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Thu Jun 28, 2012, 10:35 PM

Did you notice you didn't have to pay a copay for your annual exams the last 2 years?

That's part of the ObamaCare Act.

119 replies, 11068 views

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Reply Did you notice you didn't have to pay a copay for your annual exams the last 2 years? (Original post)
Honeycombe8 Jun 2012 OP
Zavulon Jun 2012 #1
WorseBeforeBetter Jun 2012 #6
Zavulon Jun 2012 #17
cliffordu Jun 2012 #45
Sirveri Jun 2012 #46
NNN0LHI Jun 2012 #54
cliffordu Jun 2012 #73
Sirveri Jun 2012 #80
Zavulon Jun 2012 #84
LiberalFighter Jun 2012 #103
cliffordu Jun 2012 #109
Honeycombe8 Jun 2012 #51
Zavulon Jun 2012 #86
LiberalFighter Jun 2012 #104
Honeycombe8 Jun 2012 #111
Ms. Toad Jun 2012 #35
Honeycombe8 Jun 2012 #52
Zavulon Jun 2012 #87
mzmolly Jun 2012 #43
Zavulon Jun 2012 #85
mzmolly Jun 2012 #110
mzmolly Jul 2012 #118
elehhhhna Jul 2012 #116
mzmolly Jul 2012 #117
Electro Jun 2012 #2
bigwillq Jun 2012 #5
Electro Jun 2012 #7
gkhouston Jun 2012 #25
Ms. Toad Jun 2012 #36
Dr Fate Jun 2012 #101
tridim Jun 2012 #107
Honeycombe8 Jun 2012 #56
EFerrari Jun 2012 #3
Le Taz Hot Jun 2012 #23
EFerrari Jun 2012 #28
xmas74 Jun 2012 #92
EFerrari Jun 2012 #94
xmas74 Jun 2012 #96
EFerrari Jun 2012 #98
freshwest Jun 2012 #42
Ian David Jun 2012 #4
southernyankeebelle Jun 2012 #8
kestrel91316 Jun 2012 #16
southernyankeebelle Jun 2012 #24
GObamaGO Jun 2012 #93
southernyankeebelle Jun 2012 #95
GObamaGO Jun 2012 #97
Honeycombe8 Jun 2012 #57
NickB79 Jul 2012 #114
Ms. Toad Jun 2012 #37
southernyankeebelle Jun 2012 #77
Honeycombe8 Jun 2012 #58
sammytko Jun 2012 #60
southernyankeebelle Jun 2012 #75
SoutherDem Jun 2012 #9
DURHAM D Jun 2012 #10
seabeyond Jun 2012 #12
xmas74 Jun 2012 #81
seabeyond Jun 2012 #82
xmas74 Jun 2012 #90
seabeyond Jun 2012 #106
seabeyond Jun 2012 #83
intheflow Jun 2012 #88
seabeyond Jun 2012 #105
xmas74 Jun 2012 #91
seabeyond Jun 2012 #108
seabeyond Jun 2012 #11
SickOfTheOnePct Jun 2012 #13
Zorra Jun 2012 #14
Ms. Toad Jun 2012 #38
Zorra Jun 2012 #99
kestrel91316 Jun 2012 #15
ProSense Jun 2012 #18
kestrel91316 Jun 2012 #19
Electro Jun 2012 #20
kestrel91316 Jun 2012 #22
intheflow Jul 2012 #113
kestrel91316 Jul 2012 #115
Ms. Toad Jun 2012 #59
kestrel91316 Jun 2012 #74
frazzled Jun 2012 #31
Ms. Toad Jun 2012 #40
Honeycombe8 Jun 2012 #61
madrchsod Jun 2012 #21
Matariki Jun 2012 #26
Honeycombe8 Jun 2012 #63
Nye Bevan Jun 2012 #27
frazzled Jun 2012 #29
RB TexLa Jun 2012 #30
proud2BlibKansan Jun 2012 #32
tammywammy Jun 2012 #33
dflprincess Jun 2012 #34
glowing Jun 2012 #39
Ms. Toad Jun 2012 #41
glowing Jun 2012 #48
Ms. Toad Jun 2012 #49
Honeycombe8 Jun 2012 #64
Skittles Jun 2012 #44
maryellen99 Jun 2012 #47
Ms. Toad Jun 2012 #53
maryellen99 Jun 2012 #62
Honeycombe8 Jun 2012 #66
WinkyDink Jun 2012 #50
Honeycombe8 Jun 2012 #68
WinkyDink Jun 2012 #78
Honeycombe8 Jun 2012 #112
AngryOldDem Jun 2012 #55
Honeycombe8 Jun 2012 #65
flamingdem Jun 2012 #76
JNelson6563 Jun 2012 #67
MadrasT Jun 2012 #69
Proud Liberal Dem Jun 2012 #70
Dr Fate Jun 2012 #102
undeterred Jun 2012 #71
cbdo2007 Jun 2012 #72
Xyzse Jun 2012 #79
intheflow Jun 2012 #89
Dr Fate Jun 2012 #100
budkin Jul 2012 #119

Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:37 PM

1. Then to whom do I apply for a refund? (NT)

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Response to Zavulon (Reply #1)

Thu Jun 28, 2012, 10:45 PM

6. The benevolent insurance companies. (n/t)

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Response to WorseBeforeBetter (Reply #6)

Thu Jun 28, 2012, 11:15 PM

17. Good. Maybe after 6-8 months of paperwork I will

get it back, and I can apply it to the fines I'll have to pay for not buying their services now that I've been told in no uncertain terms that I will lose my employer-sponsored coverage by the end of the year.

