scrubbedexpat099

Not getting paid for treatment provided.

retzie

OP is in Houston, IIRC. Her account of the grilling from clinics about whether "this is Obamacare" is way out of sync with my experience in NY. I don't know whether it's a case of being an opt-in/out state, but it sounds like there is a major problem of (at least) implementation in TX.

Part of O&U's experience may be down to a poor insurer website, but this latest episode, in particular, seems to involve a problem with the marketplace policy itself.

scrubbedexpat099

Not sure that would be the normal profile.

You sort of contradicted yourself but Obamacare has bucket loads of its own regulations. And policies sold that way must be compliant.

Other products will be different.

scrubbedexpat099

Not sure it would make any different as that just meant the Feds ran the marketplace and Medicaid was not expanded.

Neither would seem relevant.

I can not believe NYC is very different, very few people have the option of seeing who they want.

scrubbedexpat099

Nation’s elite cancer hospitals off-limits under Obamacare | New York Post

I looked for NY stories, this focuses on Cancer but the principal is the same.

LondonSquirrel

Ok I am a complete novice about health insurance in the US, but can you pay for the procedure and put the expense on your next tax return to reduce your tax bill? Sorry about the trouble you are having.

Omeprazole is really good for ulcers.

Giantaxe

If you are referring to the ACA "grace period" for paying of initial premiums it's a minimal risk as insurers are required to notify providers of a person's grace period status. A far bigger risk is the COBRA "grace period" of 60 days when there is no such notification requirement.

Giantaxe

I would suggest that "elite cancer hospitals" are off-limits for most patients.

Really, access to a limited number of "elite" facilities isn't what's being addressed in this thread.

OnwardandUpward

Thanks LondonSquirrel. I
am on a prescription of omeprazole.

Although there again- further weird corruption- the doctor can only write a prescription for one brand name 'Nexium' ( $273 a month and not covered by most insurance )
Pharmacist advises- go buy the generic over there instead. @ $20 or so a month!

Re Texas- yes, the president and ACA are far from popular politically here but I have no way of knowing whether this is why everything seems so difficult here, or if it would be better in another state.

I suspect most people who think US healthcare is easy simply haven't had to use it much, because that was my experience until I got older/ sicker.

retzie

Oh no, of course you can't just see who you want. I'm talking about the fact that nobody has ever shown any sign that there is a difference between a marketplace plan or not (same insurer). What seems odd to me is in-network physicians refusing to accept and/or treat a patient on the grounds that their plan is 'obamacare'. This seems above and beyond the usual for naff insurance.

notonuksoil

Retzie I'm 25 minutes from NYC and have first hand experience that in fact the issues the OP is having in TX are also happening here in NY, see my earlier post #15 in this thread.

scrubbedexpat099

Sounds like nobody read the link I do not particularly follow this subject but it is something that certainly has been covered on BE and in the general media.

Simplistically any given Company has a multitude of contracts with providers, which have different terms, reimbursement rates etc.

Obviously there is pressure in the Marketplace both politically and economically to reduce premiums. There are quite a few factors normal in insurance that are not in play. The biggest 2 factors left is which providers are in network and what the reimbursement rate is.

Without looking it up my recollection is that Medicare is the standard, may be variations say that is 100. Some plans pay Medicare plus 120 which are obviously attractive, others such as Obamacare plans, Medicaid pay Medicare minus, I think 80 on the same scale?

They also restrict who you can see with the intent to focus their business through certain providers so they can try and make up in volume.

Now in the big cities that may work, where I am in the boonies the providers are few and far between so it does not and premiums are higher.

Nothing magic about this.

As that link I posted mentioned you are not going to want to attract say Cancer patients which are likely go cost a lot over a long period of time so do not include the top Cancer providers and hope they go to somebody who does.

retzie

Oops, that somehow passed me by. I wonder if it's a United thing? Or perhaps I just got lucky with the places I used (MetroPlus; all pretty crap really). Either way, freezing out marketplace plan holders seems 'contrary to the spirit of ACA' to me. For whatever that's worth...

lansbury

You are allowed to claim medical expenses as a deduction. We do that each year. For us we can claim any medical expense once the total exceeds 7.5% of our income. Medical expenses include montly premiums, and drugs not just treatment and office visits.

scrubbedexpat091

Not likely, those kinds of stories are exaggerated for those in the US against public healthcare.