Community Centers Warn That Poor Won’t Keep Paying Obamacare Premiums

[buck]

In January, it was "most people don't understand insurance" (e.g., what a deductible is). Now they're brilliant scam artists, gaming the ACA regs. I think this is a rare feat of both underestimating and overestimating people.

Yes, because I'm sure it takes a great understanding of the health insurance industry to know that obamacare requires coverage for 90 days after you stop paying premium. You are making that piece far more complicated than it should be.

Most people have little idea how electricity works, but they sure know how to use the system, especially during winter months, to not have to pay the bill.

 

[sangha]

The policy is not terminated and that is due to Obamacare requirements. Not insurance companies or their contract.

but if the doctor has to treat them, it's because of the contract they signed, and not because of ACA

 

[sangha]

Yes, because I'm sure it takes a great understanding of the health insurance industry to know that obamacare requires coverage for 90 days after you stop paying premium.

Not at all. It takes almost no understanding to know that ACA requires coverage for 90 days after they stop paying.

But they need a PhD in insurance to know what a deductible is

 

[buck]

Not at all. It takes almost no understanding to know that ACA requires coverage for 90 days after they stop paying.

Agree. It takes little understanding of insurance in general to realize a 90 day grace period. Well done. You're finally making sense.

 

[buck]

but if the doctor has to treat them, it's because of the contract they signed, and not because of ACA

Who cares. The insured can get 90 days of free coverage. IT's that simple and that's something you disagreed with. I am glad, that again, you are agreeing and finally making sense. Well done. You're on a roll.

This is a lie. There is no free 90 days of health care. The insurance company has to cover the first 30. After that, the provider doesn't have to treat the patient.

 

[sangha]

Who cares. The insured can get 90 days of free coverage.

That has always been true

Glad to see you finally realize that ACA didn't change this

 

[fedupwithgov]

Who cares. The insured can get 90 days of free coverage. IT's that simple and that's something you disagreed with. I am glad, that again, you are agreeing and finally making sense. Well done. You're on a roll.

Even if there was a free 90 days of health care, which there is not, when the patient seeks treatment from a covered provider, the provider is told they are insured(when it is the first 30 days of insurance)and they treat the patient only to not be paid by the insurance company when the patient fails to pay their premium. Then the provider must seek payment from the patient even though they were advised the patient had insurance coverage. That is why many physicians and hospitals are refusing to accept insurance even when the insurance company advises the patient is covered.

What is wrong with this scenario? If a provider phones the insurance company to verify the patient has coverage, if the insurance company says the patient is covered for the care they are seeking, they should have to pay the provider regardless of whether the insured pays their premium. This is a huge problem with Obama care insurance plans(i.e. plans offered through exchanges). My husband, doctor, and the hospitals he is on staff at are being "burnt" by these plans and when they protest non-payment they are told that what they were told by customer service reps was not accurate and that they, the company, can not be held responsible.

This is just one flaw in the Obama care exchange insurance regulations. If providers call and are told their services are covered under the patients/insured's policy it should be law that they pay the provider for their services. What a crock of you know what. Insurance companies are making out big time while hospitals and other medical providers are losing money hand over fist and patients are paying out of pocket for the treatment they seek while their insurance company refuses to pay for the services insured's though were covered.

Where is the mainstream news on this?

 

[buck]

That has always been true

Glad to see you finally realize that ACA didn't change this

So, you went from "they don't get 90 days of free coverage" to "they always got 90 days of free coverage"? Wow. Anyway, it used to be 30 days of coverage covered by the insurance company before a lapse. In other words, you continue to show you have no idea what you are speaking of.

 

[buck]

Even if there was a free 90 days of health care, which there is not, when the patient seeks treatment from a covered provider, the provider is told they are insured(when it is the first 30 days of insurance)and they treat the patient only to not be paid by the insurance company when the patient fails to pay their premium. Then the provider must seek payment from the patient even though they were advised the patient had insurance coverage. That is why many physicians and hospitals are refusing to accept insurance even when the insurance company advises the patient is covered.

Couple of corrections. For the first 30 days, the insurance company will pay the provider. For the next 60 days, the insurance company may pay the provider but can recoup the cost from the provider if the insured does not pay the premium in arrears. So, the provider will get stuck with attempting to collect from the insured - which is often not successful.

