Are you talking about “Free Healthcare” for everyone and doubling the national debt from $20 Trillion to $40 Trillion? Will that improve Healthcare in this country? By the way, I am not sure how Bernie will affect a solution with about 5% of the vote.
I have not heard one true advocate for Universal Health care call it “free”. Bernie Sanders has repeatedly stated that it will be paid for with tax increases. At least he is honest about his proposal. Not one of the Republican candidates have discussed how their tax proposals will add trillions to the debt. How about some transparency and honesty from them?
Not one Republican candidate has proposed a replacement health care plan that I have seen. If there is one out there, please let me know so I can do some research.
Yes 2, the proponents argued vociferously that the country had a real problem with people using the Emergency Rooms for Healthcare and not paying for treatment and thus a terrible burden on society. Obamacare was supposed to fix all of that. NOT!
How long will Ron wait until he pipes in that Universal Care through the government is the solution to everything?
Reports by NBC, MSNBC, CNN, etc. lack technical details people in the insurance biz understand. So, please review online plans by Cruz, Trump, others. Trumps’ and Cruz’s plans similarly include removal of state-line barriers to competition which yields portability of HSAs. Individual plans takes control from employers and gives it back to consumers.
Trump has a single-payer proposal…. which is contrary to BIG Gummint splitting up big utilities, big pharmas, big banks, big insurers, and big anything-but-gummint.
The Trump Plan Is Out There!
Go Cruzin’ for a bruisin’ to the ACA.
I went to each of those candidates’ official campaign sites and neither even mentions health care. Marco Rubio and John Kasich have their plans on their sites. Their positions are to repeal the PPACA and replace it with talking points, buzz words and ambiguities.
Please cite the websites where I may find the health care replacement plans for Trump and Cruzs.
agent2,
No this is not what ACA was designed to address. This article is about in-network/out-of-network coverage levels. Going into the hospital for treatment under the belief it was all in-network because the hospital was in-network and your doctor is in net-work and then being hit with out-of-network charges because some other medical professional sees you and he/she is out-of-network.
Agent,this problem addressed in this article isn’t about emergency room use for healthcare. See my response above to agent2. While using the emergency room for non-emergency healthcare is a problem and ACA should help reduce it, it is likely to take years to change the mindset of people raised to run to the emergency room instead of the doctor’s office.
Bill, sorry to disagree, but Liberals said for quite a while before this law was passed that it would fix the Emergency Room problem because so many more would be covered, they wouldn’t have to run to the Emergency Room for care. The burden would be lifted from society and it would be wonderful. That is just one of the many problems of this idiotic law along with taxation, mandates, high deductibles, high out of pocket expenses.
Agent – I’m confused. People with health insurance can still use the Emergency Room, right? I’ve never heard anyone say “I just hurt myself real bad, but it’s Saturday and I have health insurance so I’m not going to the ER today – I’ll just wait until Monday to see my PCP for this bone sticking out of my leg.”
February 22, 2016 at 1:40 pm
FFA says:
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Confused, that is the reason Er’s exist (the bone thing). I have a head cold that wont go away for going on three weeks now.
Today, I am waiting on my doc to call, not run off to Urgent Care or ER.
February 22, 2016 at 4:44 pm
Confused says:
Hot debate. What do you think?
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I agree FFA, so I was wondering who in their right mind would argue the ER problem would be “fixed” if people had insurance. Agent said those dirty smelly stupid hippie liberals said that and I can’t remember ANYONE saying the ER backlog would be fixed. Better? Sure. Quicker on average? Yeah. Fixed – which means no more ER issues what so ever? No way.
February 23, 2016 at 1:32 pm
FFA says:
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Confused all the people (politicians) who pushed OBama Care down our throats said that.
February 22, 2016 at 1:38 pm
FFA says:
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Bill, I am living every penny of what you described. Lab my (my wife) used for ever is suddenly out of network. Same with the outfit that did her MRI’s. Got to eat the full force of that.