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Response to Zavulon (Reply #17)

Fri Jun 29, 2012, 01:40 AM

45. Hmm.

I'd like to know about these fines, seeing as how there's no provision in the law for actually COLLECTING these fines.

Why is your employer ending health care coverage??

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Response to cliffordu (Reply #45)

Fri Jun 29, 2012, 05:01 AM

46. The IRS is hiring 16,000 new enforcement agents specifically to collect fines for ACA.

So I'm pretty sure they'll figure out a way to do it.

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Response to Sirveri (Reply #46)

Fri Jun 29, 2012, 07:57 AM

54. Fuck Ron Paul!

http://www.factcheck.org/2010/03/irs-expansion/

Posted on March 30, 2010 , Updated on Feb. 22, 2011

: Will the IRS hire 16,500 new agents to enforce the health care law?


A: No. The law requires the IRS mostly to hand out tax credits, not collect penalties. The claim of 16,500 new agents stems from a partisan analysis based on guesswork and false assumptions, and compounded by outright misrepresentation.


Hello,

I’d like to request a fact check on Ron Paul’s claim regarding the enforcement of the health insurance mandate, "16,500 ARMED bureaucrats coming to make this program work." at 3:53 of this video:



I did a google search for "16,500" and there were a lot of hits on conservative websites stating something along the lines that the health care bill sets aside $10 billion for the IRS to hire up to 16,500 agents to enforce the mandate, but ARMED agents are another matter. Anyway, I couldn’t find anything about this from the national news outlets, so I’m just curious if this is just a scare tactic.

FULL ANSWER

This wildly inaccurate claim started as an inflated, partisan assertion that 16,500 new IRS employees might be required to administer the new law. That devolved quickly into a claim, made by some Republican lawmakers, that 16,500 IRS "agents" would be required. Republican Rep. Ron Paul of Texas even claimed in a televised interview that all 16,500 would be carrying guns. None of those claims is true.

The IRS’ main job under the new law isn’t to enforce penalties. Its first task is to inform many small-business owners of a new tax credit that the new law grants them — starting this year — which will pay up to 35 percent of the employer’s contribution toward their workers’ health insurance. And in 2014 the IRS will also be administering additional subsidies — in the form of refundable tax credits — to help millions of low- and middle-income individuals buy health insurance.

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Response to NNN0LHI (Reply #54)

Fri Jun 29, 2012, 11:54 AM

73. YEP- FUCK RON PAUL.

Some folks could use a little LESS transparency.

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Response to NNN0LHI (Reply #54)

Fri Jun 29, 2012, 04:20 PM

80. I saw it posted by another poster here.

I didn't bother to look up their claims as I was skimming the thread at the time.

But that's good info to have so thank you for providing it.

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Response to cliffordu (Reply #45)

Fri Jun 29, 2012, 04:53 PM

84. Because it's cheaper to pay the fine.

A LOT cheaper. Even paying the fine he'll come out ahead a little over two grand per year on every employee. Not a cent of those savings is going to any of us, either, so unless I find another job I'm going to be uninsured. I barely make ends meet as it is, certainly can't afford my own policy and for that matter a $695 fine will be crushing enough as it is. The only way I can scrape up $58 a month to pay the fine is to eat nothing but Ramen. As such, I'm sorry to say I'm not one of those who is applauding yesterday's decision and I'm really getting upset reading the posts about how this will benefit EVERY American. I know a lot of people WILL benefit, but I'm screwed.

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Response to Zavulon (Reply #84)

Fri Jun 29, 2012, 05:53 PM

103. You don't provide data about your situation to back up your post.

First, that $695 doesn't go into effect until 2016. The first year the tax penalty is only $95 the first year.

If someone has difficulty allocating $58 a month for this then more than likely they are exempt from the tax.

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Response to Zavulon (Reply #84)

Fri Jun 29, 2012, 06:20 PM

109. Do you have any proof that employers have to pay a fine??

I don't think that provision exists.

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Response to Zavulon (Reply #17)

Fri Jun 29, 2012, 07:53 AM

51. Who is your ins. company? In what state? Let's check this out and get this taken care of.

It's a good thing to know that you're dealing with a co. that breaks the law. That is no co. to do business with, and certainly no company on which you can rest the security of getting health care, should you get cancer.

You need to turn them in to your state's insurance commissioner, AND send an e-mail reporting them to any Democratic federal representative you have, AND send an e-mail to the White House so hopefully they can tell you who exactly you need to notify.

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Response to Honeycombe8 (Reply #51)

Fri Jun 29, 2012, 05:07 PM

86. Kaiser, Virginia (although both co-pays were collected in DC).

When I was charged my co-pay I asked when the co-pays were going to stop, and the receptionist who collected it said "That doesn't apply to us" followed by some line she was obviously told to recite when questioned.

I'm going to follow your advice. Sadly, those two co-pays, minimal as they were, would make a big difference. Thanks for your post, I really appreciate it.

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Response to Zavulon (Reply #86)

Fri Jun 29, 2012, 05:56 PM

104. Our benefit reps advise our retirees

to keep track of what they pay in copays and deductibles. That way they know when it is met. You can't trust the office people in a doctors office to get it right. Especially when they deal with many many many different insurance plans.

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Response to Zavulon (Reply #86)

Fri Jun 29, 2012, 08:24 PM

111. Here's an article that explains how it works, when it applies & doesn't.

It would be a "well exam," a checkup, by a PRIMARY physician (not a specialist). That would be an internal med. dr. or a GP (POSSIBLY a gyn, but I'm not sure about that....I think I didn't have to pay a copay for my annual gyn well exam last year).

It doesn't apply to that lab bill we always get in the mail later. It's only the copay at the dr.'s office (or mammogram facility).

