<p>Get it, regardless of your coverage.</p>
<p>Thanks for the link EB. I read it last night. We will see if yet another phonecall will yield any different answer in my case. </p>
<p>Yes, LasMa, it is still important to get it done. My dad had surgery for colon cancer this year. He’d never had a colonoscopy so it was undetected for a very long time. </p>
<p>Good news, though not for this year, for those who won’t bother to shop around for cheaper plan to replace their formerly cheap plan:
</p>
<p>Kind of a late in the game nod to the lack of pluck & self-interest in those this was formulated to help. That and a single-minded drive to keeping those premium figures down. The possibility that a switch to a new & lower priced plan is going to include the same doctors seems kind of remote, though.</p>
<p>RE: Post 81, the UCSC kid who had $9000 in bills, $3000 from out of network stuff</p>
<p>In general one can successfully fight the insurance company on that issue IF the patient had no power to choose. For example, I get a surgeon & hospital approved, if the anesthesiologist or physician assistant is not in network, that should not be my fault & my responsibility to pay. I had no choice, no means to choose, therefore they should pay. This requires an appeal letter in writing.</p>
<p>I have successfully recommended this strategy for several clients & the insurance company paid, @dietz199, give it a try, see if you have any luck.</p>
<p>I previously explained a situation with the cost of a name brand drug (my post #43). In short, the OOp cost for this drug would be $804/month - and that’s the Costco member price. I had my practitioner order the item through an pharmacy located within our North Neighbor’s territory where it runs $53/month. So, the drug has arrived and I find the following info …well…not sure if I find it funny, sad, ridiculous, or just simply inexplicable. As per the bottle and external packaging my happy pill found it’s way to me via the following path…</p>
<p>Drug developed by/patent held by GalaxoSmithKline - A British company
My product is manufactured by a company in Canada
Then it is packed by a company in Germany
Then it is dispensed by a company/pharmacy in Istanbul, Turkey
From where it is then sent to our Northern Neighbor
Who then puts it in the mail to me.</p>
<p>And…all that for $53/month VS $804. </p>
<p>It sounds like the trips some of my luggage has taken…before once again finding it’s way back to me.</p>
<p>The Fang family wants to drop our Cobra for 2015 and buy on the individual market. Fang Jr had an easy time: he switched to Kaiser, no muss, no fuss. The only issue was whether to go for an HSA, and he decided not to, although it would save him money, because he’s pretty sure that he wouldn’t get around to doing the record keeping.</p>
<p>That leaves Mr. Fang and me. We want to keep the doctors we’ve had for decades. So I checked with the medical group that we use, to see which insurances they take. For 2105, they don’t take Anthem Blue Cross. That’s OK, I wouldn’t buy Anthem anyway because they suck. What about our other choices, Health Net and Blue Shield? The group is “in negotiations” with those two insurers. </p>
<p>Yeah, thanks, that’s useful. It’s December 1st! We need to buy insurance for Jan. 1, and they can’t tell us whether the insurance we need to buy will cover our doctors. </p>
<p>Meanwhile the hospitals and medical groups are advertising heavily to induce customers to want them included in their health plans.</p>
<p>Maybe we should just switch to Kaiser. I like my doctors a lot, but I can’t stand this crap.</p>
<p>CF, how long did it take your son from the time of the application to a confirmation he was approved?</p>
<p>I applied on Friday. I don’t have that much patience. :)</p>
<p>I’m not sure if he has been approved yet. I’m assuming the approval is pro-forma, because they’re not allowed to deny him.</p>
<p>Oh. Ok. I was told not to cancel Anthem until we are approved. I guess it is in case paperwork is screwed up. </p>
<p>Good point, dstark. We won’t cancel Fang Jr’s Cobra until he gets approved. As we know from this thread and previous threads, paperwork gets screwed up all the time. We want Fang Jr to have insurance.</p>
<p>We are also going to be switching from COBRA on January 1, but we’re still considering what we want. I found two good policies on the exchange that have all my current doctors and a good choice of hospitals - $555.06/mo (per person) for an HSA silver PPO plan with a $2050 deductible, 40% copay w/$4200 OOP max, or $671.45 for an HSA gold PPO plan with a $1800 deductible, and $1800 oop max. Still running the numbers – the gold looks like it would have been cheaper for us in some years, and the silver in others. I’m still waiting to find out what H’s company will offer this year in the way of spousal coverage options. I’d like to make the decision this week.</p>
<p>We’re not eligible for any subsidies, so I hope that makes the approval process faster. </p>
<p>Is there any reason to buy through the exchange vs. from the company directly if subsides are not in play? (We are way, way out of subsidy range.)</p>
