Skip to comments.One Small Example out of 40,000+ pages of Regulations on ACA
Posted on 10/31/2013 6:17:41 PM PDT by ToastedHead
"The Departments recognize that plans may utilize multiple service providers to help administer benefits (such as one third-party administrator for major medical coverage, a separate pharmacy benefit manager, and a separate managed behavioral health organization). Separate plan service providers may impose different levels of out-of-pocket limitations and may utilize different methods for crediting participants' expenses against any out-of-pocket maximums. These processes will need to be coordinated under section 1302(c)(1), which may require new regular communications between service providers."
(This is found in the second paragraph of Question #2)
(Excerpt) Read more at dol.gov ...
“Separate plan service providers may impose different levels of out-of-pocket limitations”
That doesn’t even make sense. The medical side has its own out of pocket, which has nothing to do with any level of anything on the pharmacy side. Is the policy out of pocket max determined individually per provider, or is it aggregate?
I’d like to see a Navigator Of Excellence prune through that fine print. Right after they put down the bong.
I used to have a post about those rules that I put up many times in 2009.
I found a few of those in your last rowboat tip over. Thanks :^)
Seems like they are writing the unwritten.
Different medical insurance policies have different organizational structures coordinating between 7 to 20 entities, each with massive relational databases to operate in the industry. (e.g. within one regional healthcare system commonly accessed service providers in an outpatient surgical procedure might include: Patient, Dr., Dr’s Group, Pharmacy, Lab, Admissions, Insurance Provider, Radiology, Anesthesia, Emergency Room/Trauma Center, Ambulance, Physical Therapy).
Different plans group those services in different fashions based upon local economies of service. Any two or more of those groups may also engage in “co-pay” systems.
The clause seems to be allowing all the different plans to implement their operations in their own fashion, but failing to recognize their ‘granting’ of that freedom, might be encroaching upon the contractual relationships between service providers within their systems.
I haven’t seen a model showing the difference in ACA and the relationships in standard healthcare systems.
“The only problem is that it creates more bureaucracy instead of promoting liberty.”
At some level this amount of bureaucracy has to implode on itself and suck the planet in with it. How many lifetimes could it ever take to sort out 40,000 pages of unreadable regulations? Not to mention that Dingle fossil needed an assistant to turn his mike on and off.
Learn from my mistake. Never carry more than 10,000 rounds in a row boat. They just ain’t built for it. ;^)
The problem is that the Repubs want to save Obamacare instead of ridding the
monstrous catastrophe that's about to ruin our economy and jobs. Any delay will
also allow the full implementation of Zerocare and allow the Feds to save their
ass' after the titanic has sailed without a radio. In a year nobody will remember
the Titanic-care send off. They'll only know that the Repubs helped create the
failure and will be blamed for all of it. They must not touch one rivet!
“and that’s the TEA Party”
It is my observation that anyone who calls themselves a Tea Party person has a very great sense of personal responsibility, and is a joy to work with.
“Never carry more than 10,000 rounds in a row boat. They just aint built for it. ;^)”
You might want to think about a diet. Row boats are constructed to carry a large person.
I'm just a rare exception! lol
“I havent seen a model showing the difference in ACA and the relationships in standard healthcare systems.”
I think the biggest difference is that the usual models were designed by people driven by profit (good thing.)
These regulations are being written to shut people up, or make someone happy, or push a goal forward. The final cost is irrelevant. Other people’s money, and all.
That’s funny and a little ironic. If I wanted to do Halloween as a skeleton all I’d need to do is take my shirt off. ;-)
I appreciate your efforts but that’s the first I’ve heard of that kinda bullshit. I knew it was coming but that is my first actual evidence I can point to in regards to my “head in the sand” family members.
And get this. I know you know but this is for anyone who doesn’t.You think your excercise habits, what you drink, what you smoke, how far you drive to work, what your weight is, how much weight you’ve gained or lost, who you’ve screwed in the past, who you associate with, who those you associate with, how many stairs in your house, HOW YOU DISCIPLINE YOUR CHILDREN, who’s staying in your house, etc. etc. etc......THEY WILL CONTROL EVERY FACET OF YOUR LIFE.
And get this. You lie. About anything. And guess what? That’s Insurance Fraud AND YOU GO TO JAIL. Or re-education camps
“the Repubs want to save Obamacare”
Aren’t there some business oriented Republicans up there who can see the obvious economic black hole this thing is? The website alone looks like it will top a billion dollars before it gets fired up.
In that case, you need to next consider buying a new row boat:)
Aren’t you cold??
It can't be "fixed" -- not in the conventional meaning of the word. Obamacare is irrepairable; a total loss.
Consequently, the best fix would be to repeal it, in toto. Then,, start all over again.
There will be massive problems with this approach, too -- as you suggest. But every day of delay, part of the healthcare infrastructure erodes away -- and risks being lost forever.
Push the "re-set" button -- tomorrow, if possible -- and let the market figure out how to adapt and re-gain something like the status quo ante. Markets are really, really good at this -- and the less "guidance", the better.
They will never be able to reliably implement this. Literally dozens of private companies and government agencies trying to link all these legacy and proprietary systems will make the website launch look like a massive success.
I wish the whole thing would go away. You can accommodate for the relatively small number of people who have “enrolled” in an exchange. (Real enrollments or not, who knows.) They can invent a “Gold/Silver/Bronze Come All Ye Exchange People” plan to cover a couple thousand people.
It’s the 10-15 million people left scrambling who have an immediate need for some way to protect themselves. There’s not enough time left to put them somewhere. The day the insurers knew they’d lose that revenue and acquire all these new additional costs, affordable policies vanished.