This is me, agreeing that health insurance reforms are necessary. AKA, how employers can screw you

tuna55 wrote:

Ranger50 wrote: In reply to tuna55: Really? I haven't had any problem with my wife's OB's or their bills, HSA or not.

When you have a baby (they told us this was every OB, they could have been wrong/lying) they sign you up to prepay for the delivery. Something like $2500 gets spread over the course of the ten months. Since we have a "high deductible" type plan, that comes directly out of pocket. What we would normally just go into out HRA/FSA and get, we cannot, because prepays are not eligible expenses. We have to wait until the baby is here, and then until after the insurance company has been billed and sends you a real statement, which isn't for months afterwards. That $2500 is gone for a year.

It's not every OB, and if they're "in network" with your insurance plan, it's borderline illegal. You could have flat out refused to do it and have them bill your insurance for every visit instead.

yeah, it gets better. Even after the wage limitations were lifted, it was obvious that the incredible advantage it would bring to union labor when each contract term was up meant they didn't care about the wage cap anymore.

A labor union in effect became a tru politician at that point, and like your congressional rep brings home the bacon to their district, regardless of any actual political effectiveness; a union rep negotiating a contract brings home the bacon to its labor pool completely irrespective of the operating health of that company.

tuna55 wrote:

Ranger50 wrote: In reply to tuna55: Really? I haven't had any problem with my wife's OB's or their bills, HSA or not.

When you have a baby (they told us this was every OB, they could have been wrong/lying) they sign you up to prepay for the delivery. Something like $2500 gets spread over the course of the ten months. Since we have a "high deductible" type plan, that comes directly out of pocket. What we would normally just go into out HRA/FSA and get, we cannot, because prepays are not eligible expenses. We have to wait until the baby is here, and then until after the insurance company has been billed and sends you a real statement, which isn't for months afterwards. That $2500 is gone for a year.

Then why didn't you reduce your HSA contribution to compensate knowing you have to pay upfront and over a long period of time? I know the HSA is "tax free", but you could easily get all that tax back when filing, unless you are going to be well above any return on that money. Then I have to ask, if you were in that position, why do you even have a HSA? You can still use your HSA at each office visit too. BTDT.

Ranger50 wrote:

tuna55 wrote:

Ranger50 wrote: In reply to tuna55: Really? I haven't had any problem with my wife's OB's or their bills, HSA or not.

When you have a baby (they told us this was every OB, they could have been wrong/lying) they sign you up to prepay for the delivery. Something like $2500 gets spread over the course of the ten months. Since we have a "high deductible" type plan, that comes directly out of pocket. What we would normally just go into out HRA/FSA and get, we cannot, because prepays are not eligible expenses. We have to wait until the baby is here, and then until after the insurance company has been billed and sends you a real statement, which isn't for months afterwards. That $2500 is gone for a year.

Then why didn't you reduce your HSA contribution to compensate knowing you have to pay upfront and over a long period of time? I know the HSA is "tax free", but you could easily get all that tax back when filing, unless you are going to be well above any return on that money. Then I have to ask, if you were in that position, why do you even have a HSA? You can still use your HSA at each office visit too. BTDT.

Our company actually provides an HRA up front, cash, irrespective of our supplement. We get a bank account with $X in it at the beginning of the year whether I add to it or not. We didn't know the prepays wouldn't be eligible, so we supplemented that with a FSA, which is again available up front. This frees up real money to earn interest over the course of the year.

my wife was in the same boat when she was let go. Had bunch of doctor appt's she still had to go to. then the docs' offices sent out letters asking for full payment because... there was no coverage. we had to pay out of pocket or defer until cobra kicked in a month later. then we and the docs had to resubmit.

it's a big snafu. you don't want to know how much personal policies are, esp for a family. You'd better be suffering a financial banner year. Of course, catastrophic coverage is much less because it covers almost nothing. lol

heyduard wrote: it's a big snafu. you don't want to know how much personal policies are, esp for a family. You'd better be suffering a financial banner year.

tuna55 wrote (on page 1): I have shopped private insurance because I was under the impression I was going to be laid off. It was going to cost me $405/month for my fam of four (at the time).

tuna55 wrote:

heyduard wrote: it's a big snafu. you don't want to know how much personal policies are, esp for a family. You'd better be suffering a financial banner year.

tuna55 wrote (on page 1): I have shopped private insurance because I was under the impression I was going to be laid off. It was going to cost me $405/month for my fam of four (at the time).

well, color me lack of reading comprehension.

fwiw, the policies we were quoted were over 1200 a month for the coverage we needed. wife had medical conditions. Plus, everything in the nyc area seemed expensive.

madmallard wrote: A labor union in effect became a tru politician at that point, and like your congressional rep brings home the bacon to their district, regardless of any actual political effectiveness; a union rep negotiating a contract brings home the bacon to its labor pool completely irrespective of the operating health of that company.