Here's the article. NOTE THAT IF THE DR INSISTS ON A COPAY BUT THE PATIENT SHOULDN'T HAVE TO PAY IT, THE PATIENT CAN REQUEST A REIMBURSEMENT/REFUND, but I'm not sure from whom. I think it's discussed in the following article.

I'm guessing that dr. soon won't be able to get away with that. Once a dr. charged me a $50 copay, when it should've been $25. When I got the statement of benefits from the ins. co., it showed the copay as $25, not $50. I called the ins. co., and they said they can't do anything about that. They said I shouldn't have paid the $50! Like I had a choice.

http://www.wbur.org/2011/11/28/free-preventive-care

When Is Preventive Care Free And When Do You Pay?

By Martha Bebinger November 28, 2011


BOSTON — The still-relatively new federal health care law makes dozens of preventive tests free for patients. Doctors or hospitals are not supposed to charge patients for annual check-ups, most screening tests and a dozen other services such as tobacco cessation. This provision began taking effect more than a year ago, but there is still confusion about how it works.

Arelis Gomes, an outreach coordinator at Health Care for All, spends her days deciphering and explaining the Affordable Care Act, or ACA. For more than a year now she’s been telling consumers that they will no longer have to pay anything for preventive care.


Arelis Gomes points out the free preventive care information in her Health Care for All brochure. (Martha Bebinger/WBUR)

So, when Gomes arrived at her doctor’s office a few weeks ago for her annual check-up, she was surprised when the receptionist asked her for a co-pay.

“And I said, ‘Actually I know for a fact that under the ACA we do not have to pay a co-pay for this visit because it’s a preventative visit,’ ” Gomes remembers telling the receptionist. “And she said ‘No, I’m not aware of that and we’re not allowed to take you in today for this visit if you don’t pay the co-pay.’ ”

After a frustrating back and forth, with her husband looking on, Gomes paid the co-pay.

Gomes appealed the payment with her insurer and expects to receive a rebate. As Gomes shares her story to friends and audiences, she says many people don’t know they are not supposed to be charged for preventive care.

Among people who do know, there is still confusion about what is free and what is not. If you go in for an annual check-up the visit won’t cost you anything but you will still have a charge for the lab work your doctor orders. And some tests may start off as a preventive screening, but then switch to a diagnostic test if a doctors finds a problem.

Take, for example, a colonoscopy. It will not cost you anything unless the doctor finds a polyp, which happens fairly often. If the doctor does find a polyp while you are lying there on the table, the test is no longer a preventive screening, it’s a procedure and there will be a charge.

Jill Madigan, a self-employed 57-year-old, found this out during a call to her insurer.

“I said, ‘If they bill it as routine and they find polyps, are you going to say it’s not routine?’ ” Madigan asked the insurance representative. “And she said yes.”

Some patients would just get a bill for the co-payment. But if Madigan’s preventive colonoscopy becomes a surgical procedure to remove polyps, she’d be expected to pay the full charge — about $1,500, because she has a deductible.

So is she thinking about skipping the test?

“Well, yeah, I’ve been thinking about it,” Madigan said. “The likelihood is that I probably will have the test. I’m not sure I’m willing to take that risk with my life and yet, the whole system is messed up.”

Messed up, Madigan says, because if she declined the test but eventually needed colon surgery, it would cost much more than a colonoscopy.

Now, to be clear, before the health care law was passed, Madigan would have had to pay for the test whether it was preventive or not. But she and other patients are upset by what now feels like a bait and switch.

The option of free, preventive care is coming at a time when more and more patients have deductibles or rising co-payments.

Dr. Tom Hines, president of the Massachusetts Academy of Family Physicians, mentions the example of a woman coming in for a pap smear. If that test shows something abnormal it triggers the need for a more specialized test.

“It’s not an uncommon situation for a patient to delay that follow-up appointment,” Hines said. “If you unearth something, it’s important to follow up on the problem that’s been unearthed.”

Supporters of the law say it’s important not to overlook the benefits of encouraging patients to get preventive care. Employers and insurers still pay for the visits and tests, they just don’t pass along any costs to the patient.

“It is a clear advantage for the employee or retiree as the case may be,” said Dolores Mitchell said, who runs the Massachusetts Group Insurance Commission, which covers more than 350,000 retirees, employees and their families. She says the lesson, while there is still confusion about this part of the law, is to ask a lot of questions about what your doctor is prescribing and why.

“It’s a good thing to be a pushy patient who asks questions,” Mitchell said. “There are an awful lot of procedures out there that are subject to some difference of opinion about what’s preventive. It will take some shakedown time before it all gets resolved.”

In the meantime, your insurance company should have a list of procedures considered preventive, for which you won’t be charged. Here are the lists for some of the states largest insurers:
Blue Cross Blue Shield
Harvard Pilgrim Health Care
Tufts Health Plan

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Response to Zavulon (Reply #1)

Fri Jun 29, 2012, 12:17 AM

35. Your doctor.

Your insurance company should have issued an EOB to you and your doctor, which listed a $0 copay. If you paid your co-pay to your doctor at the time of the visit, the doctor should have refunded it to when s/he received the EOB. (They shouldn't have collected it in the first place...but it has been taking some of them a while to get used to it.)

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Response to Ms. Toad (Reply #35)

Fri Jun 29, 2012, 07:54 AM

52. Yes, I think it's the DOCTOR who incorrectly charges the copay. Remember, it's free for PREVENTIVE

care, like annual well exams. For women, that includes an internal med. dr., OR a gyn OR a gp.

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Response to Ms. Toad (Reply #35)

Fri Jun 29, 2012, 05:10 PM

87. Thanks.

I plan on following up on this. Starting next year I'll lose my coverage and will have no choice but to pay the tax, so I need to get every benefit I can out of the ACA. The only upside to this so far is that I had the sense to insist in receipts for my co-pays, something not offered unless you ask for it.

