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Old 01-29-2014, 12:42 PM   #481
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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.
I'm unsure at this point if you're trolling or not. Or are you legitimately one of those people that think that your insurance policy denies all your claims until your deductible is met?



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I'm actually such a moron for continuing to post on this subject...
I feel more like a moron for thinking that a US citizen would care enough to be at least somewhat educated concerning a product they spend thousands of dollars on a year.

Not everyone has to be an expert on how health insurance works like myself, but In-network vs. Out-of-network is about as basic as it gets. I understood this concept in my late teens when i purchased my first insurance policy, well before an insurance company started cutting my paychecks.
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Old 01-29-2014, 12:44 PM   #482
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I'm unsure at this point if you're trolling or not. Or are you legitimately one of those people that think that your insurance policy denies all your claims until your deductible is met?
One time I billed an old insurance company when I went to the dentist because I had coverage under a new plan/employer but I was too lazy to give the receptionist my new insurance information...they denied the the claim because I wasn't covered by them.


also not all plans will cover anything out-of-network, so we should never consider that when arguing against, because it's a high possibility that wouldn't work in our favor.

My insurance plan doesn't cover out-of-network, this is a concept I learned when I picked my insurance plan that said: we don't cover out-of-network.

I could be lying, because you said they always do, and what people say on the internet is correct. But wait, then I'm telling the truth...
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Old 01-29-2014, 12:46 PM   #483
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One time I billed an old insurance company when I went to the dentist because I had new coverage but I was too lazy to give the receptionist my new insurance information...they denied the the claim because I wasn't covered by them.

That's a pretty cool anecdote. It's a lot like when i was given bogus car insurance information by some dumb bitch.
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Old 01-29-2014, 02:14 PM   #484
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Ben -

I think this is actually a case of people genuinely not understanding the verbiage here. This is a lot like some of the tax-related discussions I've had where there is a simple - but perfectly understandable - misunderstanding of the (often sloppy) use of terms like "tax rate" without specifying whether it's a marginal or effective rate, for example.

I would think that, most people would understand the terms as such: "in network" means the doctor's bills will get paid by insurance. "Out of network" means the patient pays out of pocket with no expectation of reimbursement from the insurance company.

You are explaining that this is an incorrect understanding. Very broadly, that may or may not be the case, depending on the insurance policy? But more specifically, for all of the plans under the ACA, that is not the case.

If you see an out of network doctor, you will most likely need to pay up front and then are eligible (but not guaranteed?) to be reimbursed by the insurance provider [edit: under those plans covered by the ACA].

Is that an accurate summary?

Last edited by Scrappy Jack; 01-29-2014 at 03:41 PM.
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Old 01-29-2014, 02:18 PM   #485
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it depends. sometimes you just have a higher co-pay, but the doctor will charge normal rates.

sometimes you just have a higher co-pay (20% vs. $10), but the doctor will charge normal, non-negotiated, rates, and your insurance will only cover so much (e.g., 30% vs. 80%), but you're on the hook for the difference between the normal rate and the in-network rate.

sometimes you just have a higher co-pay (20% vs. $10), but the doctor will charge normal, non-negotiated, rates, your insurance will only cover so much (e.g., 30% vs. 80%), you're on the hook for the difference between the normal rate and the in-network rate, and they have a cap on how much they'll pay for out-of-network billings ($1000 max).

sometimes they just wont cover out-of-network whatsoever.

it just depends on your specific plan. My plan does not cover out of network whatsoever, I chose this plan cause it was cheaper and I have no reason to go out-of-network.


But to say that your insurance will reimburse you for an out-of-network doctor, is not technically true and not technically false.

Hell, sometimes paying out of pocket is cheaper cause cash talks; I know doctors that don't accept gov't plans because of rate they actually get paid and the rate they get paid.
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Old 01-29-2014, 02:57 PM   #486
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The reality is that health insurance has now gotten more confusing, not less.

A new layer of bureaucracy has been added to healthcare in America, and we were sold several lies:

--more people would be insured; right now millions more have been dropped by their insurance than have gained.

--costs would go down by $2,500...anectodally and otherwise, all costs have increased or will soon.

--We were told we could keep our doctors. Even Obama has half-apologized for this whopper. "Yes, but you need to look at the FINE PRINT".

This **** doesn't cut it. We've been lied to by our employees. They need to be FIRED.
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Old 01-29-2014, 03:39 PM   #487
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Originally Posted by Braineack View Post
But to say that your insurance will reimburse you for an out-of-network doctor, is not technically true and not technically false.
I think Ben is saying, very specifically, that all of the plans under the ACA do have provisions to cover out-of-network doctors.

That, as I understand it, is his main issue with the article or the Congressman saying his doctor is "not covered." The doctor's fees are not covered in the same way that they were under the Congressman's old policy would be a more accurate way to phrase it.

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Old 01-29-2014, 03:57 PM   #488
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Originally Posted by Scrappy Jack View Post
Ben -

I think this is actually a case of people genuinely not understanding the verbiage here. This is a lot like some of the tax-related discussions I've had where there is a simple - but perfectly understandable - misunderstanding of the (often sloppy) use of terms like "tax rate" without specifying whether it's a marginal or effective rate, for example.

