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Help, I don't understand medical insurance

Help, I don't understand medical insurance

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Old May 1st 2013, 12:50 pm
  #46  
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Default Re: Help, I don't understand medical insurance

Originally Posted by Jerseygirl
Aetna are saying that premiums will rise 20 to 50% next year.
Oh, sure, because raising premiums to unaffordable levels is going to delay the spread of nationalized medicine. I don't THINK so.
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Old May 1st 2013, 12:52 pm
  #47  
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Default Re: Help, I don't understand medical insurance

We recently, for the second time in 4 years I think, received a check back from a health organization with a note to say that as part of a review they note that they overcharged me for something last year. I suspect that no-one, not even the organizations involved in the process, fully grasps how it all works. On several occasions while dealing with the front desk of some health place the struggle for the receptionist to figure out what they should be charging me under my insurance takes longer than the treatment.

Health insurance is one of the reasons nature built the human being with the ability to cross its fingers.
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Old May 1st 2013, 1:18 pm
  #48  
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Default Re: Help, I don't understand medical insurance

Originally Posted by Pulaski
Are you sure? That's not what President Obama promised!

Interesting that Congress is trying to excuse itself from Obamacare, would that include the Administration as well?
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Old May 1st 2013, 1:23 pm
  #49  
 
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Default Re: Help, I don't understand medical insurance

Originally Posted by Jerseygirl
Aetna are saying that premiums will rise 20 to 50% next year.
My guess would be that the intention is to force people off legacy programs, that may not even be Obamacare compliant, onto schemes that are competitive with the market.
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Old May 1st 2013, 1:26 pm
  #50  
 
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Default Re: Help, I don't understand medical insurance

Originally Posted by Boiler
Interesting that Congress is trying to excuse itself from Obamacare, would that include the Administration as well?
I don't think anyone thinks that Obamacare in its current form, as legislated, will last. Depending on who follows Obama, a number of changes are possible; IMO some sort of change is certain.

Last edited by Pulaski; May 1st 2013 at 1:59 pm.
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Old May 1st 2013, 1:59 pm
  #51  
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Default Re: Help, I don't understand medical insurance

Originally Posted by limeynus
This is why I like my HMO, although they might be more restrictive on who you can see - the referrals (so far) have always been covered by my insurance and I've never had to worry about that in-network/out of network issue. My insurance seems to cover whomever my PCP refers me to.

I also don't like the % thing on PPOs you can never get a straight answer as to how much that is. At least with my OOP maximum I know that's all I'll be paying out if I have, but even then there can be some hidden surprises - and I have to say after 24 years I still don't get it, and I administer our plan at work!
It's easy to check out if a doctor is in network or not. Even with a HMO you can still see a doctor at the ER who is not in network. There is no end of people you may see or tests you may have that your insurance will not cover.
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Old May 1st 2013, 2:00 pm
  #52  
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Default Re: Help, I don't understand medical insurance

There was an item on the Radio about increasing premiums in Colorado, this was Progressive Radio. The highest increase I remember was 40 odd %.
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Old May 1st 2013, 2:01 pm
  #53  
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Default Re: Help, I don't understand medical insurance

Originally Posted by Jerseygirl
It's easy to check out if a doctor is in network or not. Even with a HMO you can still see a doctor at the ER who is not in network. There is no end of people you may see or tests you may have that your insurance will not cover.
When I visited Hospital last week, I was tagged. Seems simple enough to tag your Insurance info and a do not treat me if you are not in my network instruction.
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Old May 1st 2013, 2:04 pm
  #54  
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Default Re: Help, I don't understand medical insurance

Originally Posted by Boiler
When I visited Hospital last week, I was tagged. Seems simple enough to tag your Insurance info and a do not treat me if you are not in my network instruction.
That seems like a good solution as long as its not an emergency.
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Old May 1st 2013, 3:10 pm
  #55  
 
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Default Re: Help, I don't understand medical insurance

Originally Posted by Zez
re what lansbury said, one the example policy they referred to on the PPO said this...." out of pocket max is the maximum you would pay in any one year for deductable and copayment for network covered services. Once you reach this maximum the plan pays 100% for most services."

Am I reading it right that that is the opposite of Lansbury's experience....say 10% copay up to the MAX of annual max-deductable?
If what I posted was misleading my apologies. What you posted is what I was trying to say, and what I would expect the policy to say. Once your reach the out of pocket max you get 100% coverage. In the case you quote I would ask what is not included in "most services", so you know in advance.
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Old May 1st 2013, 3:30 pm
  #56  
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Default Re: Help, I don't understand medical insurance

Originally Posted by GeoffM
but tomorrow all will be harmonised .
Hah! The new plan lists the same service twice - one at "no cost"; the other at $50 copay.

Originally Posted by GeoffM
Preventative care was free, [...] even a vasectomy
And that was wrong too (including my mistake). I was quoted anything from $2500 upwards to $30 copay. After the 3rd time of calling them it turns out the $2500 applied to general anaesthetic; the $30 for a standard day procedure. But the plan says $250. The new plan says $50 in one section and free in another section. Just one example of how you can't get a cost up front for a routine procedure.
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Old May 1st 2013, 3:38 pm
  #57  
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Default Re: Help, I don't understand medical insurance

Originally Posted by lizzyq
Not me, I think UK prescription charges are great value - OK often you pay £7.65 (or whatever) for 50p worth of medication, but balance that against £7.65 for £500 worth of stuff and it is a no brainer. Also if I really need that 50p worth of stuff to turn me back into a functioning human being 7 quid is a bargain.
Also you can get a card that means you pay a fixed amount per year no matter how many prescriptions you need. Plus it's free for kids, older people and unemployed.
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Old May 1st 2013, 3:42 pm
  #58  
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Default Re: Help, I don't understand medical insurance

Originally Posted by Sally Redux
Also you can get a card that means you pay a fixed amount per year no matter how many prescriptions you need. Plus it's free for kids, older people and unemployed.
All prescriptions are also free for pregnant women and for the following 12 months after the birth...free for people with a chronic illness.
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Old May 1st 2013, 3:45 pm
  #59  
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Default Re: Help, I don't understand medical insurance

Originally Posted by Jerseygirl
All prescriptions are also free for pregnant women and for the following 12 months after the birth...free for people with a chronic illness.
Yes forgot about those.
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Old May 1st 2013, 4:04 pm
  #60  
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Default Re: Help, I don't understand medical insurance

Originally Posted by Pulaski
I don't think anyone thinks that Obamacare in its current form, as legislated, will last. Depending on who follows Obama, a number of changes are possible; IMO some sort of change is certain.
60 votes to get a change through the Senate so it will be tough...The basic tenets of Obamacare are here to stay imo: no discrimination on those with pre-existing conditions, no dropping people because they get sick, insuring young adult children etc.
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