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Response to Zavulon (Reply #1)

Fri Jun 29, 2012, 12:40 AM

43. No need to apply.

You'll be sent a refund if your insurance company didn't spend X amount on care.

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Response to mzmolly (Reply #43)

Fri Jun 29, 2012, 04:56 PM

85. I thinfk if I had any refund coming for those visits

I'd have gotten it by now. Not trying to be snotty at all, just saying that I did have co-pays despite the promised benefit.

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Response to Zavulon (Reply #85)

Fri Jun 29, 2012, 06:44 PM

110. The refunds haven't been sent

Last edited Sun Jul 1, 2012, 07:33 PM - Edit history (1)

out yet. They're not required until the end of the year, if I recall correctly? (On edit, refunds will be mailed in August.)

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Response to Zavulon (Reply #85)

Sun Jul 1, 2012, 06:53 PM

118. Duplicate

Last edited Sun Jul 1, 2012, 07:34 PM - Edit history (2)

Response.

FWIW, you may be correct in that you will not get a refund. However, according to the AARP, the checks are due out on August 1st.

http://blog.aarp.org/2012/05/02/insurance-refund-the-checks-might-be-in-the-mail/

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Response to mzmolly (Reply #43)

Sun Jul 1, 2012, 02:46 PM

116. IIRC the refund is issued to the client who holds the policy --

meaning your empoloyer, if that's how you're insured

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Response to elehhhhna (Reply #116)

Sun Jul 1, 2012, 06:48 PM

117. On edit, I've read differing

Last edited Sun Jul 1, 2012, 07:32 PM - Edit history (2)

reports on this. Some reports say what you noted, others suggest a percentage based upon the premium you pay. I defer to Kaiser.

http://www.kff.org/healthreform/8305.cfm

... "The analysis finds that consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates from health insurers who spent more on administrative expenses and profits than allowed by the ACA. The rebates include $541 million in the large employer market, $377 million in the small business market, and $426 million for those buying insurance on their own. Rebates in the group market will generally be provided to employers, and in some cases be passed on to employees as well.Rebates are expected to go to almost one-third (31%) of consumers in the individual market. Among employers, about one-quarter (28%) of the small group market and 19% of the large group market is projected to receive rebates. The share of consumers in the individual insurance market expected to receive rebates ranges from near zero in several states to as high as 86% in Oklahoma and 92% in Texas. "

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:41 PM

2. I've paid a copay every single time I went to every one of my doctors this year.

What are you talking about?

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Response to Electro (Reply #2)

Thu Jun 28, 2012, 10:43 PM

5. Hello

Welcome to DU!

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Response to bigwillq (Reply #5)

Thu Jun 28, 2012, 10:46 PM

7. Thanks and

Hello to yourself


ETA: I wanted to say hello and introduce myself in the Help and Welcome forum, but it won't allow me to make new posts because I am new. Usually they turn that feature off in the Introduction type forums so that new people can make new threads.

I couldn't find where it says how many posts a new person needs to make in order to post a new thread.

Anyway thanks for the welcome!

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Response to Electro (Reply #7)

Thu Jun 28, 2012, 11:34 PM

25. You can do it now. Welcome to DU!

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Response to Electro (Reply #2)

Fri Jun 29, 2012, 12:19 AM

36. It applies to your annual physical, and certain other exams

Mammogram and gyn exam, for women. Colonoscopy once you reach 50 (but if they find anything, that one turns into treatment and is subject to copays and coinsurance). I don't remember the entire list - but you should receive an EOB which shows a $0 copay. If the doctor collected one and didn't refund it or apply it to a future visit, go have a nice chat with him/her.

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Response to Ms. Toad (Reply #36)

Fri Jun 29, 2012, 05:50 PM

101. I was charged a co-pay for my annual physical exam- back in March of 2012. nt

nt

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Response to Dr Fate (Reply #101)

Fri Jun 29, 2012, 05:58 PM

107. Call your insurance company and tell them they BROKE THE LAW.

I just finished researching individual plans and every single one said annual exams and basic preventative care is "no cost".

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Response to Electro (Reply #2)

Fri Jun 29, 2012, 07:58 AM

56. It is now the law of the land that PREVENTIVE well exams do not have copay amounts.

That is the law.

That is NOT an exam to treat or be examined for some problem.

If you have been charged copays, it is the CARE PROVIDER who is illegally charging you, I believe. They are in essence getting money under the table.

Look at your Statement of Benefits from your ins. co. I'm gonna guess they don't credit you for any copay, because they didn't authorize one. If they did, then it was the INSURANCE COMPANY who illegally got that copay.

Now you know. It is the law that PREVENTIVE CARE well exams do not require copays. You should tell the care provider that, next time they try to charge you.

It must be a main treating physician, like an internal med. dr., a gp, and it must be an exam for wellness (as opposed to checking you out for a complaint). That includes mammograms.

That are exceptions for kinds of ins. that don't fall under the ACA, like federal government plans, military insurance, etc. The ACA doesn't apply to those, I believe.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:42 PM

3. What are annual exams? n/t

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Response to EFerrari (Reply #3)

Thu Jun 28, 2012, 11:29 PM

23. +1

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Response to Le Taz Hot (Reply #23)

Thu Jun 28, 2012, 11:36 PM

28. Hey, sweetie.

I guess I should be glad that many DUers don't have any idea what a lot of us go through.

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Response to EFerrari (Reply #28)

Fri Jun 29, 2012, 05:35 PM

92. I went through that myself until recently.

For a few years I had no insurance, even when offered. (It wasn't affordable.) Even after I could afford it I didn't use it, for fear that the doctor would want to run tests that wouldn't be covered. (Been there, done that, got the t shirt.)