<p>For “way, way out of subsidy range” - you are probably better off dealing with the company directly – exchange just adds another layer or bureaucracy and potential for something to mess up. </p>
<p>But if there is is a possibility of qualifying for a subsidy in the near future (such as uncertainty about current employment) – then being on-exchange might make things easier if you need to make a change. But a significant change in income that would qualify you for a subsidy would allow you to apply to an exchange outside of open enrollment in any case. </p>
<p>You might want to verify that you are paying the same price for the same plan on and off exchange – there might be some minor variations in premium costs. For example, last year in California off-exchange buyers were being charged extra for children’s dental from Anthem even if they didn’t have kids, but weren’t charged that on-exchange. </p>
<p>On-exchange weren’t charged for pediatric dental? I thought <em>every</em>one was charged for that, whether or not they have children. That’s what’s happening in my state. </p>
<p>It was a complicated California thing, because their exchange wasn’t set up to handle the dental part last year. I think whatever problem they had in 2014 has been addressed for 2015. But I’m just saying that it’s probably worth taking a few minutes to compere costs, if there are appropriate tools to do so.— just in case. I think that if you are paying full cost, it’s more likely that you will find a slightly less expensive policy off exchange, because there are more policies available off-exchange than on. Also, there are some insurance companies that aren’t participating in the exchanges-- they may have different networks as well as different costs. </p>
<p>All of the off-exchange policies also have to comply with the law (guaranteed issue, metal-tier levels, etc.) – but there certainly is flexibility in how they structure their networks and the balance between deductibles and co-pays. </p>
<p>I just signed up for health insurance through Colorado’s exchange. It was amazingly easy: we used an agent (free of charge) who went through all the variables with us. She clearly knew what she was talking about – at one point, she even caught a mistake on one company’s website – and asked all the key questions we wouldn’t have necessarily asked ourselves. There was a lot to consider, including my son’s medication which is not covered at all by many of the cheaper plans (and would cost almost $300/mo out-of-pocket.) We were surprised just how affordable some of the plans were: as little as $70/mo for a single young person. Of course, we’re paying a heck of lot more than that (but a WHOLE lot less than COBRA) but we chose a more expensive option that lets us keep our current doctors. We’re now signed up, starting January 1.</p>
<p>It feels good. I’m looking forward to seeing the plan work in action. </p>
<p>OK, this could be veering into forbidden territory – I don’t know where the lines are drawn between humor and politics - but I can’t resist posting this link:
<a href=“The Colbert Report - TV Series | Comedy Central US”>The Colbert Report - TV Series | Comedy Central US;
<p>(I’d add that there is a college connection: the video linked to is from an event that took place at GWU)</p>
<p>Yup. Classic video, calmom. </p>
<p>That’s great, Katliamom! Hope it works out well for you and your family. </p>
<p>Saw Colbert last night. Was great. </p>
<p>Well, I’ve got to make a choice this weekend. I’m dithering between an HSA-compatible plan and a traditional ppo plan. The rest is pretty straightforward. H is going to be charged 25 cents/hour worked to cover me on his dental and vision plan. I could get health coverage through his company, but the spousal premium is really high and the family deductible is 3x the employee deductible, and those numbers don’t make any sense to me.</p>
<p>It will be the first time in 30+ years of marriage that we haven’t had the same insurance. Not sure why that weirds me out, but it kind of does. Actually, way back when we cross-covered each other in the day when having dual insurance meant basically 0 out-of-pocket expenses. (Though there was an awful lot of paperwork flying around.)</p>
<p>Our 2014 ACA plan came to us for renewal with a much higher premium, but also some “enhancements” , ie a lower deductible, so we searched for a less expensive plan. Our new plan for 2015 is bronze, while this year’s plan was silver. Our 2 person family deductible is now $11,000 (gulp!) which is the only number they gave us - so there is no lower individual deductible. We have to spend a combined $11,000 to meet the deductible, whether it is for one or both of us. Prescriptions drugs are included, so we will pay full price for drugs until we hit the $11k. Previous plan had a separate $200 deductible for drugs and a $10 copay. I am on a cheap generic statin, and wife was taking something for her bones but has now stopped, so all of this only becomes an issue if we get sick. (That last statement made with only a slight overtone of irony and/or sarcasm) Doctors visits are still a co-pay, along with one free visit for a physical each year. </p>