I'm on the "management" side of the table when the contract is up and even I have to say that is certainly not true in every case. May be the reality in some cases, but not even close to being a blanket statement.

madmallard wrote: A labor union in effect became a tru politician at that point, and like your congressional rep brings home the bacon to their district, regardless of any actual political effectiveness; a union rep negotiating a contract brings home the bacon to its labor pool completely irrespective of the operating health of that company.

Is that a Fox News quote? I'm asking because of it's lack of hard facts and obvious bias.

tuna55 wrote: See the "republican debate" thread page 4. Statists have made the -EMERGENCY ONLY- system the defacto system for everyone. This is an issue.

Same issue with making Emergency rooms the only option for the indigent and working poor. It drives up cost and creates many other issues that are easily avoided with preventative care.

Xceler8x wrote: Same issue with making Emergency rooms the only option for the indigent and working poor. It drives up cost and creates many other issues that are easily avoided with preventative care.

Yup - as soon as you make a universal benefit with the intent on helping a few that really need it, you find that it's going to cost a few powers of ten more than it should because of abuse.

Free part of medicare is for hospital only. Medical/doctors is covered by part B and is NOT free, Then you have to buy a gap insurance. I have had all three and I have never had any problems with coverage. The biggest problem is greedy doctors who do not want to accept what medicare pays. Medicare works for what it is intended. It costs me app $138 a month. Those that complain about medicare don't know all of the details.

Datsun1500 wrote:

iceracer wrote: The biggest problem is greedy doctors who do not want to accept what medicare pays.

And who made Medicare the expert on what things should cost? I'm sure those doctors have spent a lot of time and money to become a doctor. How would you like someone coming to your job and saying we are only going to pay you a third of what you think it should be?

Ding, ding, ding!

If Medicare said that your quadruple bypass was only $10, when your real cost is $10k, who is being greedy? Greed goes both ways. We just call one a cheapskate by holding onto their money instead of the "greedy" one asking for payment on services rendered.

Ranger50 wrote:

Datsun1500 wrote:

iceracer wrote: The biggest problem is greedy doctors who do not want to accept what medicare pays.

And who made Medicare the expert on what things should cost? I'm sure those doctors have spent a lot of time and money to become a doctor. How would you like someone coming to your job and saying we are only going to pay you a third of what you think it should be?

Ding, ding, ding! If Medicare said that your quadruple bypass was only $10, when your real cost is $10k, who is being greedy? Greed goes both ways. We just call one a cheapskate by holding onto their money instead of the "greedy" one asking for payment on services rendered.

No doubt, my Dr. needs to see 6 medicare patients for every regular patient. That's not greed, that's insane.

tuna55 wrote: Does my car insurance company cancel my policy the second they issue a bill? The second that bill is overdue?

I'm pretty sure they would if you had a claim after it had lapsed due to non-payment. I am absolutely confident that is you had an accident at 12:01 in the morning after it became overdue you would not be covered.

Xceler8x wrote: Same issue with making Emergency rooms the only option for the indigent and working poor. It drives up cost and creates many other issues that are easily avoided with preventative care.

I'm calling BS.

Emergency rooms are not the only option for the working poor. It is the option they CHOOSE to take advantage of the system and not pay for basic preventative costs, or negotiate with doctors themselves. Nobody MADE it the only option.

I've been poor. Still paid for preventative care myself.

Here's what to do: send a written appeal of the denial to the health insurer.

I know bupkus about health insurance but have 15 years in life & disability, including some ancillary products w/ health beneifts, so take my advice with a dash of Morton's, but it could work.

In my work, policies usually state benefits end on the date employment ends (probably, they terminated you on the 15th and treated your last 2 weeks as severance rather than salary). The catch is that you may have paid premiums to the end of the month in which you were terminated. Because of this ambiguity, we have overturned appeals in situations like yours.

Can't promise you a fairytale ending but it's worth a shot.

I E-mailed a copy of my last pay stub showing deductions for health insurance coverage to the boss to bring to HR - now I have help on the inside. I'll keep you posted.

SVreX wrote: I'm calling BS. Emergency rooms are not the only option for the working poor. It is the option they CHOOSE to take advantage of the system and not pay for basic preventative costs, or negotiate with doctors themselves. Nobody MADE it the only option. I've been poor. Still paid for preventative care myself.

