Skip to comments.Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met
Posted on 12/27/2013 7:36:44 AM PST by Innovative
If you buy one of the less expensive insurance plans sold through the health laws marketplaces, you may be in for a surprise. Some plans will not pay for a doctor visit before you meet your annual deductible, which could be thousands of dollars.
This could be the next shoe to drop, as people don't realize that if they're buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny," said Carl McDonald, senior analyst with Citi Investment Research, speaking at a Washington, D.C., conference last month.
Plans that list a price for a doctor visit followed by the phrase "after the deductible is met" mean the consumer must pay the full deductible before getting doctor visits for a small copayment.
(Excerpt) Read more at kaiserhealthnews.org ...
Work on defeating all who voted for this monstrosity!
It is a sad commentary that they actually have to explain that to most of the policy holders.
I suspect this whole Obamacare law was written for revenge. I suspect Ezekiel wrote this maze of illegal crap in retaliation for Valerie kicking his brother out of the WH.
Unfortunately, the history of the US repealing social pogroms of this scale is not one to foster confidence that we’ll ever be rid of this horrendous piece of legislative effluent.
As has been pointed out many other places, it is now more likely that FedGov (the executive or legislative branches, at least) will tweak, fiddle, amend, and massage this monstrosity, all while escalating the penalties for non-compliance.
Currently, the ‘fine’ is only collectible from tax refunds due. If anyone thinks that is going to be the case in three or four years, I’ve got some ocean front property in Colorado for sale, and a small bridge in London.
As it turns out, LIV are also insurance-stupid.
This is so horrible, and people have no idea - I hope it hits home soon enough to get rid of all those who voted for it and are up for reelection in 23014.
I was just looking at some of the state portals for Obamacare and the more I read the more I am horrified.
It could be worse. At least you get the plan’s negotiated rate, not the “walk-in” rate. True, if you find a cash doc, that can be better, but sometimes you don’t have time to search.
I wonder if the $5000 get billed at “retail” or the “negotiated” billing rates.
So what's the point of having any insurance?
Should one get a loan to pay for their insurance?
How did people survive before any health insurance was invented?
Maybe I'll add leeches to my stock pile.
Another aspect of the "get YT" Obama domestic policy.
It's not really health insurance, in the expected sense, if you're 6k out of pocket before it pays anything.
Part of the issue is that the details of the plan aren’t freely available, even if one understands how typical plans work.
We’re doing it the easy way. No health insurance. On the rare occasion when we need a doctor we’ll just buy it like we do anything else. It really is a LOT cheaper that way.
I’m sure the Navigators are knowledgeable enough to explain this to prospects.
The way it works for me in Massachusetts (Romnobamacare) is:
1. I go to the doctor, pay a copay
2. The doctor submits his bill to the insurance company
3. The insurance company “allows” a portion of his fee
4. I get a bill from the doctor for the portion “allowed”
Whoever makes those signs that say “If you have a past due balance it must be paid before the doctor will see you again” should have a banner year.
Call whoever your new doctor under the plan is and wait 2 months for an appointment. You will have plenty of time to search.
This piece of crap was written long before Rahmbo was kicked out. It was written long before it was even discussed as the bill. It is nothing more than an insurance company bailout scam and the setup to punish them after the deal is done for opposing it in ‘92 and to usher in single payer when the desperate masses scream for relief.
The sad irony is that nobody will escape the wrath of the Progressives in both parties.
Hopefully the LIV who voted for, and then who signed up for 0bamacare will begin visiting their (new) doctors in droves, right after the first of the year, and start to discover the fact that nothing is covered until thousands out of pocket are paid for premiums and deductibles.
obamacare is the same as having no insurance.
it is a tax paid on services that can never be used.
a 6500 deductable is the same as no insurance for the vast majority.
it makes obamacare defacto single payer.
I think the new rule of thumb is, if your current plan had something you liked or considered of value, it won’t be available in Obamacare.
Obamacare is strictly cash confiscation.
It’s not really health insurance if it pays for either expected or elective expenses. I would never go to a doctor who was paid for by my insurer. It’s not me that doctor would be looking out for.
Thanks for the info. Appreciate it.
Those are the best words I've seen to describe a terrible law that was legally passed by the US House, Senate and President ... a House, Senate and President CABAL that US Citizens ELECTED to office.
Chief Justice Roberts could have killed the bill with his one vote. If he had done so, Roberts would now be going down as the nost uncaring human in history.
Instead, Roberts did the right thing ... and Americans should be thanking him for giving us an adult lesson.
Our family deductible went from ~3K/yr to $12,500/yr.
We were happy our premiums ‘only’ went up $100 from $800/m to $900/m.
We get to pay nearly TWENTY FIVE THOUSAND dollars out of pocket before we get ONE DIME in insurance.
EVERY. SINGLE. YEAR.
Ask me what this is going to do for our consumer spending this coming year...