 

[ludin]

Who cares. The insured can get 90 days of free coverage. IT's that simple and that's something you disagreed with. I am glad, that again, you are agreeing and finally making sense. Well done. You're on a roll.

i see nothing in there that doctors can't bill them for the full amount of service. more so if they know that the insurance company isn't going to pay. if the insurance company did end up paying they could issue a refund.

doctors are not going to just eat these costs. they can't afford to. it some times takes months to get payments from insurance companies anyway.

we are back to we have to pass it to know whats in it.

 

[sangha]

What is wrong with this scenario? If a provider phones the insurance company to verify the patient has coverage, if the insurance company says the patient is covered for the care they are seeking, they should have to pay the provider regardless of whether the insured pays their premium.

ACA requires the insurer to tell the provider that the patient is in their 2nd month of non-payment

 

[sangha]

So, you went from "they don't get 90 days of free coverage" to "they always got 90 days of free coverage"?

No, I went from "doctors have always been allowed to treat people who couldn't pay" to "doctors have always been allowed to treat people who couldn't pay" and "doctors have never been required to treat people who couldn't pay" to "doctors have never been required to treat people who couldn't pay"

 

[buck]

i see nothing in there that doctors can't bill them for the full amount of service. more so if they know that the insurance company isn't going to pay. if the insurance company did end up paying they could issue a refund.

You'd have to take that up with the BC/BS rep and the AMA rep that were both quoted. I suspect that even though I have some experience in the process and know some details, they will both know far more than I.

Dr. Dan McCoy, vice president and chief medical officer for Blue Cross Blue Shield of Texas, said his plan will cover claims throughout the entire 90-day period as a result of a state prompt payment law, but can recoup payments from physicians if patients' policies are terminated.

He stressed that participating physicians are expected to care for patients throughout that period even if payments have lapsed, adding, "We strongly feel that people who carry a Blue Cross Blue Shield card in their pocket should be treated as members."

Hoven, the AMA president, said that physicians are contractually and ethically bound to continue caring for their patients. “Most physicians are not going to turn away these patients, particularly if someone comes in with a life-threatening condition,” she said.

The AMA’s guide to the grace period specifically warns physicians that postponing or rescheduling patients could be a breach of contract because of anti-discrimination clauses in many managed care contracts.

doctors are not going to just eat these costs. they can't afford to. it some times takes months to get payments from insurance companies anyway.

I agree. They're going to attempt to collect from the patient. If they fail.. i'm not sure what you think the alternative is. Maybe the provider will have to get insurance to cover these forms of potential losses? Dunno.

 

[buck]

No, I went from "doctors have always been allowed to treat people who couldn't pay" to "doctors have always been allowed to treat people who couldn't pay" and "doctors have never been required to treat people who couldn't pay" to "doctors have never been required to treat people who couldn't pay"

Well then you are wrong... Unless you mean that a provider can choose to be in breach of his contract with the insurance company.. Which seems to be a silly argument for you to make - but certainly something I can see you doing.

Other than that, as the policy is still active and to fulfil the rquiremetns of the contracts, the provider has to provide treatment until that policy is terminated.

Delaying treatment, requiring the insured to pay up front, denying treatment... all are often a breach of the contract.

 

[sangha]

Well then you are wrong... Unless you mean that a provider can choose to be in breach of his contract with the insurance company.. Which seems to be a silly argument for you to make - but certainly something I can see you doing.

Other than that, as the policy is still active and to fulfil the rquiremetns of the contracts, the provider has to provide treatment until that policy is terminated.

Delaying treatment, requiring the insured to pay up front, denying treatment... all are often a breach of the contract.

Doctors aren't required to sign contracts with insurers. Not before ACA, and not after

 

[buck]

Doctors aren't required to sign contracts with insurers. Not before ACA, and not after

Hack away at that straw man.

 

[ludin]

You'd have to take that up with the BC/BS rep and the AMA rep that were both quoted. I suspect that even though I have some experience in the process and know some details, they will both know far more than I.

I agree. They're going to attempt to collect from the patient. If they fail.. i'm not sure what you think the alternative is. Maybe the provider will have to get insurance to cover these forms of potential losses? Dunno.

the other case scenerio is that you see doctors drop out of the insurance game all together and only accept cash. that is looking like a more viable option than insurance at this point. offering conceirge services for a lower cost than insurance. most charge 50 dollars for full services that they offer.

 

[ludin]

Hack away at that straw man.

the exact reason i quit responding to him.

 

[buck]

the other case scenerio is that you see doctors drop out of the insurance game all together and only accept cash. that is looking like a more viable option than insurance at this point. offering conceirge services for a lower cost than insurance. most charge 50 dollars for full services that they offer.