FFA, I read a very good article through Bloomberg which highlighted the voter anger in this country. It starts with – Many Americans have had it with:
Anyone named Bush
Anyone named Clinton
Anyone who’s held political office
Political Correctness
Illegal Immigration
Massive Unemployment
Phony “official” unemployment and inflation figures
Welfare waste and fraud
People faking disabilities to go on the dole
VA waiting lists
TSA airport groping
Obamacare
The Federal Reserve’s money printing schemes
Wall Street crooks like John Corzine
Michelle Obama’s vacations
Michelle Obama’s food police
Barack Obama’s golf
Barack Obama’s arrogant and condescending lectures
Barack Obama’s criticism/hatred of America
Valerie Jarrett
Holiday Trees
Hollywood hypocrites
Global Warming nonsense
Cop Killers
Gun confiscation threats
Stagnant Wages
Chevy Volts
Clock Boy
Pajama Boy
Mattress Girl
Boys in girl’s bathrooms
Whiny, spoiled college students who can’t even place the Civil War in the correct century…and that is just the short list.
The elitist politicians just can’t understand why the folks are angry with them. I say Enough is Enough.
February 22, 2016 at 4:46 pm
Confused says:
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Okay Agent……..so what’s your solution?
February 23, 2016 at 8:26 am
Ron says:
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As the new CEO of America, Donald Trump will fix all of these problems by filing for bankruptcy, firing everyone, and making the U.S.A. a reality T.V. show.
February 23, 2016 at 12:13 pm
BS says:
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Agent, could you provide the link for that article? I’d like to read it.
Thanks!
February 18, 2016 at 2:01 pm
Yogi Polar Berra says:
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Medical emergencies give rise to surprise fees?! {feigned surprise}
If true, we can classify The Affordable Care Act as a ‘medical emergency’.
Is it any surprise that a service with inelastic demand has high prices?
I think he meant to say, “about as predictable as an ignored regulation leading to a mass fatal disaster in Texas.”
I agree full-heartedly with you on universal care, Ron. I hope to see it some day in my lifetime. I’ll add it to my list which includes a Cubs World Series win and a ticket to The Masters.
The issue of out of network providers has nothing to do with Obamacare. It is related to Hospital staffing and the operation of the free market. All we will get in 2017 is a blast of hot air.
It has everything to do with it Simon. All carriers scaled back their network coverage in IL this year. Docs are in, but Hospitals they have privileges at are not.
Go back to the way it was with reasonable premiums & OOPs – a true out of pocket max.
Subsidize the Pre X Crowd.
Extend Cobra Benefits with no term limit. Take the employer out of the billing procedure.
Look at underlying factors that run the cost up. Start with Tort caps.
Look at Gouging by the drug companies & Med Mall attorneys.
I have a tale of Domestic Abuse evolving. If things are gong like I think they are, its gonna make you vomit when I lay it out on this site. Proof positive Tort Reform and sleezy lawyers need to be addressed.
FFA, I received a notice today from Blue Cross. Not unexpected, but it said that they would no longer pay commissions on new business on Individual Medical after 4-1-16. They also prefaced the announcement that they were “all in” on the ACA. Thank god, we haven’t tried to write Individual policies for a while. They were gracious to give us commissions on existing business. Aren’t they wonderful?
Well agent, I got my notice after I read your post that Blue Cross don’t want any more PPACA business from me. They are going to re-evaluate the commis schedule moving forward for existing biz which means that Obamas quest to hurt agents and furthere unemployment is moving forward.
FFA, can we guess that commissions for existing business will be reduced again? By the way, if Obamacare is repealed and replaced and the market starts being used again, Blue Cross and others will offer new plans and be enthusiastic about it.
There were in-network/out-of-network issues the way it used to be.
While I agree with some of your solutions, they would still not solve many of the issues millions of Americans faced regarding health care/insurance before the PPACA.
The studies I have seen regarding tort reform, an issue where we agree needs to be done, would only have a minimal impact on health care costs. Most state it would be less than a 2% decrease. Why I advocate for tort reform is to reduce the number of frivolous lawsuits that delay legitimate lawsuits from getting heard and settled, thus reducing the number of sleazy lawyers.
The big issues prior to the PPACA were the cost of the premiums / medical care. Defensive medicine have been practiced for more then a decade. If your reading Govt Stats about tort, I am pretty sure they are put together by lawyers themselves to minimize their impact.
