ACA 2015 Policies Available

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Mick
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Joined: Fri Aug 02, 2013 10:48 am

ACA 2015 Policies Available

Post by Mick »

For those interested, the Healthcare.gov website has the 2015 insurance options and prices available for preview. Got the notice this morning and looked at what was available for us. System actually ran with no glitches!

For me, the BCBS HSA policy I had for this year went up on all points. A higher deductible, higher out of pocket and a higher premium. Luckily, United Healthcare came in this year and has a comparable HSA for $250 less a month. Like last year, the cheaper HSA turns out to be the best deal for us except in some limited circumstances.

One question for the insurance smart out there. The UHC plan does not cover out of network except for emergency care and network is limited to my state. So if I am traveling out of state and go to the ER where I am admitted is it all covered (hospital, surgery, anesthesiologiest, etc)? Think something like appendicitis or heart attack or something. The BCBS has a separate deductible for out of network but eventually covers things over $12500 but also says out of network emergencies go against in network deductible. Not worried about it if emergencies are covered out of state.
mhalley
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Re: ACA 2015 Policies Available

Post by mhalley »

Looks like I made the right decision by going with my Cobra plan, Similar ACA plan is 225 per month more.
Mike
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magellan
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Re: ACA 2015 Policies Available

Post by magellan »

Mick wrote:The UHC plan does not cover out of network except for emergency care and network is limited to my state. So if I am traveling out of state and go to the ER where I am admitted is it all covered (hospital, surgery, anesthesiologiest, etc)? Think something like appendicitis or heart attack or something. The BCBS has a separate deductible for out of network but eventually covers things over $12500 but also says out of network emergencies go against in network deductible. Not worried about it if emergencies are covered out of state.
I'm pretty sure all ACA policies have to cover emergency and urgent care even if it's out of network. This is usually mentioned in the benefits listing. They'll cover only what you need to get stabilized and not anything that could wait. Something like appendicitis should be covered. Either way, it'd be smart to have a loved one call your insurer immediately if that's possible to avoid snags.

The big problem with using an out of network emergency facility, or any out of network provider, is something called balance billing. Since your insurer won't have a contract with the provider, the provider can charge whatever they want. Your insurance contract probably has a provision that says the insurer will only pay 'reasonable and customary charges' for services rendered by out of network providers (even in an emergency). The insurer will reimburse the provider what they think is reasonable and the provider will bill you any remaining balance.

For this reason, it's usually safer to use an insurer with a national network instead of a limited state network. But don't assume that any given ACA plan uses an insurer's best network. For example, even though BCBS has a big national network and has probably negotiated rates with most providers across the country. many BCBS plans sold on the exchange use separate in-state-only networks, made up of only providers willing to take lower reimbursements compared to the usual BCBS reimbursements.
bluemarlin08
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Re: ACA 2015 Policies Available

Post by bluemarlin08 »

Unfortunately, the closest hospital to me is out of network. Had to be taken to their ER with severe pneumonia. We told the staff that if I needed to be admitted I needed to be transferred to an in network facility. The doctors said I was to critical to be transferred and I would be covered. Transferred to ICU for 4 days, told billing about being out of network and they assured me not to worry. A few weeks later received a large bill from the provider. Called and they said don't worry. They were suing BCBS for the claim. Make sure you have witnesses that confirm you tell the providers you are out of network.
lululu
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Re: ACA 2015 Policies Available

Post by lululu »

bluemarlin08 wrote: Make sure you have witnesses that confirm you tell the providers you are out of network.
In those circumstances I would myself or have someone write it on paperwork.

An in state only network sounds somewhat appalling, perhaps because I live in a small state. Being old enough for Medicare does have some benefits. I suppose this will be deleted, but now I see one of the reasons people advocate Medicare for everyone.
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magellan
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Re: ACA 2015 Policies Available

Post by magellan »

bluemarlin08 wrote:Transferred to ICU for 4 days, told billing about being out of network and they assured me not to worry. A few weeks later received a large bill from the provider.
If you don't mind sharing, approximately how much was the bill? Did it ever get resolved or is it still in dispute?

Most people don't realize how much even a short hospital stay costs and concrete cases can be enlightening and may provide an inducement to uninsured folks to pony up and get covered.
furwut
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Re: ACA 2015 Policies Available

Post by furwut »

Timely topic. Have to check if my state run exchange is showing information as well.

For my first year of retirement I chose the cheapest HDHP Bronze plan offered. I'm not sure how good my out of network coverage is. For future years I may be traveling more and so have to bring this into consideration. Another issue is covered services. Does the ACA do anything to level what is or ins't covered so that one can truly compare policies just on price/cost-sharing?

