurance company and then we get an EOB stating what the insurance pays and what amount, if any, is our responsibility. Then, we get a bill from the doctor or hospital. This is the first time someone had to pay upfront. I wanted to know if anyone else had this experience. </p>
<p>
</p>
<p>Not a new practice. Been doing that with hospitals and outpatient surgery centers for 10+ years. (We just show up for surgery at 6:00 am with a credit card for the amount not paid by insurance; in our case, its a small deducible and 20% copay.)</p>
<p>My doctors are now requiring that people pay their copays upfront. It doesn’t seem unreasonable to me that doctors and hospitals are asking for the patient’s part of the bill at the time of service. After all, the patient owes the money and the provider wants to make sure they are paid.</p>
<p>@musicmom1215 – re the HSA – you don’t need to put the full amount in at once (or ever). Our credit union will open an HSA if you make a $25 deposit to open your CU (general) account, and then you can put whatever you like (up to the limit) into your HSA – If you’ve going to have a bill for $90, you could put $100 into the HSA, and then pay the bill for $90 from the HSA a few days later. You’d still get the HSA deduction for whatever you did contribute when you do your taxes. </p>
<p>A friend who worked for our local hospital a few years ago in the patient registration section earned bonuses for each pre-payment a patient made. It is a lot easer for hospitals to get paid up-front for at least some of the bill than to wait. She also mentioned that if people had trouble with the up-front payment that there was a protocol for referring them to the hospital’s charitable program and that more people took advantage of the charitable program than before they did that. Not sure how it works now. </p>
<p>“My doctors are now requiring that people pay their copays upfront.”</p>
<p>I have had to pay my co-pay ($20) upfront for years at all my doctors. ER and hospital never had to do that. However, I live in an area where my insurance (NYS employee) is probably the most prevalent of all insurance in the area, so they know they are going to get paid. Also, practically every doctor and all hospitals in a five county area are in network. </p>
<p>@kvillemom: It is not a new practice…especially if a patient is new to a particular office or provider. H has had to have several out patient procedures over the past 5 years. It’s always the same doc and the same hospital. Each time we first stopped at the check in/billing office. We paid the estimated co-insurance/deductible before anything could proceed. (no pay, no lovely backless gown and matching nubby socks)</p>
<p>My parents are with Kaiser. First stop is always the front office where the patients’ portion is calculated and paid. Again, not new at all. </p>
<p>@emilybee: I don’t think hospitals and providers are as concerned about being paid by an insurance company as they are concerned that a patient can’t cover their portion. If a deductible is 5K, the hospital would be out a good chunk if the patient defaults.</p>
<p>There are a lot of people with Obamacare policies who do not have 5-thousand dollars in the bank. Maybe most.</p>