One of the articles I read on the topic is that this is one of the reasons that many hospitals chose not to sign up with Obamcare networks. So, you could very well be correct.

 

[ludin]

One of the articles I read on the topic is that this is one of the reasons that many hospitals chose not to sign up with Obamcare networks. So, you could very well be correct.

Hospitals chose not to join ACA networks because the reimbursment rates were so horrible that they would lose money which means increased costs for someone else.
Hospitals will gladly take cash as well. in fact the offer 80-90% discounts if you can pay upfront in cash.

Many hospitals, doctors offer cash discount for medical bills - Los Angeles Times
Is Concierge Medicine the Future of Health Care? - Businessweek

this is the way to go. the way to implement this is to have a system to deal with it which is a national HSA program.
you get to save tax free dollars towards medical, your company gets a 1:1 tax deduction up to 10k in donations after that they get a 1:2 for every dollar over that.
so if a company spends 20k on each person for their healthcare they get a 10k tax deduction and then they get a 20k deduction for the next 10k.

the government offers a one time tax credit of 1k-2k depending on income and phases out if you make over say 500k a year. that way everyone has money in their account up front.
the only thing you would need is a hospitalization plan for major medical emegancies.

but even that could be bought with the HSA account. if that would be even needed. a full cash system would cover everyone and be cheaper.
if insurance would get you the best price then you would pay 1k for that abdomen ct not 2k.

 

[buck]

Hospitals chose not to join ACA networks because the reimbursment rates were so horrible that they would lose money which means increased costs for someone else.
Hospitals will gladly take cash as well. in fact the offer 80-90% discounts if you can pay upfront in cash.

Poor reimbursement rates... Absolutely one of the bigger reasons not to sign up with one of the networks offered through the exchanges.

 

[ludin]

Poor reimbursement rates... Absolutely one of the bigger reasons not to sign up with one of the networks offered through the exchanges.

how do you think the government is trying to keep their costs down? they have to pay next to nothing to do it.
The Least Surprising Impact of the Affordable Care Act: Lower Pay For Physicians

it is why people are having a hard time finding doctors to accept them because the reimbursement rates are so low that it isn't worth the doctors time. he would have to see 100 more patients to make the same amount of money now.

it is the same reason that they are not taking medicaid patients. those got cut as well and they were already low to begin with.

 

[buck]

how do you think the government is trying to keep their costs down? they have to pay next to nothing to do it.
The Least Surprising Impact of the Affordable Care Act: Lower Pay For Physicians

it is why people are having a hard time finding doctors to accept them because the reimbursement rates are so low that it isn't worth the doctors time. he would have to see 100 more patients to make the same amount of money now.

it is the same reason that they are not taking medicaid patients. those got cut as well and they were already low to begin with.

Just read an article today:

http://finance.yahoo.com/news/consumers-losing-doctors-insurance-plans-214605729.html

Anyway, I agree. Lower reimbursement rates are the biggest reason... and the lower reimbrusement rates are largely a consequence of how the Obamacare set up competition on the exchanges and what customers are most looking at (premium).

But, at least according to that article I read (I can't relatocate it) another reason was the potential for a hosiptal to get stuck with bills between 31 and 90 days after last payment.

 

[clownboy]

First, the right said nobody would sign up for exchange policies in large numbers. The right ended up being wrong.

No, they were correct. The highly spurious figures being played with are not the grand figures needed. And no one was talking about signing up but PAYING. And we don't know how many have paid just yet. Signing up doesn't count for ****.

Second, First, the right said the exchange wouldn't make their projected targets. The right ended up being wrong.

Again they were correct, the exchanges did NOT make their projected target numbers.

Third, the right said the young wouldn't sign up. The right ended up being wrong.

And yet again they were correct. The young have NOT signed up in the necessary numbers. Not even close.

Fourth, the right said nobody would pay for their policies after the signed up. The right ended up being wrong, as insurance company executives testified before Congress.

Four for four so far, they were indeed correct. You need to review that testimony again, that's why the whole talk is of grace periods, because people aren't paying in sufficient number.

Now, the claim by the right is, ok, they'll pay the first couple of months, but nothing after that -- we just know that. Anyone want to bet based upon the right-wing's track record?

Here you're wrong again - that "claim" is fairly new and it not just the "right" saying it. But hey, this right you don't seem to have a clue about sure has a track record for being correct on this issue. Perhaps you should listen.

 

[Renae]

One question just bugs me about you. Why is it that you claim to love America but hate so many Americans?

Why do you equate love with government programs