ACA (Obamacare) updates for 2014

archer wrote: Of course you are right PS, it has always been that way. The insurance company gets to decide what treatment is right for you, not your doctor. We wouldn't want doctors to make that decision now would we?

Another collectivist lie hoping to be fundamentally transformed into truth if repeated often enough. The insurance company has absolutely no part in deciding the treatment, that is between you and your doctor, always has been. No, the only part the insurance company plays is whether or not your policy covers the expense of the treatment your doctor has recommended to you. And that information is contained within the four corners of the contract that you entered into with them in exchange for the premium you paid. If you didn't pay the insurance company to insure you for the treatment you are seeking, then it is unrealistic to expect that they will foot the bill for the treatment the doctor recommended to you. Ultimately it is you, not the insurance company, which decides what treatment is right for you.

PrintSmith wrote:

archer wrote: Of course you are right PS, it has always been that way. The insurance company gets to decide what treatment is right for you, not your doctor. We wouldn't want doctors to make that decision now would we?

Another collectivist lie hoping to be fundamentally transformed into truth if repeated often enough. The insurance company has absolutely no part in deciding the treatment, that is between you and your doctor, always has been. No, the only part the insurance company plays is whether or not your policy covers the expense of the treatment your doctor has recommended to you. And that information is contained within the four corners of the contract that you entered into with them in exchange for the premium you paid. If you didn't pay the insurance company to insure you for the treatment you are seeking, then it is unrealistic to expect that they will foot the bill for the treatment the doctor recommended to you. Ultimately it is you, not the insurance company, which decides what treatment is right for you.

So I take it you've never had a problem with a health insurance company covering what they were supposed to, PrintSmith?

I sure have, plus with other insurance companies. In most cases I finally got it resolved, but it took a whole lot of my time, even if the coverage was pre-approved.

Not that I see how Obamacare would improve the situation for heath insurance...

Personally, no, my insurance carriers have always adhered to the contract I had with them. No one in my immediate circle of family and friends have ever had issues either. Regardless, that has nothing to do with an insurance company deciding your treatment regime. That decision is, and always has been, a decision that the person makes in consultation with their care provider, not their insurance provider. The only part that an insurance company plays in that is whether or not your contract covers the treatment or procedure. That might figure into whether or not you decide to have a certain treatment or procedure done, but the ultimate decision still is yours to make. Insurance companies don't decide whether or not the "lifesaving" procedure is received by you, you do. What insurance companies decide is whether or not the cost of that "lifesaving" procedure is required to be payed by you or them, and that information is contained within the four corners of the contract that both parties entered into.

Insurance companies do not, have not, ever decided anything about individual care despite what the collectivists wish you to believe to the contrary.

pineinthegrass wrote:
Not that I see how Obamacare would improve the situation for heath insurance...

Is this sarcasm?

And I agree with PS... I have several years of examples to draw from and only had "sub-par" (according to Obama) plan.

Here's some more from "we have to pass it to find out what's in it."

The Obama administration ignited a new election-year controversy Friday when regulators handed down fresh cuts to Medicare Advantage (MA).

Next year, plans in the program will see their payments cut by at least 2 percent on average between ObamaCare and a regular annual update, the announcement stated.

The Centers for Medicare and Medicaid Services (CMS) argued that the reductions will help to strengthen the program — an increasingly popular alternative to traditional Medicare — and guard against waste.

http://thehill.com/blogs/healthwatch/me ... icare-cuts

Another time bomb from the ACA.

Rick wrote:

pineinthegrass wrote:
Not that I see how Obamacare would improve the situation for heath insurance...

Is this sarcasm?

And I agree with PS... I have several years of examples to draw from and only had "sub-par" (according to Obama) plan.

My point was that if you've had problems with health insurance companies before Obamacare, I don't see how Obamacare would improve the situation because it continues to deal with the same insurance companies and medical system.

I've had several issues in the past. I've had 2 sport related MRI's that were done by MRI facilities listed on my preferred provider list and preapproved (in the 2nd case I even called the insurance company in advance of the MRI to make sure it would be covered). In both cases the insurance companies denied the coverage after the fact. But after spending a lot of my time dealing with my doctor who referred me to the MRI facility, the MRI facility, and the insurance companies, they finally paid up.

The worst instance took about a year to resolve. Again I went to a facility listed on my preferred provider list, showed them my insurance card, was told they accepted it, and was admitted. A few weeks later I got a letter from the insurance company stating they covered the facility's costs less my deductible and copay. But 2 months later I got a letter from the facility saying I owed them tens of thousands of dollars. It turns out there was a dispute between the facility and insurance company in renewing their contract. How was I supposed to know? Also the insurance did not cover the full amount for the doctor I saw there, saying he was with Blue Shield of Nevada while I was with Blue Shield of California. But it was an emergency and I had no choice in the doctor. They knew that but still hassled me over it. Anyway, the dispute took about a year to resolve, and I finally got everything covered which should of been covered in the first place.

Based on my experiences I got the feeling that the insurance company may hassle you over some high priced services thinking that some people won't fight them back.

Again, I don't see how Obamacare would make a difference in that type of stuff. I suppose similar things happen in Medicare too.

The difference I have seen between medicare and the BC/BS insurance I had before is that medicare is more consistent. Doctors know what medicare will cover and what it won't., the rules are very specific and there seem to be fewer surprises. I spent half the time I was dealing with cancer and chemo fighting with BC/BS over what they would cover, they covered my first chemo treatment then denied the next two. I was on the hook for over $20,000 because they disagreed with my doctor on what was appropriate treatment for my particular cancer. Like you it took over a year to get it resolved, just what I needed to be doing in the midst of treatments. The doctor seems to have been right, I've been cancer free almost 4 years.

And what both of these anecdotal stories help illustrate is that the individual, in consultation with their doctor, is the one who decides how they will be treated, not the insurance companies as archer earlier alleged. Thank you both for helping me make that point so clearly as well as the point that who is responsible for paying for the treatment is contained within the 4 corners of the contract that the individual and the insurance carrier have entered into.

So, WHAT insurance vehicle has the LEAST amount of problems (over-all)....excluding the
recent Obama care issue?.....it appears Blue Cross/Blue Shield is NOT user friendly, have others
had experience with UnitedHealthCare? KP has been EXCEEDINGLY good for the most part, BUT
AGAIN I am proactive and assertive in my care.

I give Kaiser an A+ for immediate service, cost, and pure efficiency... exactly the opposite of what we will eventually get with a bureaucratic nightmare we're all going to be stuck with (unless you're rich).