Braineack

iTrader: (62)

the same way one keeps a boner.

concealer404

iTrader: (3)

The point is: That article is a piece of ****.

cordycord

iTrader: (2)

Brain kept his words really short, and yet you still don't understand. Perhaps when you "lose" your doctor or when your rates skyrocket, you'll get it.

On the other hand, I got to keep my doctor. The punch line is that I got a 20% cost increase last week on top of the 38% increase I got a year and a half ago.

So instead of saving $2,500 per year as the ACA advertised, my plan has increased by over $3,300. So in short, Obama is a lying piece of ****.

concealer404

iTrader: (3)

I'm going to ask you the same question: How do you "lose" your doctor?


Unless Obamacare runs differently from pretty much every other health insurance policies administered in the last couple decades (it doesn't), i'm still going to say that the article is a misleading piece of ****.


Let me elaborate on my question:

Is this a case of Obamacare saying that they won't pay for visits to this doctor for any services? Or is this a case of the doctor saying that he won't accept payment from Obamacare?


Again: I think ACA is a steaming coiler at best, but that doesn't excuse all the horrendously written and blatantly un-researched articles that have been spewed all over the media in days since.


The ONLY real take-away from that article that could be logically generated is: "Look at this guy that decided to pay his doctor directly out of pocket."

Braineack

iTrader: (62)

The point of the article is very simple:

Cancer-stricken Sen. Tom Coburn revealed Tuesday that his health insurance under Obamacare doesn’t cover his oncologist.

That sums it up right there -- you do not have to continue reading.

But if you must have me tie it together, then it's because the people who voted for the law were told over and over and over that:

No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period.

This is a just a higher-profile example of how that was false.

The caveat being, that of course if you change your plan, then you also change your network, and not all doctors accept all insurance. So I'm sure you'll just argue this point, that this would have happened before Obamacare and that **** has sharp edges.

Braineack

iTrader: (62)

is that correct? is that what happened? he just decided to pay him directly instead of through his new insurance that no longer covered him?

He woke up one day and was like? hmmm i really hate having my insurance cover my doctor and treatment, especially when i have cancer. I think im going to sign up for a different insurance package that doesn't cover him, even though I don't really want to stop seeing him. So I'll just pay for him out of pocket, because that's so much better than paying him through insurance, that I also pay for as well. I like double paying for things, and to pay full price on top of that.

Braineack

iTrader: (62)

Correct.

Braineack

iTrader: (62)

What's your point?

insurance increases every year before obamacare.

the point is: you decided to pay more.

concealer404

iTrader: (3)

But that's exactly what i have a problem with.

Because it's not true. Every last ACA plan i've seen has in-network and out-of-network benefits.

Are out-of-network benefits worse than In-network? Of course. That's how this works.

He can still keep his doctor. In fact, his health plan will even pay for a portion of the visits. Just a lesser portion than if he went to an in-network provider. Though, the payment (if made, depending on deductible accumulation status) would be made to the senator himself in the case of the doctor not accepting insurance payment.

Again, how it works.


In terms of how doctors may now not be in-network on your plan, but were before? Yeah. That happens. It'll even happen if you change plans WITHIN THE SAME INSURANCE COMPANY, even if they're administered for YOUR SAME EMPLOYER. That's not a function of ACA in any way, shape, or form.


You aren't getting it. This has nothing to do with whether or not the doctor accepts insurance payments from certain companies. That **** happens all the time. (Hey look, i said it!)

But it has everything to do with someone willfully choosing to not use their benefits, even if they aren't reduced vs. seeing an in-network provider.

Just because a doctor won't accept insurance payment doesn't mean that insurance won't pay. Not a tough concept.


The article, you, and Cordycord are all trying to tell me via fear-mongering or whatever silly ignorant agenda is going on, that this dude's health plan is saying point-blank that they will not pay for any services rendered by this oncologist. The end. Period.

And that's blatantly incorrect.

And that's why the article is a misleading piece of ****. Sure looks good to people that don't know any better, though. Riles up the masses and all that.

cordycord

iTrader: (2)

It really is that simple.

Here's another way you lose your doctor: all of Target's part-time employees lost their insurance coverage. Like it or not, it's a DIRECT RESULT of ACA. They go out, get mandatory insurance that they can afford, and find that their current doctor does not support that insurance.