One of my former clients, hit with $6mill because the deceased stopped taking his heart meds on the week ends.
I have never been hit with Out of Network Charges like I did last year. Its much worse. Much Worse.
And Shirley, they way I see Medicare / Medicaid taking care of my parents, you better be careful what you wish for. Shove you in a home and let you rot. All in the name of cost savings. A true sales pitch for Long Term Care.
Unfortunately, I think tort reform and caps have a bigger effect on malpractice premiums than they do on patient healthcare premiums. I found an article that I thought was kind of interesting about the effect of tort reform in Texas. It’s a couple of years old, (2012) but it it talks about how tort reform helped reduce malpractice costs, but had no effect on healthcare costs:
“A new study found no evidence that health care costs in Texas dipped after a 2003 constitutional amendment limited payouts in medical malpractice lawsuits, despite claims made to voters by some backers of tort reform…”
“The researchers’ findings come after a report last fall in which the Ralph Nader-founded consumer group Public Citizen said it found Medicare spending in Texas rose much faster than the national average after tort reform. Critics of that study said that tort reform leaders never promised health care spending would decline and noted that caps on damage awards brought steep drops in malpractice insurance rates for doctors and large increases in new doctors coming to Texas.”
It’s a shame, but I don’t think any amount of tort reform or caps are going to help lower healthcare costs. Defensive medicine has become so ingrained in our medical system, that even with protections against frivolous lawsuits, doctors are still going to run that one last test, just in case.
As for the $6m claim, let me guess… Cook county? :/
No. Far west Burbs. Hospital involved was one of Blagos pay to play projects (a coincidence I believe). $3m to the doc and $3m to the hospital that tried to bring him back. Prompted the Med Mal Carrier to stop writing new biz for several years.
I read through that things several times and could not find negligence on either side. The docs notes were clear on him not taking his meds on the week ends. What a boring read.
FFA, a while back, my wife had a fall in the house and hit her eyebrow which split open and she was bleeding profusely. Carried her to the Emergency Room of my network hospital. After examination, they said they could not sew it up without possible scarring and they called in a plastic surgeon to do it. Guess what, he wasn’t in network even though they called him in. We had quite a fight over that and we eventually made him accept network payments.
February 23, 2016 at 3:45 pm
Rosenblatt says:
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Agent – your story speaks to exactly the main issue I feel this article was talking about — if I ensure my [doctor] is in-network, I shouldn’t have to ask for the name of every other person involved in my care too, just to make sure they’re all in-network.
Can you explain how you knew the surgeon wasn’t part of your network? Did you learn that before they worked on your wife? Did you have a resource provided by your health insurance company listing in- and out- of network surgeons, or did you not find out that fact until after your wife was treated by that party and you received a bill?
You and your saint of a wife would not have had that problem if we had Universal Health care.
February 23, 2016 at 4:23 pm
FFA says:
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Rose, my Out of Network Charges did not come about until the bills showed up. They were the same providers my doc used all along pre PPACA.
Everyone yammers about Single Payer. How about a single biller system? Get treatment at one hospital, get one bill that covers all providers for the injury/illness? Include all providers at network charges. This would reduce a whole bunch of paper / ink / postage billing departments, ect….
Its hard enough for an Ins Agent to figure things out, would it not be so much easier for someone outside the industry?
Single biller is something the private sector could fix, but won’t because it would not benefit them enough. They don’t care about the patients, only profits. When you realize that profits are the problem with our health care system, not the government or the PPACA?
February 23, 2016 at 4:32 pm
FFA says:
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Agent, Ive been lucky with my wife. When she has fallen, she has not hit anything on the way down. Not sure whats going on, but her spirits have improved over the past two weeks. She is not sleeping as much as she was. She is in a better mood.
She is actually smiling and laughing again, getting out of the house.
February 23, 2016 at 5:02 pm
Agent says:
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Rosenblatt, in a perfect world, everything would be wonderful and Obamacare would work as advertised and everyone would be able to check out all providers who were in network before receiving services. What would you do if you were 100 or more miles from home and had an accident? I think you would be up the creek without a paddle and more than likely be out of network for everything.