I know you're a responsible and stand up guy so I know you did this. But there are degrees to being "poor". Some folks can't even afford the preventative care you were able to pay for. Some of those folks have no choice in the matter, aka kids of working poor parents or just deadbeat parents.

The emergency room is their only healthcare option because they know they will not be turned away.

Deny it all you want but it's a true. When you're faced with getting a physical or eating for two weeks. What choice is that?

Also keep in mind that medical costs change with geography. What was affordable for you may not be affordable for people living in DC. The same people who can't choose food over healthcare will not have the resources to move. Also, this invisible price difference is a symptom of our lack of clear/fair pricing in medical treatment. What costs a private citizen $500 cost's an insurance company $100. Fair? Not hardly. Good for society? Nope.

tuna55 wrote: I E-mailed a copy of my last pay stub showing deductions for health insurance coverage to the boss to bring to HR - now I have help on the inside. I'll keep you posted.

Good luck man. Please let us know how it goes.

yesyes... let us know how it goes. A lot of us are all too aware how bad employers have been trying to screw their employees recently

tuna55 wrote: I E-mailed a copy of my last pay stub showing deductions for health insurance coverage to the boss to bring to HR - now I have help on the inside. I'll keep you posted.

That should be all you need.

In most states, if not all, accepting payment/premiums is binding toward coverage.

Ranger50 wrote:

Datsun1500 wrote:

iceracer wrote: The biggest problem is greedy doctors who do not want to accept what medicare pays.

And who made Medicare the expert on what things should cost? I'm sure those doctors have spent a lot of time and money to become a doctor. How would you like someone coming to your job and saying we are only going to pay you a third of what you think it should be?

Ding, ding, ding! If Medicare said that your quadruple bypass was only $10, when your real cost is $10k, who is being greedy? Greed goes both ways. We just call one a cheapskate by holding onto their money instead of the "greedy" one asking for payment on services rendered.

Heh... it's not anything like that. Medicare is hardly "holding onto their money." They're bleeding money like no tomorrow.

I'd bet good money that Medicare's "Usual and customary" figures are very close to those of your own insurance company. And those rates that your insurance companies have for services are negotiated with the providers. If they don't like the price, they don't have to be in network, and they can bill you the difference.

But here's the thing... every doctor wants to be in network for the most part. Because they STILL make a profit at the negotiated rates. What most of them do, is jack up THEIR rates to give them a better bargaining chip with insurance.

If you don't like how insurance "dictates" (but they don't) price of care, then don't carry insurance, i suppose.

Oh wait. That'll be illegal shortly.

Medicare sucks, for sure. But it's sure not for the reason we're talking about.

tuna55 wrote:

Ranger50 wrote:

Datsun1500 wrote:

iceracer wrote: The biggest problem is greedy doctors who do not want to accept what medicare pays.

And who made Medicare the expert on what things should cost? I'm sure those doctors have spent a lot of time and money to become a doctor. How would you like someone coming to your job and saying we are only going to pay you a third of what you think it should be?

Ding, ding, ding! If Medicare said that your quadruple bypass was only $10, when your real cost is $10k, who is being greedy? Greed goes both ways. We just call one a cheapskate by holding onto their money instead of the "greedy" one asking for payment on services rendered.

No doubt, my Dr. needs to see 6 medicare patients for every regular patient. That's not greed, that's insane.

You mean he needs to see/treat 6 medicare patients to make the same profit as seeing one patient with no insurance, right?

This past winter when I wrecked my shoulder. I tried to see the Doc I have been seeing for years off and on. I could not get in. He does not see "self pay" clients.

Two years ago when I was working full time and had insurance that covered most anything, I could walk in the door.. now they do not even want to see my face

tuna55 wrote:

Ranger50 wrote:

Datsun1500 wrote:

iceracer wrote: The biggest problem is greedy doctors who do not want to accept what medicare pays.

And who made Medicare the expert on what things should cost? I'm sure those doctors have spent a lot of time and money to become a doctor. How would you like someone coming to your job and saying we are only going to pay you a third of what you think it should be?

Ding, ding, ding! If Medicare said that your quadruple bypass was only $10, when your real cost is $10k, who is being greedy? Greed goes both ways. We just call one a cheapskate by holding onto their money instead of the "greedy" one asking for payment on services rendered.

No doubt, my Dr. needs to see 6 medicare patients for every regular patient. That's not greed, that's insane.

My point being that there are more doctors working under Medicre than not.