Or, as a direct result of the ACA your insurance costs go up. So you switch plans and lose access to your primary care physician.

Or, the law is written so that if the insurance plan changes in any way (add a comma, change a sentence, drop or add a prescription drug) then you can lose it if it doesn't fit with what the government wants. This year that means contraception for nuns, abortifacents for Catholic hospital employees, maternity coverage for 70 year olds, etceteras.

cordycord

iTrader: (2)

a) Tom Coburn has cancer

b) The doctor's who have treated him and know is condition were being paid under is old insurance.

c) When Tom Coburn signed up for the ACA (probably to make a political point), his plan changed and those doctors no longer accepted his insurance. While political, this move is representative of millions of what millions of Americans are going through now.

d) Since he's got some money stashed away for a boat or a Miata, Sen. Coburn can afford to pay out of pocket to continue seeing the doctors who have been treating his cancer.

Holy crap. Glue sniffing should not be on anyone's morning regimen.

concealer404

iTrader: (3)

So? They still didn't lose their doctor. Stop telling me that they lost their doctor, it's incorrect. Nobody is telling them they can't go see their doctor. Their mandatory insurance coverage will still process and approve claims for services rendered from said doctor.

But again, this is no different from what could and does happen if you choose to move from a CMM to a PPO policy under the same employer/insurance company.

You don't lose access to your primary care physician.

I'm not defending that. Like i said, i think ACA is a pile of ****.

And it has that in common with the article.

concealer404

iTrader: (3)

Yes. Agree. Never said otherwise.

Yes. Agree. Never said otherwise. Would also be paid under his new insurance once his deductible and/or out of pocket were met.

Yes. Agree. Never said otherwise.

Yes. Agree. Never said otherwise.

Yes. Agree. Never said otherwise.


So what's your problem with what i said, exactly?

cordycord

iTrader: (2)

IF YOUR DOCTOR DOESN'T ACCEPT YOUR NEW ACA INSURANCE, THE ONLY WAY YOU CAN SEE HIM/HER IS BY PAYING OUT OF POCKET. NO REIMBURSEMENT. NO INSURANCE. NO BUENO.

concealer404

iTrader: (3)

Correct.


Not correct.

cordycord

iTrader: (2)

Not not correct. If you seek medical help outside of coverage, it's on you. ACA is a requirement for insurance, but it's not a guarantee of treatment no matter where you decide to find it.

If Tom Coburn wants to start all over again with doctor's who don't know him but are within his ACA coverage, he can do that. Otherwise, the ACA does not cover.

Personally I think it's smarter for him to stick with the doctor's he's chosen and who know his history.

Braineack

iTrader: (62)

cord, you're such a moron.

you and I both know that when you're forced to go into an exchange (he had to enter one as a lawmaker), you can keep your doctor, because keeping your doctor and having insurance cover your doctor mean two different things.

do not try to confuse.

cordycord

iTrader: (2)

I'm actually such a moron for continuing to post on this subject...

Braineack

iTrader: (62)

you made the mistake of arguing on the internet. You should notice I almost never get into a real debate; there's no point.

concealer404

iTrader: (3)

Look, let's get a couple things straight here.

1) "outside of coverage" is a term that ONLY applies to those plans that have NO out of network benefits at all.

2) There are NO ACA plans that have no out of network benefits at all.

3) In the event that you choose to see an out of network provider, you may very well pay up front to receive services.

4) Insurance has nothing to do with guarantee of treatment.

5) Whether or not services are approved for "payment" (And by payment, i mean "the claim is not denied") has nothing to do with network status of the provider rendering the services.



So i'm telling you point blank: You're wrong. The good senator can absolutely submit claims to his plan for reimbursement. However, because his doctor does not accept insurance payment from his current plan (because he's out of network), reimbursement when it is due, will go directly to the senator. I said this prior in this discussion. It's truth, it's what happens, it's how it works.

Source: Currently processing a $288k out of network claim. I'm not denying it.


That's his choice.

Wrong. There is out of network coverage under the ACA plans.

My opinion on this subject doesn't matter. Only he knows best in his situation.