February 24, 2016 at 8:21 am
Rosenblatt says:
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Agent – thank you for your response, but you didn’t answer what I asked you.
First, I agree “in a perfect world, everything would be wonderful and…everyone would be able to check out all providers who were in network before receiving services”
However, I’m curious as to how your specific situation with your wife played out.
Can you explain how you knew the surgeon wasn’t part of your network?
Did you learn that before they worked on your wife?
Did you have a resource provided by your health insurance company listing in- and out- of network surgeons?
Or did you not find out that fact until after your wife was treated by that party and you received a bill?
February 23, 2016 at 3:56 pm
Agent says:
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BS, Tort Reform has caused MedMal rates to be better than most other states. Premiums for consumers are tied to Obamacare where the chronically ill were put in with the healthy instead of Pools where they belonged. This is why there are so many failures with Exchanges. They cannot collect enough premium to pay all the medical claims. Also, the doctors are not being remunerated as well for Medicare/Medicaid so they do everything they can to get remunerated for their services.
Are you aware of any studies that indicate tort reform has or would have a meaningful impact on health insurance premiums?
February 24, 2016 at 12:10 pm
Agent says:
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Rosenblatt, surely you are not that naïve. In times of an accident, no one has the time to check all providers of service. We went to the network hospital fully believing we would be treated in network. We didn’t know the plastic surgeon was out of network until much later and the bill showed up. The argument was that the network hospital failed to tell us that important fact. I had quite a discussion with the administrator about using non network doctors in their hospital. I made him see the light. Now that we have Obamacare, the networks have shrunken drastically. Talk to FFA about how limited his options are now. It is a joke up there in Wisconsin.
February 24, 2016 at 1:16 pm
Rosenblatt says:
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Agent – thank you for explaining at what point in the treatment/billing cycle you initially realized the doc was out of network. As for your naive comment – when I seek medical treatment, even at an Emergency Room, I can log into the mobile application or a website and put in a doctor’s name and immediately be told if they are in or out of network. It’s not naive to think others could do the same if their health carrier has a similar verification system for individuals.
February 24, 2016 at 4:15 pm
BS says:
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While I don’t doubt that there are some shady doctors that order unnecessary tests for extra money, I do doubt that they are the majority. It’s the fear of lawsuits stemming from bad outcomes and the thought of having to defend against them, that’s pushing them to run the extra tests. So, while tort reform has definitely helped malpractice rates, it hasn’t really had much of an effect on healthcare premiums. Because even if they know that there may be less frivolous and any possible judgements/settlements would be lower, physicians are still practicing defensively. They’re still going to run every test they can, so they can prove they did everything they could if/when they get dragged into court. And I don’t necessarily see that changing any time soon.
February 24, 2016 at 5:05 pm
Agent says:
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Rosenblatt, please explain to the forum how you would pull up all your providers if you were unconscious in the Emergency Room or was lying there in great pain. If you were conscious, would you tell the attending doctor to get out because he wasn’t in network and you didn’t want him to bill you out of network? It is one thing to be scheduled for an operation in advance and check everyone out and quite another in an Emergency situation, especially if you are out of town at the time. My wife has been in the Emergency Room numerous times over the years. We didn’t ever have a problem until Obamacare was passed limiting access to doctors and hospitals. It is a joke and you know it.
February 23, 2016 at 1:15 pm
louie says:
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can we stop with the mass-downvoting of people we don’t agree with, and mass-upvoting of our own comments, for that matter?? I thought we all grew out of that. It’s unbelievable; my 5 year-old at least will pretend to listen when she doesn’t agree with me.
I remember a time when you could actually go on this forum and LEARN about INSURANCE, not just get someone’s opinion about politics. It seems like every article turns into a massive political rant . If the IJ moderator is reading this, I hope you realize that this is probably costing you readers.
I would like to mass up-vote you right now, but then I’d just be proving your point :)
I’m lucky enough that my employer provides a treatment cost calculator where you can pull up in-network and out-of-network prices for treatment before you even go to the hospital. Unfortunately, that doesn’t get to the meat of this article
“In many cases, patients don’t realize they’ve received out-of-network care until they’re slapped with a bill for hundreds or thousands of dollars.”