My oldest kid wanted skates for Christmas. No way. We can’t afford the injury downside for them. Their bikes and trampoline are off limits as well after Jan 1.
the point of having some type of insurance is, an unexpected chest pain on a Saturday morning can lead to discovery of a blocked artery, 3 days in the hospital, a stent (or 2 or 3) and a $44,000 bill
not counting the months of cardio rehab and lifetime of maintenance meds
How did people survive before surgery and insurance covered that? Often, they didn’t. Nowadays a waiting room for heart stent surgery looks like the waiting room of a very busy auto repair ship! At least it did on one ordinary weekday at Washington Hospital Center
I suspect for many 50-60 something middle classers, a $50K health emergency that is a big chunk of savings gone- with limited earning power to replace it- and another 30 years of life’s unexpected curveballs ahead (God willing)
Most plans? Would that not be any plan with a deductible? What’s the point of the deductible if they are going to pay for things before you meet it?
I hope you write this letter to your congressman and senator
they need to get testimonials from every single one of the millions of people affected by this monstrous social experiment gone awry
Ping to 0scumbagCareLess thread...
Won’t do a bit of good. They’re all in on the scam. Too much lobbyist money in all their pockets.
Both parties want to kill the middle class. This bill does that job and how.
But the upside is, at nearly fifty, I get free birth control. It only costs us TWENTY FIVE THOUSAND DOLLARS A YEAR.
Why are you even paying that? You essentially are paying (A LOT!) for nothing. You now have “insurance” that is unusable.
Most people will have insurance that is unusable.
Unless you get a silver or higher plan. We can’t afford the monthly premiums for the silver plan. The premium + deductible are close to the same for both. The difference is the ‘chance’ we won’t get sick with the bronze plan. The silver plan premiums were over double the bronze plan premiums. In our case, the silver plan premiums were OVER double our monthly mortgage payment. The mortgage + silver plan insurance premiums were approximately what my hubby brings home in a month.
If you’ve never worked a day in your life and never intend to you have nothing to worry about!
**This could be the next shoe to drop, as people don’t realize that if they’re buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny,”**
This can't stand. Who is going to partake in this madness? I just don't see enough people willing to give up all their enjoyments in life to pay for unusable insurance.
(Rambling but I am in a mood...)
In general, doctor prices are set really high because virtually no one pays full price. They are a fake game.
The insurance companies who contract with doctors (or who do not contract and abusively ACT like the have a contract) generally pay a percentage of the prevailing prices in the area for a service, HIGHLY biased by what MEDICARE will pay. (And dont get me started on why the doctors in flyover country get paid less than east and west coast doctors for the same thing.)
Most clinics and doctors therefore set prices high, at the point where even with the resulting forced “discount” (the “reasonable” price according to the insurance company) they will receive about the price they need to make all ends meet, including of course all their expenses (which are a lot) plus the amount doctors expect to make, which is also lot, though per hour similar to what many many professionals and even non-professional make for similar hours and risks.
The effect of that “game” is, ironically, that if a patient just pays CASH, simple and cheap to manage, that he or she pays the highest price of all!
Of course the patient can attempt to negotiate a cash deal, although there are no guarantees they will get it or that it will be as good a deal as the insurance company could get away with paying.
But do you think that the insurance company is going to agree that the first $4000 a patient pays is all applicable to the $4000 deductible?
NO — even if you the patient are forced to pay the $4000, the insurance company will only count fees it considers REASONABLE toward the deductible. Patients will not even know if they have or have not met the deductible until all the paperwork goes through!
On top of that everyone including generally the doctors are forced to do thousands of dollars worth of tracking and accounting for various insurance issues even though for no payments will actually kick in until reasonable payments by the patient add up to enough. So we can’t even save money by the efficiency of cash payments!
One possibly good thing is that some insured patients will be with a company that contracted with the doctor in advance for reasonable prices, so even though the patient has to pay all the way to the deductible, the amount the patient has to pay is LIMITED to what the insurance company would have been willing to pay.
With any luck, you put the difference between a high and a low deductible plan in the bank, and then are contracted to more sensible prices and pay those from your savings. However “high deductible plans” as originally visualized did not force straight sane man to pay for mammograms for women and HIV care for those with out of control sexual risk taking and psychiatric care for the chronically angry. Therefore the cost is a lot more than high deductible plans used to be. Congress has made it ILLEGAL for you to freely associate with others to care for your own health care in your own way.
Patients on this may try to save money because they have skin in the game. So middle class working people will take some careful risks to save money. Medicaid patients and illegal aliens on Title V will of course just got to the ER even for common colds and not be charged even $0.50 (fifty cents) co-pay!
In the 20th century 260 million people were killed by their own government. (If that figure is a little or a lot off, it remains that LIMITING GOVERNMENT, the essential invention of Orthodox Americanism, is one of the most important things that the humans can do for each other and ourselves.
Any method except letting most health care happen through the free market constitutes misguided, guaranteed-to-fail, elitism perpetrated by utopian philosopher king fascists through violence (to get and maintain what they want). That’s what the people doing this and supporting this actually are. That’s what your friends who really believe in Obamacare are. So CALL them that (as nicely as you can), and emphasize your concern for their love of violence and elitism: they don’t generally want to “be that,” but they have already proven they have a blind spot to the truth, so their eyes need to be opened. Friends don’t let friend be fascists!