The court decision makes me feel a bit more comfortable about using my insurance. I'm booking an appointment with an ob/gyn for a yearly exam-something I haven't had in a decade.

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Response to xmas74 (Reply #92)

Fri Jun 29, 2012, 05:36 PM

94. I hope it goes well for you. :)

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Response to EFerrari (Reply #94)

Fri Jun 29, 2012, 05:42 PM

96. thank you.

It is sad it say I'm a bit excited about it? I haven't had one in years and the thought of one makes me actually feel human, like I deserve that type of care, compared to the days of when I couldn't afford it and was made to feel like pond scum.

Maybe that's just me being silly.

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Response to xmas74 (Reply #96)

Fri Jun 29, 2012, 05:44 PM

98. Not silly at all!

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Response to EFerrari (Reply #3)

Fri Jun 29, 2012, 12:39 AM

42. It's the one you get the same year a truck runs you over. Then they tell you to go away...



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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:43 PM

4. Unless, I believe, your doctor diagnoses a new condition. n/t

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:47 PM

8. What are you talking about. I always pay a co-pay. But I am not complaining. I have

 

tricare and I pay either $25.00 for a specialist or $12.00 for my primary doctor. I love my Tricare and I wish the whole country could get this program. My poor son has terrible health insurance paying over $400 a month for his family of 4. The care is terrible. What he pays in a month I and my husband pay in a year. Before long I will be on Tricare for Life and Medicare. I will be happy.

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Response to southernyankeebelle (Reply #8)

Thu Jun 28, 2012, 11:13 PM

16. $400/mo for a family of 4 is FABULOUSLY cheap insurance.

I'd have to pay $400+ a month just for myself here, but I can't afford it. Plus those stupid deductibles and copays if you actually make the mistake of getting sick or hurt.

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Response to kestrel91316 (Reply #16)

Thu Jun 28, 2012, 11:30 PM

24. I guess the prospect you come from. My son is a cook. Over $400 a month for terrible

 

insurance isn't great for a family of 4. I don't know your situation but I think yours is terrible high also. But it's just me and my husband. Come Jan I go on Medicare and I will change to Tricare for Life which will bring my husbands costs down for Tricare. Tricare for Life will be my sublement to medicare. Again both are government benefits.

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Response to southernyankeebelle (Reply #24)

Fri Jun 29, 2012, 05:36 PM

93. I know someone who was laid off

The monthly bill to maintain their insurance for a family of 3 was $1800 a month.

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Response to GObamaGO (Reply #93)

Fri Jun 29, 2012, 05:39 PM

95. Wow, what the heck the guy suppose to do? Give them a damn leg for payment? LOL awful

 

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Response to southernyankeebelle (Reply #95)

Fri Jun 29, 2012, 05:42 PM

97. Apparently they were supposed to stop paying their mortgage

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Response to kestrel91316 (Reply #16)

Fri Jun 29, 2012, 08:01 AM

57. $400/mo. is cheap for an entire family. That doesn't mean it's easy for anyone to afford, but it's

cheap, by comparison to what I can get.

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Response to kestrel91316 (Reply #16)

Sun Jul 1, 2012, 02:35 AM

114. I pay $225/mo, but that's thanks to the Teamster's Union

$10 copays on prescriptions and doctor's visits (even urgent-care if the kid is sick in the middle of the night), no deductible, two free dental cleanings a year, eyeglasses are 50% covered, and it applies to the entire family. I could have 10 kids and they'd still be covered for the same $225/mo. My wife's entire pregnancy cost us a whopping $500, from the first sonogram to us walking out of the hospital with our new baby girl. Even the $300 breast pump was covered as reimbursable.

People really don't know what they've lost now that unions are dying out. It's a shame how people get screwed in this country when it comes to affordable health care when they don't have the power of a union to back them up against the overwhelming force of the health insurance industry.

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Response to southernyankeebelle (Reply #8)

Fri Jun 29, 2012, 12:22 AM

37. You are entitled to a general check up once a year without charge,

plus a few other visits (mammogram and gyn, for example) which are considered preventative care. Your EOB should show a $0 co-pay, and you should go ask your doc for a refund for any of these $0 co-pay visits for which you paid him/her.

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Response to Ms. Toad (Reply #37)

Fri Jun 29, 2012, 04:08 PM

77. I live at the at doctors office unfortunately. I thought he/she was talking in general. I misunder

 

stood.

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Response to southernyankeebelle (Reply #8)

Fri Jun 29, 2012, 08:04 AM

58. A specialist is not a well exam. A well exam is where you go to the dr once a year...

to a PRIMARY DR. (an internal med. dr., or gp) for a general checkup for wellness. It includes an annual mammagram for women over a certain age (which is no copay, also).

$12 is a very cheap copay, but it is the law of the land that preventive care well exams have no copay now.

Unless your ins. falls under the kind that the ACA doesn't apply to at all (federal govt healthcare plans, military, etc.).

Consider that your son is paying for twice as many people as you and your husband, so it would be more, wouldn't it? Also consider that his plan includes coverage for children, who get sick and injured a lot. Measles, mumps, chicken pox, broken arm, etc.

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Response to southernyankeebelle (Reply #8)

Fri Jun 29, 2012, 08:07 AM

60. I'm on Tricare

And didn't pay for my mamogram this year.