If I ensure my surgeon is in-network, I shouldn’t have to ask for the name of the anesthesiologist and every other person involved in the operation too, just to make sure they’re in-network as well.
It’ll never happen, but it would be nice if you make sure your doctor is in-network that your doctor ensures those helping him/her are also in your network.
DCMS, no you dont have to worry about Network. Just Doc who dont care and will actually treat you with out mis diagnosing you or shove you in a room and let you die.
This VA in Chicago is a repeat offender and no govt entity does anything about it. They were Low Lited in that news piece I seen last week or so. They did not look good at all.
I do understand that there are much better facilities across the country then (I think its called) Edwards Hospital in Mel Rose Park. Thats is a facility that needs to be completely gutted (Employee Wise) as a piece on the news last year stated how the big cheese over there were letting people die so as to keep cost of treatment down.
We just have to worry about the VA offering a suicide hot line and then getting voice mail and no return call. Yes, that is the latest scandal and veterans still have a long waiting list for treatment. That is Universal Care in a microcosm.
Thank you Obamacare for your signature legislation which ruined Healthcare for everyone.
The last question was – Is anyone working on a permanent solution? Yes, and it will begin in Jan 2017.
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Are you talking about “Free Healthcare” for everyone and doubling the national debt from $20 Trillion to $40 Trillion? Will that improve Healthcare in this country? By the way, I am not sure how Bernie will affect a solution with about 5% of the vote.
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This problem existed long before Obamacare, but nice try.
Wait…..I thought Obama care was to fix this sort of thing?
Yes 2, the proponents argued vociferously that the country had a real problem with people using the Emergency Rooms for Healthcare and not paying for treatment and thus a terrible burden on society. Obamacare was supposed to fix all of that. NOT!
How long will Ron wait until he pipes in that Universal Care through the government is the solution to everything?
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Reports by NBC, MSNBC, CNN, etc. lack technical details people in the insurance biz understand. So, please review online plans by Cruz, Trump, others. Trumps’ and Cruz’s plans similarly include removal of state-line barriers to competition which yields portability of HSAs. Individual plans takes control from employers and gives it back to consumers.
Trump has a single-payer proposal…. which is contrary to BIG Gummint splitting up big utilities, big pharmas, big banks, big insurers, and big anything-but-gummint.
The Trump Plan Is Out There!
Go Cruzin’ for a bruisin’ to the ACA.
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Bill, sorry to disagree, but Liberals said for quite a while before this law was passed that it would fix the Emergency Room problem because so many more would be covered, they wouldn’t have to run to the Emergency Room for care. The burden would be lifted from society and it would be wonderful. That is just one of the many problems of this idiotic law along with taxation, mandates, high deductibles, high out of pocket expenses.
Agent – I’m confused. People with health insurance can still use the Emergency Room, right? I’ve never heard anyone say “I just hurt myself real bad, but it’s Saturday and I have health insurance so I’m not going to the ER today – I’ll just wait until Monday to see my PCP for this bone sticking out of my leg.”
Confused, that is the reason Er’s exist (the bone thing). I have a head cold that wont go away for going on three weeks now.
Today, I am waiting on my doc to call, not run off to Urgent Care or ER.
I agree FFA, so I was wondering who in their right mind would argue the ER problem would be “fixed” if people had insurance. Agent said those dirty smelly stupid hippie liberals said that and I can’t remember ANYONE saying the ER backlog would be fixed. Better? Sure. Quicker on average? Yeah. Fixed – which means no more ER issues what so ever? No way.
Confused all the people (politicians) who pushed OBama Care down our throats said that.
Bill, I am living every penny of what you described. Lab my (my wife) used for ever is suddenly out of network. Same with the outfit that did her MRI’s. Got to eat the full force of that.
