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(1,209 posts)
Sat Nov 21, 2015, 10:45 AM Nov 2015

U.S. Proposes Obamacare Changes to Ease Shopping, Lower Bills

Source: Bloomberg.com


The U.S. proposed new Obamacare rules Friday that it says will make it easier for people to shop for health insurance, protect them from some out-of-pocket costs, and help states run the marketplaces where plans are sold.

The changes would apply to insurance plans sold on the Affordable Care Act’s marketplaces for 2017, the law’s fourth year of coverage. Consumers will buy those policies starting on Nov. 1, 2016. The rules are still in proposal form and will have to be finalized after a period of public comment.

The proposal “seeks to improve the consumer experience, both when individuals shop for health insurance and when they use it,” the Centers for Medicare and Medicaid Services, which oversees many aspects of the law, said Friday in a statement.

One proposal would cut down on what the government called “surprise bills” when a patient goes to an in-network hospital and gets care from a provider who isn’t in their insurance plan. That can result in paying higher, out-of-network rates that don’t count toward the maximum amount patients are supposed to have to spend out of pocket. The proposal would count some of those services toward the patient’s out-of-pocket maximums.

“The question for exchanges over time is how they would evolve,” said Elizabeth Carpenter, a vice president at Avalere Health. “What we’re seeing in this rule is a move toward additional consumerization and transparency.”

Read more: http://www.bloomberg.com/news/articles/2015-11-20/u-s-proposes-obamacare-changes-to-ease-shopping-lower-bills

I wondered if this why United Health is threatening to drop out

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(3,133 posts)
1. So, if I'm in the hospital I have to ask the Dr. entering the room if he's in my network or get out
Sat Nov 21, 2015, 11:22 AM
Nov 2015

I hope I'm conscience enough to do it. Imagine, in a hospital you have to worry about who is walking into your room to treat you! They say go to any hospital. Doctors don't do 'rounds' anymore. You are forced to see who is on staff, at their given times. This is outrageous!

Also, more are choosing Bronze plans that all were told to avoid. They cover so little. But people are forced due to 'rising costs of premiums'.

So, you get a good plan only if you have good money. For all the subsidies the insurance companies are given for those who contribute less, we should have equal care. I find the ACT disgusting, in many ways. I hope it gets changed to single payer, soon.


(3,982 posts)
2. What is happening is insurance companies are angry they can't continually increase profits
Sat Nov 21, 2015, 11:51 AM
Nov 2015

on the backs of the sick.



(3,818 posts)
4. It's the sky high deductibles that are breaking everyone's pocketbook - ours went to $8.5k next year
Sat Nov 21, 2015, 12:07 PM
Nov 2015

What's the point of having insurance in the first place with a deductible as high as that, even if yearly's are supposed to be free. Had to pay for flu shots that were clearly supposed to be paid for but were denied. Oh, yeah, by law, we are mandated to have insurance, so can you blame people for going into the lowest plans? They are getting raped either way.


(8,303 posts)
6. Network plans are often fake insurance, and these changes are COMPLETELY inadequate.
Sat Nov 21, 2015, 12:20 PM
Nov 2015

ER, labs and radiology are often contracted out. Specialty services are often contracted out.

If one goes to an in-network hospital, all charges ought to be paid as if in-network. The contractors can chase you later, but the insurance company ought to be forced to pay at least the amount they would pay to an in-network.

And then what if you are traveling and get hurt/ill? You can't go to an in-network hospital. Again, insurance companies ought to be forced to pay whatever they would have paid for an in-network provider available.

A lot of these network plans that cover nothing out-of-network don't have very good networks. I just read a study that found that the provider networks in 13% of plans weren't sufficient to cover basic care. In some areas, no endocrinologist or rheumatologist was even available. In those cases, the regulations ought to force the plan to pay double the allowed Medicaid charge for the services.

Dealing with this crap is hell from a doctor's perspective. Somebody comes in, you do the check-up, you find out that they have diabetes or a kidney problem or arthritis with risk factors, and then you can't find anyone who can treat them!!!!

This law was written by insurance companies for insurance companies.



(14,449 posts)
3. If you chose in network hospital then everything from bed to Doctor should automatically be in netwo
Sat Nov 21, 2015, 12:03 PM
Nov 2015

It's absurd to even think this doesn't happen that way. Whoever didn't catch this before was not very intelligent to say the least.



(3,818 posts)
5. There was an article - NY Times I think - where a woman priced everything for her surgery,
Sat Nov 21, 2015, 12:12 PM
Nov 2015

saved up her portion of it, goes in to have the procedure, and the hospital on purpose brought in an anesthesiologist, from out of state to perform that portion of the procedure, out of network of course, and then sues her when she refuses to pay for this doctor? Do you blame her, wtf did they bring him in the first place, when there was one on staff? It wasn't anything unusual or on a weekend. This surgery had been planned for awhile. The hospital needs to eat those charges.

I guess when you go in to talk to the billing dept. you will have to have a huge note on your chart - in network only. Make sure you inform your family and friends, so they too can make sure, on top of your health, that you won't be raked over the coals for out of network charges.


(8,303 posts)
7. In many cases there are no in-network providers for some services, so even that doesn't help.
Sat Nov 21, 2015, 12:23 PM
Nov 2015

These types of plans should simply not be permitted. The consumer isn't making a choice because the consumer can't find the information necessary to make a choice, and if the consumer did spend two months finding out what was covered at the named hospital, it could change two weeks later - without the consumer being able to change the plan for another year.

There's a reason why people are dropping their insurances. They are crap. The game is rigged against the person who is theoretically paying for it.


(7,699 posts)
8. I don't understand this quote in the article:
Sat Nov 21, 2015, 10:33 PM
Nov 2015

"But Hemsley said patients are using their plans more than the company had expected and dropping coverage when they're healthy, slamming profits".

Why are people dropping the plans if they are healthy? Are they opting to pay penalties for no insurance (meaning that the numbers of uninsured would grow), or did they finally get a chance to see how crappy a bronze plan is, and take a different type of policy? Are more people back to work and getting coverage outside of the ACA, through an employer? Are people earning more as the economy slowly recovers, and no longer eligible for the fed subsidies on premiums?

I don't give a crap about United Health's profits, but I am interested in what is actually happening out there. But that would require some journalism, and that profession is dead.

On edit: if United were to drop out, and another carrier then picks these people up (it said there was some other low cost bronze plan), then that company should be able to manage with the higher number of enrollees. And that might even, in a few years time, drive down costs and premiums. Maybe what we need isn't 'competition', but rather, single payer healthcare, duh.


(7,120 posts)
9. Anything but affordable!
Sun Nov 22, 2015, 09:49 AM
Nov 2015

As a family of four on the higher end of the subsidy-eligible, our premium in January will be almost $1100 a month, up $270 from this year, which is still considerably cheaper than what the ACA Blue Cross is charging. The plan has no out-of-state benefits, so we have to buy a school plan for our daughter who's in college in another state.

The deductibles, co pays, and out-of-pocket maxes are astronomical. We are still paying off last year's $2000 ER visit for a broken toe, and a similar bill for a colonoscopy, along with dental bills. And yes, a simple ER visit or procedure involves several other specialists' involvement, whose services are not covered.

I can't see how these plans are called "affordable". If anything there is a little grease added but the insurance companies continue to rape us.



(1,859 posts)
11. Single payer. I can't afford Obama care or the deductible if I had it.
Mon Nov 23, 2015, 05:45 AM
Nov 2015

I have insurance through my work and it's only a few hundred a month - way less than any Obamacare option I looked at.

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