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Response to sammytko (Reply #60)

Fri Jun 29, 2012, 04:04 PM

75. I am not talking about tests. I didn't either. How do you like Tricare Primary? I love it.

 

Of course I will love Tricare for Life in January better.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:51 PM

9. The company I was with sold it as something they did for us

not something they had to do.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:53 PM

10. So who has an annual exam?

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Response to DURHAM D (Reply #10)

Thu Jun 28, 2012, 10:55 PM

12. ha... i was sayin. but, if i dont have to pay, i may have one, lol. nt

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Response to seabeyond (Reply #12)

Fri Jun 29, 2012, 04:42 PM

81. I'm booking an appointment with an ob/gyn as we speak.

I thought the no cost preventative didn't start until another year or so.

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Response to xmas74 (Reply #81)

Fri Jun 29, 2012, 04:51 PM

82. remember the day when that use to be a given. preventative covered. nt

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Response to seabeyond (Reply #82)

Fri Jun 29, 2012, 05:28 PM

90. I'm glad to see that it's covered again.

I remember having them for years and then, out of nowhere, not being able to afford them anymore, even with insurance. One year, my ob/gyn annual cost me nearly $400, according to the bill that was sent to my home. Not much was done-simple breast exam, pelvic, pap, a bit of blood work and my Depo shot. My insurance (I believe it was Coventry at the time) refused to cover any of it, since I hadn't met my deductable.

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Response to xmas74 (Reply #90)

Fri Jun 29, 2012, 05:57 PM

106. yup. nt

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Response to xmas74 (Reply #81)

Fri Jun 29, 2012, 04:52 PM

83. what about eye doctor. my son has his yearly on monday. $160 for me.

goes toward our deductable of 15k a year, lol.

LOVE my fuckin not really insurance.

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Response to seabeyond (Reply #83)

Fri Jun 29, 2012, 05:23 PM

88. Yep.

Eye care and dental. Actually had a DUer tell me once that those weren't "real" medical issues. Even though without my glasses I'm legally blind and would not be able to get to work or do the work that I do. But it's not real!

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Response to intheflow (Reply #88)

Fri Jun 29, 2012, 05:56 PM

105. oh geez... i never had eye issue, no one in our family did. everyone in hubbies family

both my boys have really poor site. i have learned more about eyes and the HUGE issue it is. my youngest got an ulcer in one eye, could have blinded him and was a big deal. a scary deal. prior to kids with issues, i might have shrugged it off, too.

and dental is very much a health issue.

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Response to seabeyond (Reply #83)

Fri Jun 29, 2012, 05:31 PM

91. I don't know about the eye.

I have EyeMed through work and my exam is covered, every twelve months. My dental, Metlife Dental, covers our preventative quite nicely.

I have decent insurance but my hope is that everyone else will have decent insurance too. I don't think it should make a difference about where (or if) you work or how much money you make-you should have the right to low cost (or free) preventative health care.

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Response to xmas74 (Reply #91)

Fri Jun 29, 2012, 05:58 PM

108. sigh... lol, ya. nt

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:55 PM

11. sheeeit, i just pay thru hsa cause i have a piece of shit insurance.

whatchu talking about.

i dont think i have ad an annual exam in the last two years, but kids have

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 10:58 PM

13. I've never had to pay a co-pay for preventive visits n/t

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:08 PM

14. No one told the insurance companies! CALL CONGRESS RIGHT FRACKING NOW!1!1!

Seriously. What annual exams are we talking about?

Our little company's insurance provider has not only jacked or stopped paying the copay on preventative checkups until after we've met the ridiculous deductible, they no longer cover some of them at all.

And that's after jacking our rates almost 40% over last year.

We're paying way more and getting way less for our money, and that was the best "deal" we could find anywhere.

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Response to Zorra (Reply #14)

Fri Jun 29, 2012, 12:24 AM

38. Your once a year check-up with your primary doc

your mammogram, gyn exam, colonoscopy (there is a list). Your EOB should show $0 for those visits, and your doc should refund anything you paid for them.

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Response to Ms. Toad (Reply #38)

Fri Jun 29, 2012, 05:46 PM

99. Thanks!


I found problems with my PCP annual checkup and vision screening billings, and they are the only preventive services I've had performed since our policy change went into effect.

You're correct, some basic preventive services such as the ones you listed are no charge.

Looks like August will be preventive checkup month for me.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:10 PM

15. IIRC this only applies to NEW policies. If you have an old pre-ObamaCares policy

from before that part took effect, you are screwed.

It's one of the reasons it's not a perfect law.

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Response to kestrel91316 (Reply #15)

Thu Jun 28, 2012, 11:16 PM

18. Yes, or

"IIRC this only applies to NEW policies. If you have an old pre-ObamaCares policy"

...if you change policies during an open-enrollment period.

When the exchanges are up and running, more people will benefit.

What's at stake in today's Obamacare decision

<...>

  • If you're employed, and insured, you'll probably lose the free preventative care services you've enjoyed since last year. Some 54 million people took advantage of the physical exams, cancer screenings, flu shots, child immunizations, etc. that the law provides for, with no co-pay.
http://www.dailykos.com/story/2012/06/28/1103719/-What-s-at-stake-in-today-s-Obamacare-decision


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Response to ProSense (Reply #18)

Thu Jun 28, 2012, 11:19 PM

19. Problem is, if you have ever seen a doctor for squat, you have a pre-existing condition

and you can't drop an old policy because no company will write you a new one.

In 18 months that will change, of course. But people are stuck with bad policies until then.

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Response to kestrel91316 (Reply #19)

Thu Jun 28, 2012, 11:22 PM

20. Really?

I thought the pre-existing thing would be immediate...?