FFA, I read a very good article through Bloomberg which highlighted the voter anger in this country. It starts with – Many Americans have had it with:
Anyone named Bush
Anyone named Clinton
Anyone who’s held political office
Political Correctness
Illegal Immigration
Massive Unemployment
Phony “official” unemployment and inflation figures
Welfare waste and fraud
People faking disabilities to go on the dole
VA waiting lists
TSA airport groping
Obamacare
The Federal Reserve’s money printing schemes
Wall Street crooks like John Corzine
Michelle Obama’s vacations
Michelle Obama’s food police
Barack Obama’s golf
Barack Obama’s arrogant and condescending lectures
Barack Obama’s criticism/hatred of America
Valerie Jarrett
Holiday Trees
Hollywood hypocrites
Global Warming nonsense
Cop Killers
Gun confiscation threats
Stagnant Wages
Chevy Volts
Clock Boy
Pajama Boy
Mattress Girl
Boys in girl’s bathrooms
Whiny, spoiled college students who can’t even place the Civil War in the correct century…and that is just the short list.
The elitist politicians just can’t understand why the folks are angry with them. I say Enough is Enough.
Okay Agent……..so what’s your solution?
As the new CEO of America, Donald Trump will fix all of these problems by filing for bankruptcy, firing everyone, and making the U.S.A. a reality T.V. show.
Agent, could you provide the link for that article? I’d like to read it.
Thanks!
Medical emergencies give rise to surprise fees?! {feigned surprise}
If true, we can classify The Affordable Care Act as a ‘medical emergency’.
Is it any surprise that a service with inelastic demand has high prices?
Yogi, as I predicted, Ron showed up with his Universal Care proposal. He is as predictable as a snowstorm in Buffalo in the winter.
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The issue of out of network providers has nothing to do with Obamacare. It is related to Hospital staffing and the operation of the free market. All we will get in 2017 is a blast of hot air.
It has everything to do with it Simon. All carriers scaled back their network coverage in IL this year. Docs are in, but Hospitals they have privileges at are not.
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Go back to the way it was with reasonable premiums & OOPs – a true out of pocket max.
Subsidize the Pre X Crowd.
Extend Cobra Benefits with no term limit. Take the employer out of the billing procedure.
Look at underlying factors that run the cost up. Start with Tort caps.
Look at Gouging by the drug companies & Med Mall attorneys.
I have a tale of Domestic Abuse evolving. If things are gong like I think they are, its gonna make you vomit when I lay it out on this site. Proof positive Tort Reform and sleezy lawyers need to be addressed.
FFA, I received a notice today from Blue Cross. Not unexpected, but it said that they would no longer pay commissions on new business on Individual Medical after 4-1-16. They also prefaced the announcement that they were “all in” on the ACA. Thank god, we haven’t tried to write Individual policies for a while. They were gracious to give us commissions on existing business. Aren’t they wonderful?
Thats not good news for me. Was that an Mail Blast or something in writing?
Thats just gonna make me hate the guy even more.
Well agent, I got my notice after I read your post that Blue Cross don’t want any more PPACA business from me. They are going to re-evaluate the commis schedule moving forward for existing biz which means that Obamas quest to hurt agents and furthere unemployment is moving forward.
Next up, AETNA for my clients.
FFA, can we guess that commissions for existing business will be reduced again? By the way, if Obamacare is repealed and replaced and the market starts being used again, Blue Cross and others will offer new plans and be enthusiastic about it.
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The big issues prior to the PPACA were the cost of the premiums / medical care. Defensive medicine have been practiced for more then a decade. If your reading Govt Stats about tort, I am pretty sure they are put together by lawyers themselves to minimize their impact.
One of my former clients, hit with $6mill because the deceased stopped taking his heart meds on the week ends.
I have never been hit with Out of Network Charges like I did last year. Its much worse. Much Worse.
And Shirley, they way I see Medicare / Medicaid taking care of my parents, you better be careful what you wish for. Shove you in a home and let you rot. All in the name of cost savings. A true sales pitch for Long Term Care.