The reason this comes to mind is that I'm currently going through this with my COBRA dental insurance. The insurer is stating that a procedure is not covered. When I asked why not they said it wasn't part of the contracted services with my employer. I then asked what the contracted services were and they replied they don''t release that information to individuals.

So I'm wondering - one way insurers are controlling costs is with limited provider networks. Another way, perhaps, is trimming what services will be covered. The consumer is in a poor position to evaluate the robustness of an insurers network and completeness of covered services.
bluemarlin08
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Re: ACA 2015 Policies Available

Post by bluemarlin08 »

My charges for that visit was 97,000, 2 months later went back to the same ER with recurring Pneumonia, again too critical to transfer, again transferred to ICU, during testing discovered some artery blockage, ended up with one stent, that visit was around 125,000. Pneumonia nearly killed me. All claims are being lumped into a class action suit against the carrier. I just went on Medicare a couple of months ago and decided to go with Medicare Aand B drug plan and part G. Monthly premium 265. Had heard if I went on a Med Advantage plan their networks were very narrow and if I wanted to go outside to say Mayo they would be out of network. Talked with BCBS this morning and my fear was unfounded, their PPO plans were accepted in any state that had a BCBS preferred plan like most all states. You do have a co pay for in patient hospital for the first 5 days. My drugs were cheaper with this plan as well. My point, I'm in the business but don't work the Medicare market and I had to dig deep to find the best fit.
lululu
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Re: ACA 2015 Policies Available

Post by lululu »

furwut wrote: The reason this comes to mind is that I'm currently going through this with my COBRA dental insurance. The insurer is stating that a procedure is not covered. When I asked why not they said it wasn't part of the contracted services with my employer. I then asked what the contracted services were and they replied they don''t release that information to individuals.
In general, dental insurance sucks. However, any dental insurance plan I've had lists what it does and does not cover. Try calling hr. Also, some dental procedures are covered by medical insurance.
lululu
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Re: ACA 2015 Policies Available

Post by lululu »

http://www.channel3000.com/news/woman-t ... y/29648000

"Woman taken to 'wrong' hospital faces bankruptcy" Wrong as in out of network, when she was unconscious and without anyone along who knew her insurance. Also, I am not sure the ambulance could have even taken her to the slightly more distant in-network hospital, as in my state it's the law that emergency providers have to transport to the closest hospital.
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magellan
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Re: ACA 2015 Policies Available

Post by magellan »

lululu wrote:[url]"Woman taken to 'wrong' hospital faces bankruptcy" Wrong as in out of network, when she was unconscious and without anyone along who knew her insurance.
Balance billing is a real problem and getting a plan with a broad network is a much safer bet if you can afford it. Folks with employer plans should pay attention too, because narrow networks are being used there as well.

OTOH, while this article has an eye catching headline, it doesn't give us enough facts to know how much this women will pay compared to if she had a plan with a better provider network or had gone to an in-network hospital.

From the article, the hospital billed over $250k and BCBS paid around $150k. The hospital forgave $90k, leaving $10k for the patient to pay out of pocket. With $250k of care, even at an in-network hospital, she'd almost certainly hit her out-of-pocket maximum, which is usually $6k-10k. Also, since limited network plans usually cost 25% less than broad network plans, she likely saved another $1k on policy premiums. So it seems that this $250k medical emergency cost her $10k out of pocket vs. $7k if she had gotten a broader network plan. The article mentions that there are other bills as well, and it doesn't detail those, so we're left guessing there.
lululu
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Re: ACA 2015 Policies Available

Post by lululu »

I'm thinking that the other bills were pretty substantial, when you consider they included bills from the doctors, but who knows.
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magellan
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Re: ACA 2015 Policies Available

Post by magellan »

lululu wrote:I'm thinking that the other bills were pretty substantial, when you consider they included bills from the doctors, but who knows.
You may be right. It just doesn't detail them enough for us to know.

IMO, this case serves more as a warning to young invincibles that going uninsured is a recipe for financial disaster. Also, it reminds us that most individual policies require a lot of cost sharing, regardless of whether they're sold on or off the exchange. If you have a $250k medical emergency, it's likely your share will be $10k or more, no matter how good your policy is. Finally, it does show the potential financial consequences of choosing a lower cost plan with a limited provider network.

Folks could protect themselves against this by building a $10k-20k emergency medical fund in an HSA. Once funded, the HSA balance would cover unforeseen costs like these. Unfortunately, most people can't afford to do this so the HDHP gets labeled a bad idea. Really though, the problem is that medical costs are higher than most people can afford to pay. The trouble is this risk stays hidden and people go along thinking they're all set, until something bad happens.

Jim
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