Owebamacare is single payer...and that single payer is YOU!
We partake because of the chance that we’ll have some sort of catastrophic injury or affliction. If my kid breaks a leg we will come close to bankruptcy. If we don’t have insurance and one of us has a heart attack or cancer diagnosis we would be completely SOL. That’s why we partake in this insanity.
The worst thing that could happen to middle class america is for one year to have a broken limb of some sort and be out the $12.5K + premiums, the next year have a cancer scare and be out another $12.5K + premiums, and the next year have a heart pain and ER visit for same and be out another $12.5K + premiums.
That’s easily $75K over 3 years.
Out of pocket.
After tax income.
That’s going to cause a LOT of bankruptcies in this country.
Additionally, aren't you still on the hook for a certain percentage of the bill? Something like they pay 80% and you pay 20%?
So, premiums, in your case 900x12. ($18k), $12,500 deductible. Say a $112,500 bill for simplicity sake. So, another 20k in co-payment.
So, even, with insurance, for most, it may as well be a million bucks.
I listened to all of this Bullsh&t about Obamacare paying for preventative medicine.
How does a $6,000 dollar deductible give you free preventative medicine?
Thats the ticket.
Pay $10,000 per tyear for health insurance.
Then pay for all of your doctor visits and medicines until your $6000 deductible gets paid
The only thing that would happen if we got out in the street with pitchforks would be the government having an excuse to use the billion bullets they bought.
Although once consumer spending craters in Feb or Mar of next year when the LIV’s figure out they are massively on the hook for big bucks we might see some action. I doubt it though.
This isn’t going to result in a return to ‘sane’ insurance policy, it’ll be used to argue for single payer.
This is the insurance companies racking up HUGE profits for the 3-5 years it will take to fully implement single payer. It will be the last profits they make before they’re regulated out of existence. Lots of golden parachutes in that time period though. Why do you think the insurance company execs wanted Obamacare so badly?
That was how Obama sold it.
He claimed you could get one free check-up/mammogram a year with no co-pay or deductible.
just another one of his lies.
Add into that, the fact that the amount you can write off on your taxes jumps from 7.5% of AGI to now 10% of your Adjusted Gross before it kicks in.
Oh yeah, we’ve got the 80/20 for monies over and above the deductible.
This will crush the middle class. Absolutely crush them.
And anyone who relies on consumer spending for a job. Restaurants, fast food places, clothing, sports, etc.
No way we will let my kids play sports with this deductible. We simply can’t afford it. Look for little league stuff to go under for lack of participation. If jr. breaks an arm it’ll be $4K or $5K out of pocket for mom/dad. Whoooeeee.
After 20+ years of corporate health insurance and the last several years on private health insurance with no big claims, the last year being a COBRA plan costing 1650 per month and which they paid out less than $10 due to the high deductible, we switched plans in August to a 5k deductible followed by 100% coverage which was about 1200/month. End of October, my son fell and broke his ankle/leg. Couple of operations and about 50k in bills later (still new bills to be added for care while he completes the healing) my wife fell down the stairs, broke a vertebrae, and ended up in the hospital. Haven’t seen all the bills yet, but between the two events in two months, we surely would have been bankrupted without insurance. In a way, I almost feel sorry for our new insurance company that barely took in a few premiums before being hit with the catastrophic bills companies over the last 30 years avoided.
What I see is the law of unintended consequences. Obama thinks he is getting everyone health care- no, he has totally screwed things up. Faced with a 5k deductible, many people will not go to see a Dr. at the first sign of a problem because they can’t afford the $100 office visit. People literally will die waiting too long to seek care trying to avoid paying the initial amounts. We didn’t have much choice, we blew through the deductible pretty fast - too bad it wasn’t at the beginning of the year.
Which, at our income level, makes no difference in the fact that we’re out twenty five thousand dollar out of pocket before they pay a dime.
The writeoff is like the ‘free’ cat I got once that cost me $500 in vet bills to ‘fix’ and ‘repair’ first.
I do believe Zero Care also limits the profits the insurance companies can make.
Someone correct me if I’m wrong about that.
Obama did NOT think he was getting people healthcare. He KNEW he was destroying the current system in order to get the middle class to agitate for single payer.
And if you and/or your wife are over 60, under Obama’s single payer, you will not be getting any serious treatment. And, like the IRS persecuting the tea partiers you probably won’t get any treatment anyways if you’ve posted on FR or any other conservative sites.
But not, I’m sure, the compensation packages of the executives. You know, the ones who were schmoozing with the Obamacare authors?
Not to mention several Freepers with whom I've had some spiritied conversations. I guess they never herad the term 'deductible' applied to an insurance policy before.
Karma: A concept that the parasitic liberals who supported socialism will soon understand.
Silly question. Free birth control!
And it's only a couple hundred dollars a week!!!