Unfortunately, I think tort reform and caps have a bigger effect on malpractice premiums than they do on patient healthcare premiums. I found an article that I thought was kind of interesting about the effect of tort reform in Texas. It’s a couple of years old, (2012) but it it talks about how tort reform helped reduce malpractice costs, but had no effect on healthcare costs:
“A new study found no evidence that health care costs in Texas dipped after a 2003 constitutional amendment limited payouts in medical malpractice lawsuits, despite claims made to voters by some backers of tort reform…”
“The researchers’ findings come after a report last fall in which the Ralph Nader-founded consumer group Public Citizen said it found Medicare spending in Texas rose much faster than the national average after tort reform. Critics of that study said that tort reform leaders never promised health care spending would decline and noted that caps on damage awards brought steep drops in malpractice insurance rates for doctors and large increases in new doctors coming to Texas.”
http://www.statesman.com/news/news/local/new-study-tort-reform-has-not-reduced-health-care-/nRpcp/
It’s a shame, but I don’t think any amount of tort reform or caps are going to help lower healthcare costs. Defensive medicine has become so ingrained in our medical system, that even with protections against frivolous lawsuits, doctors are still going to run that one last test, just in case.
As for the $6m claim, let me guess… Cook county? :/
No. Far west Burbs. Hospital involved was one of Blagos pay to play projects (a coincidence I believe). $3m to the doc and $3m to the hospital that tried to bring him back. Prompted the Med Mal Carrier to stop writing new biz for several years.
I read through that things several times and could not find negligence on either side. The docs notes were clear on him not taking his meds on the week ends. What a boring read.
FFA, a while back, my wife had a fall in the house and hit her eyebrow which split open and she was bleeding profusely. Carried her to the Emergency Room of my network hospital. After examination, they said they could not sew it up without possible scarring and they called in a plastic surgeon to do it. Guess what, he wasn’t in network even though they called him in. We had quite a fight over that and we eventually made him accept network payments.
Agent – your story speaks to exactly the main issue I feel this article was talking about — if I ensure my [doctor] is in-network, I shouldn’t have to ask for the name of every other person involved in my care too, just to make sure they’re all in-network.
Can you explain how you knew the surgeon wasn’t part of your network? Did you learn that before they worked on your wife? Did you have a resource provided by your health insurance company listing in- and out- of network surgeons, or did you not find out that fact until after your wife was treated by that party and you received a bill?
Hidden due to low comment rating. Click here to see.
Rose, my Out of Network Charges did not come about until the bills showed up. They were the same providers my doc used all along pre PPACA.
Everyone yammers about Single Payer. How about a single biller system? Get treatment at one hospital, get one bill that covers all providers for the injury/illness? Include all providers at network charges. This would reduce a whole bunch of paper / ink / postage billing departments, ect….
Its hard enough for an Ins Agent to figure things out, would it not be so much easier for someone outside the industry?
Hidden due to low comment rating. Click here to see.
Agent, Ive been lucky with my wife. When she has fallen, she has not hit anything on the way down. Not sure whats going on, but her spirits have improved over the past two weeks. She is not sleeping as much as she was. She is in a better mood.
She is actually smiling and laughing again, getting out of the house.
Rosenblatt, in a perfect world, everything would be wonderful and Obamacare would work as advertised and everyone would be able to check out all providers who were in network before receiving services. What would you do if you were 100 or more miles from home and had an accident? I think you would be up the creek without a paddle and more than likely be out of network for everything.
Agent – thank you for your response, but you didn’t answer what I asked you.
First, I agree “in a perfect world, everything would be wonderful and…everyone would be able to check out all providers who were in network before receiving services”
However, I’m curious as to how your specific situation with your wife played out.
Can you explain how you knew the surgeon wasn’t part of your network?
Did you learn that before they worked on your wife?
Did you have a resource provided by your health insurance company listing in- and out- of network surgeons?
Or did you not find out that fact until after your wife was treated by that party and you received a bill?
BS, Tort Reform has caused MedMal rates to be better than most other states. Premiums for consumers are tied to Obamacare where the chronically ill were put in with the healthy instead of Pools where they belonged. This is why there are so many failures with Exchanges. They cannot collect enough premium to pay all the medical claims. Also, the doctors are not being remunerated as well for Medicare/Medicaid so they do everything they can to get remunerated for their services.