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Response to Electro (Reply #20)

Thu Jun 28, 2012, 11:28 PM

22. No, that part goes into effect Jan 2014.

You rally do need to read up on the law. The website is very easy to understand.

http://www.healthcare.gov/

Timeline page: http://www.healthcare.gov/law/timeline/index.html

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Response to kestrel91316 (Reply #22)

Sun Jul 1, 2012, 02:19 AM

113. Website is not really that easy to understand.

For instance, the cost estimator asks me my gender, age, and location, but not my income, so it quoted me a base rate of more than I make in month for a private insurance option, and no numbers at all for any of the other options. So I still don't have any idea what I'll be expected to shell out.

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Response to intheflow (Reply #113)

Sun Jul 1, 2012, 02:11 PM

115. Somebody found an estimator online from some university I think

and I was very happy to see that at my current pathetic income (self-employed and struggling in this recession) my premiums will be under $600/YEAR and copays/deductibles limited to 6% of the actual cost of care.

I wish I could find the link for you but OF COURSE I DID NOT SAVE IT, rofl.

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Response to kestrel91316 (Reply #19)

Fri Jun 29, 2012, 08:06 AM

59. There is an option available now -

but you have to be willing to be without insurance for 6 months.

There are PCIP plans for people with pre-existing conditions who cannot obtain health insurance. The premiums range from around $90 to around $600 a month (depending on age and geography). Most have a substantial deductible. But that premium is dirt cheap for anyone with pre-existing conditions.

If I had overpriced insurance (because it was the only thing I could get) I would consider getting 3 months worth of drugs, and any medical care I could predict, the day before I terminated my policy. Live off the drugs for 3 months, purchase the next 3 months worth out of pocket, then buy into the PCIP plan for my state. (And hope I didn't have a medical disaster during those 6 months.)

My daughter's out of pocket drug costs for 3 months come to around $2500 - so as long as I could save that much in premiums in a reasonable period of time under the new plan it would be a pretty easy decision. (With our current plan, if we were paying the premiums rather than work, it would take about 2 months to recover the out of cost drug costs in premium savings. Pretty much a no brainer.)

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Response to Ms. Toad (Reply #59)

Fri Jun 29, 2012, 01:30 PM

74. I checked out PCIP on the advice of a friend. It would cost me $500/mo. If I had that kind of money

I'd just go ahead and buy regular insurance.

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Response to kestrel91316 (Reply #15)

Thu Jun 28, 2012, 11:42 PM

31. Not true: we had the same old policy and didn't have to co-pay for the physical

Many insurers are going ahead and implementing this aspect of the law even before it becomes mandatory for them in 2014.

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Response to kestrel91316 (Reply #15)

Fri Jun 29, 2012, 12:35 AM

40. Interesting. I read that differently at the time it was written -

and our pre-3/23/2010 plan granted us those rights in the first new plan year after enactment (which is how I read the plan at the time it was written). I'll have to go back and re-read it - my impression was that employment related plans were treated as new on the plan anniversary. Ours certainly was. But, I may be wrong as to whether that is requried.

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Response to kestrel91316 (Reply #15)

Fri Jun 29, 2012, 08:07 AM

61. Not sure about that. I have a new employer and new plan, but it was no copay under old plan....

the way ins. works is that when it is renewed every year, it is a new policy, I think. Ins. cos. are constantly updating the provisions, etc., which in essence makes a policy new.

But whatever the case, I think the law applies to existing insurance, even if you initially signed up with that ins. company years ago.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:28 PM

21. my annual exams are free...medicare!

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:34 PM

26. Um, no.

My doctor is "out of network". I want single payer health care. Not blood-sucking parasitic insurance companies skimming cash from every patient/doctor transaction.

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Response to Matariki (Reply #26)

Fri Jun 29, 2012, 08:11 AM

63. Um, yes. The ins. co. CAN put some restrictions, I guess, but I'm not sure it can, regarding copay

for preventive well exams.

We all want single payer. But you are glad for the millions of people that this ACA will help, I'm sure. The people who won't be kicked off their plans because they got sick (like my mother was), the people who are assured they won't hit a cap when being treating for cancer, the people who will be able to get insurance even though they have a pre-existing condition, the people who will be able to shop more easily for insurance plans.

I'm sure you're glad for others, even though you aren't aware yet of how the ACA helps you out.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:35 PM

27. YES. And for my kids too, even though I have a high-deductible plan.

Thank you Mr President.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:38 PM

29. Yes

Mr. Frazzled and I had to go in for physicals this spring, and when we went to the desk after to find out our copays, the young woman said there would be none ... that insurance companies were already complying. Yay (except for having to go get the physical in the first place: we only needed new prescriptions, which had run out; and every time I go my doctor gives me a 10-minute harangue about getting a colonoscopy.)

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:42 PM

30. I paid full price for all medical services last year because I wasn't going to pull anything out of


my HSA so I just paid out of pocket.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:43 PM

32. No. I still have to pay every time I go to the doctor.

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:47 PM

33. My insurance already covered annual exams before ACA as passed with no copay. n/t

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Response to Honeycombe8 (Original post)

Thu Jun 28, 2012, 11:48 PM

34. The problem is copays and deductibles apply to any follow up care those annual exams may indicate

you need.

And, from personal experience, I can tell you that it can cost nearly $7,000 to find out the spot on the mammogram is benign. Lucky for me I had really good insurance at the time and only had to come up with $500 or so. If I had had the craptacular high out of pocket ("consumer driven") policy I had last year, I would have been on the hook for $5,950 of that bill (that was the maximum the law allowed for out of pockets on high deductible plans- but that limit goes up annually).

With more people getting stuck with high out of pockets there will more people skipping the "free" tests.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 12:31 AM

39. Still paying co-pays.. Some companies are ahead of the curve. other's waiting for 2014.

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Response to glowing (Reply #39)

Fri Jun 29, 2012, 12:38 AM

41. It is required for some plans.

I thought all employment based plans, but I have to double check that.

