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Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met
Kaiser Health News & NBC News ^ | Dec 23, 2013 | Julie Appleby

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 law’s 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 ...


TOPICS: Extended News; Government; News/Current Events
KEYWORDS: deductibles; healthcare; healthinsurance; obamacare; outofpocketexpenses
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To: PubliusMM
this piece of legislative effluent

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.

21 posted on 12/27/2013 8:08:22 AM PST by OldNavyVet
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To: Innovative

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.


22 posted on 12/27/2013 8:12:15 AM PST by Black Agnes
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To: 1_Rain_Drop

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)


23 posted on 12/27/2013 8:12:37 AM PST by silverleaf (Age takes a toll: Please have exact change)
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To: Innovative

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?


24 posted on 12/27/2013 8:14:59 AM PST by riri (Plannedopolis-look it up. It's how the elites plan for US to live.)
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To: Black Agnes

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


25 posted on 12/27/2013 8:15:47 AM PST by silverleaf (Age takes a toll: Please have exact change)
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To: thouworm

Ping to 0scumbagCareLess thread...


26 posted on 12/27/2013 8:16:46 AM PST by Carriage Hill (Peace is that brief glorious moment in history, when everybody stands around reloading.)
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To: silverleaf

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.


27 posted on 12/27/2013 8:17:43 AM PST by Black Agnes
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To: Black Agnes

Why are you even paying that? You essentially are paying (A LOT!) for nothing. You now have “insurance” that is unusable.


28 posted on 12/27/2013 8:18:42 AM PST by riri (Plannedopolis-look it up. It's how the elites plan for US to live.)
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To: riri

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.


29 posted on 12/27/2013 8:21:57 AM PST by Black Agnes
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To: Innovative

If you’ve never worked a day in your life and never intend to you have nothing to worry about!


30 posted on 12/27/2013 8:25:56 AM PST by SWAMPSNIPER (The Second Amendment, a Matter of Fact, Not a Matter of Opinion)
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To: Innovative

**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,”**

BTTT!


31 posted on 12/27/2013 8:33:38 AM PST by Salvation ("With God all things are possible." Matthew 19:26)
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To: Black Agnes
Most people will have insurance that is unusable.

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.

32 posted on 12/27/2013 8:36:11 AM PST by riri (Plannedopolis-look it up. It's how the elites plan for US to live.)
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To: Innovative

(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 don’t 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!


33 posted on 12/27/2013 8:38:17 AM PST by Weirdad (Orthodox Americanism: It's what's good for the world! (Not communofascism!))
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To: Innovative

Owebamacare is single payer...and that single payer is YOU!


34 posted on 12/27/2013 8:38:52 AM PST by Beagle8U (Unions are Affirmative Action for Slackers! .)
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To: riri

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.

A lot.

Trust me.


35 posted on 12/27/2013 8:41:26 AM PST by Black Agnes
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To: Black Agnes
I have already said this is going to cause massive bankruptcies. The idea that people are not out in the streets with pitchforks is mindboggling. This is not a livable scenario. It can't work.

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.

36 posted on 12/27/2013 8:53:40 AM PST by riri (Plannedopolis-look it up. It's how the elites plan for US to live.)
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To: Innovative

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?


37 posted on 12/27/2013 8:57:14 AM PST by Venturer (Half Staff the Flag of the US for Terrorists.)
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To: Innovative

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


38 posted on 12/27/2013 9:02:17 AM PST by rdcbn
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To: riri

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.

Seriously.

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?


39 posted on 12/27/2013 9:03:52 AM PST by Black Agnes
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To: Venturer

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.


40 posted on 12/27/2013 9:13:42 AM PST by digger48
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