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Rosenblatt, surely you are not that naïve. In times of an accident, no one has the time to check all providers of service. We went to the network hospital fully believing we would be treated in network. We didn’t know the plastic surgeon was out of network until much later and the bill showed up. The argument was that the network hospital failed to tell us that important fact. I had quite a discussion with the administrator about using non network doctors in their hospital. I made him see the light. Now that we have Obamacare, the networks have shrunken drastically. Talk to FFA about how limited his options are now. It is a joke up there in Wisconsin.
Agent – thank you for explaining at what point in the treatment/billing cycle you initially realized the doc was out of network. As for your naive comment – when I seek medical treatment, even at an Emergency Room, I can log into the mobile application or a website and put in a doctor’s name and immediately be told if they are in or out of network. It’s not naive to think others could do the same if their health carrier has a similar verification system for individuals.
While I don’t doubt that there are some shady doctors that order unnecessary tests for extra money, I do doubt that they are the majority. It’s the fear of lawsuits stemming from bad outcomes and the thought of having to defend against them, that’s pushing them to run the extra tests. So, while tort reform has definitely helped malpractice rates, it hasn’t really had much of an effect on healthcare premiums. Because even if they know that there may be less frivolous and any possible judgements/settlements would be lower, physicians are still practicing defensively. They’re still going to run every test they can, so they can prove they did everything they could if/when they get dragged into court. And I don’t necessarily see that changing any time soon.
Rosenblatt, please explain to the forum how you would pull up all your providers if you were unconscious in the Emergency Room or was lying there in great pain. If you were conscious, would you tell the attending doctor to get out because he wasn’t in network and you didn’t want him to bill you out of network? It is one thing to be scheduled for an operation in advance and check everyone out and quite another in an Emergency situation, especially if you are out of town at the time. My wife has been in the Emergency Room numerous times over the years. We didn’t ever have a problem until Obamacare was passed limiting access to doctors and hospitals. It is a joke and you know it.
can we stop with the mass-downvoting of people we don’t agree with, and mass-upvoting of our own comments, for that matter?? I thought we all grew out of that. It’s unbelievable; my 5 year-old at least will pretend to listen when she doesn’t agree with me.
I remember a time when you could actually go on this forum and LEARN about INSURANCE, not just get someone’s opinion about politics. It seems like every article turns into a massive political rant . If the IJ moderator is reading this, I hope you realize that this is probably costing you readers.
I would like to mass up-vote you right now, but then I’d just be proving your point :)
I’m lucky enough that my employer provides a treatment cost calculator where you can pull up in-network and out-of-network prices for treatment before you even go to the hospital. Unfortunately, that doesn’t get to the meat of this article
“In many cases, patients don’t realize they’ve received out-of-network care until they’re slapped with a bill for hundreds or thousands of dollars.”
If I ensure my surgeon is in-network, I shouldn’t have to ask for the name of the anesthesiologist and every other person involved in the operation too, just to make sure they’re in-network as well.
It’ll never happen, but it would be nice if you make sure your doctor is in-network that your doctor ensures those helping him/her are also in your network.
Next, there will be extra charges for the cafeteria worker being out-of-network. “Hey, this isn’t in-network Jello!”
Say what you will about the V.A., but at least we don’t have to worry about any of the treatment being out-of-network.
DCMS, no you dont have to worry about Network. Just Doc who dont care and will actually treat you with out mis diagnosing you or shove you in a room and let you die.
This VA in Chicago is a repeat offender and no govt entity does anything about it. They were Low Lited in that news piece I seen last week or so. They did not look good at all.
I do understand that there are much better facilities across the country then (I think its called) Edwards Hospital in Mel Rose Park. Thats is a facility that needs to be completely gutted (Employee Wise) as a piece on the news last year stated how the big cheese over there were letting people die so as to keep cost of treatment down.
FFA, here is some food for thought about how Progressive Socialists think:
Karl Marx once said – Remove one freedom per generation and soon you will have no freedom and no one would have noticed.
This is exactly how Obama and his minions have operated for 8 long years and Obamacare is their “signature” achievement.
We just have to worry about the VA offering a suicide hot line and then getting voice mail and no return call. Yes, that is the latest scandal and veterans still have a long waiting list for treatment. That is Universal Care in a microcosm.