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Response to Ms. Toad (Reply #41)

Fri Jun 29, 2012, 06:14 AM

48. Perhaps its a Florida thing, but we are still paying co-pays... My son's physical yesterday was

a co-pay.. and that is a normal "well-ness" check up I thought.

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Response to glowing (Reply #48)

Fri Jun 29, 2012, 07:18 AM

49. There's a quirk I wasn't aware of -

The requirement is federal, so states can't exempt themselves from it. But plans existing before 3/23/2010 are apparently grandfathered in. If your plan started after that date, it is apparently exempt.

I understood that employer plans were treated as new as of the anniversary of the plan - I've was on the same plan since 2005-ish, and as of November (our plan anniversary) our co-pays for preventative care were zero. Apparently the grandfathering for some things is in the "we won't take away your plan if you have one you like" part of the bill. Nice. I need to actually look at the law, since the summary I looked at had the language about the plan year & a note about the grandfathering.

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Response to glowing (Reply #39)

Fri Jun 29, 2012, 08:18 AM

64. That is against the law. That provision went into effect a year or so ago. It is the drs. who charge

the copays.

There are some plans that the ACA doesn't apply to at all, of course. Military, govt. plans, etc.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 01:25 AM

44. I've never paid a copay for preventative stuff

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 05:51 AM

47. I hadn't been to the doctor for a long time and was having some issues

I had to pay the co-pay for my physical($20), I didn't have to pay anything for my pap smear and mammogram. I had to pay a co pay for my colonoscopy because if they to take a biopsy, ACA doesn't cover it.

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Response to maryellen99 (Reply #47)

Fri Jun 29, 2012, 07:57 AM

53. We ran into that quirk, as well...

If they find something during the exam they need to biopsy, it becomes a treating rather than screening event. Somehow I don't thinks "gotcha" bills was part of the plan - but that is how the insurance companies are treating it.

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Response to Ms. Toad (Reply #53)

Fri Jun 29, 2012, 08:08 AM

62. I knew I was going to have to pay a part of it going in

Because I was having gastro/Colon issues and U of M called me about it 2 weeks ahead of time.

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Response to maryellen99 (Reply #47)

Fri Jun 29, 2012, 08:23 AM

66. Yes. Before patients had to pay for colonoscopies. NOW they only don't have to pay IF nothing is

found. If they had to do a biopsy, that means they found something, and the colonoscopy becomes not a preventive well exam or test, but a treatment procedure, or something like that.

Check out http://www.wbur.org/2011/11/28/free-preventive-care where that is explained.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 07:19 AM

50. WHAT?! I just paid co-pay to get my BP taken!

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Response to WinkyDink (Reply #50)

Fri Jun 29, 2012, 08:23 AM

68. You can take your bp yourself. Why would you go to a dr. for that? nt

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Response to Honeycombe8 (Reply #68)

Fri Jun 29, 2012, 04:08 PM

78. Because it was taken earlier by a dentist, and it was sky-high. I needed meds for the first time.

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Response to WinkyDink (Reply #78)

Fri Jun 29, 2012, 08:26 PM

112. Oh.....that's not a "well exam." That's a diagnostic exam for a problem. Copays apply.

At least that's my understanding.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 07:58 AM

55. I've had to pay.

But that said, I can't remember the last time I got a bill for my yearly mammograms.

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Response to AngryOldDem (Reply #55)

Fri Jun 29, 2012, 08:21 AM

65. It is against the law to be charged a copay for a preventive well exam

by a primary provider.

If they find a problem, or if you make complaints that the dr. checks out, then that may turn the exam into a treatment exam, not a wellness exam.

You can apply to the ins. co. for a refund of any copay you had to pay for a preventive well exam by a primary care provider. (this doesn't apply to lab work, as usual)

That is the law.

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Response to Honeycombe8 (Reply #65)

Fri Jun 29, 2012, 04:06 PM

76. Do you know the exact date this started?

That's important to those who have paid last year for instance

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 08:23 AM

67. I cannot imagine such a luxury as an annual exam.

When you're poor in America you go to the doctor if you can;t stop the bleeding and that's about it. Oh and may the gods help you if it's a dental problem. Then you are even more well & truly fucked.

Julie

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 08:29 AM

69. Not a very good deal

When the premium has gone up much more than what the copay used to be.

Paying 600 dollars more per year to get "free" annual exams is not a great trade.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 08:31 AM

70. We still need to pay for labwork

but its nice not having to pay for the exam!

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Response to Proud Liberal Dem (Reply #70)

Fri Jun 29, 2012, 05:51 PM

102. I paid a co-pay, plus $100 for labwork for my physical exam.

nt

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 08:34 AM

71. I noticed I haven't had insurance for more than 2 years, so NO.

I pay full price.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 09:16 AM

72. I don't get annual exams but my wife just got a colonoscopy without copay

for some pain she was feeling back there. We just got the eobs yesterday and.....no copay!! We were expecting $100 and didn't know if it would be covered as a preventative service or not since she's not over 50. Thanks President Obama!!!

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 04:18 PM

79. Actually

My co-pay went down mysteriously for meds and check ups.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 05:24 PM

89. I notice that you've been living a privileged existence where you had health insurance

and could afford a yearly exam. Seriously, this is one smug, out-of-touch OP.

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Response to Honeycombe8 (Original post)

Fri Jun 29, 2012, 05:48 PM

100. No. I paid a co-pay 3 times this year alone. Who do I write to to get my money back? nt

nt

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Response to Honeycombe8 (Original post)

Sun Jul 1, 2012, 07:42 PM

119. Nothing has changed for me... always have to pay copays

I'd like a refund too.

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