I would think that, most people would understand the terms as such: "in network" means the doctor's bills will get paid by insurance. "Out of network" means the patient pays out of pocket with no expectation of reimbursement from the insurance company.

You are explaining that this is an incorrect understanding. Very broadly, that may or may not be the case, depending on the insurance policy? But more specifically, for all of the plans under the ACA, that is not the case.

If you see an out of network doctor, you will most likely need to pay up front and then are eligible (but not guaranteed?) to be reimbursed by the insurance provider [edit: under those plans covered by the ACA].

Is that an accurate summary?
That's pretty much it.


But the more succinct point is simply that in no way, shape, or form, has the senator "lost his doctor."

Cut and dry policies in which there are NO out of network benefits are exceedingly rare these days, and almost NEVER are the same policies that utilize relatively narrow networks for in-network services. (ACA plans.)

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Originally Posted by Braineack View Post
it depends. sometimes you just have a higher co-pay, but the doctor will charge normal rates.

sometimes you just have a higher co-pay (20% vs. $10), but the doctor will charge normal, non-negotiated, rates, and your insurance will only cover so much (e.g., 30% vs. 80%), but you're on the hook for the difference between the normal rate and the in-network rate.

sometimes you just have a higher co-pay (20% vs. $10), but the doctor will charge normal, non-negotiated, rates, your insurance will only cover so much (e.g., 30% vs. 80%), you're on the hook for the difference between the normal rate and the in-network rate, and they have a cap on how much they'll pay for out-of-network billings ($1000 max).

sometimes they just wont cover out-of-network whatsoever.

it just depends on your specific plan. My plan does not cover out of network whatsoever, I chose this plan cause it was cheaper and I have no reason to go out-of-network.


But to say that your insurance will reimburse you for an out-of-network doctor, is not technically true and not technically false.

Hell, sometimes paying out of pocket is cheaper cause cash talks; I know doctors that don't accept gov't plans because of rate they actually get paid and the rate they get paid.
Sure, there's a million different permutations of how out-of-network benefits are administered, but the vast majority of plans aren't that complicated. A pretty typical plan would have twice the deductible and out of pocket maximums for out of network benefits vs. in-network, and probably twice the coinsurance. (60/40 split instead of 80/20). (Then there's plans that think it's a great idea to let INN and OON accumulations contribute to each other, which creates a whole 'nother coding nightmare that rarely works properly and then i have to have phone calls with the client asking exactly why in the **** they thought they wanted that benefit and blah blah blah)

The biggest downside is that the negotiated rate is then technically thrown out the window, although your benefits (in most cases, there are quite a few exceptions) would be processed by your insurance company based on the "usual and customary" rate.


The takeaway here is that i would never actively seek out an out of network provider, but if your existing provider goes out of network (happens even if you don't change plans), and you feel very strongly about continuing to utilize them, then do so. Just 1) check to see what your out of network benefits are and 2) if you have them, ******* use them. This way stupid articles like the one we're all bitching about don't get written.


The only logical explanation for the article is either 1) lack of research, or 2) the senator is making a political statement and hoping that nobody will realize that it's largely a farce.

Quote:
Originally Posted by Scrappy Jack View Post
I think Ben is saying, very specifically, that all of the plans under the ACA [i]do[/u] have provisions to cover out-of-network doctors.

That, as I understand it, is his main issue with the article or the Congressman saying his doctor is "not covered." The doctor's fees are not covered in the same way that they were under the Congressman's old policy would be a more accurate way to phrase it.
Exactly.

Though i wouldn't expect the doctor's services to be covered in the same way as the old policy, regardless of network participation status. Simply because the senator now has a new policy.


I mean... i suppose i wouldn't expect everyone in the US to know that the ACA plans have out of network benefits, but that's why i explained it. I WOULD expect the write of the article to have at least made the half-*** effort to check that out before writing about a subject they obviously know absolutely nothing about. They're being paid to know what they're writing about.

I'm being paid to understand benefits and process claims. One of us is doing their job.
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Old 01-29-2014, 04:30 PM   #489
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So to parse further, a "copper" or "tin foil" plan has no provisions for out of network, and yet may cost you more than your current plan. The "gold" plan probably has out of network provisions, and yet will cost you several thousand dollars more.

So "technically" everything you're saying is correct. In other words, by fighting over the nuances to prove a point is to avoid the big picture lie that is Obamacare.

Boy, did I just get on the "straight talk express" bus or what!
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Old 01-29-2014, 04:40 PM   #490
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My only point was that the article sucked, and here's why. Wasn't exactly a nuance. Wasn't really a nuance when you freaked the hell out over it, either. :lol:


I also said many times that ACA sucks a fat one. Why was this a problem, again? Shitty laws don't excuse horrible journalism.
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Old 01-29-2014, 04:43 PM   #491
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My only point was that the article sucked, and here's why. Wasn't exactly a nuance. Wasn't really a nuance when you freaked the hell out over it, either. :lol:


I also said many times that ACA sucks a fat one. Why was this a problem, again? Shitty laws don't excuse horrible journalism.
Nuance is hard for me in any situation. With Obamacare, we've got literally millions of people losing their coverage and nearly the rest of us paying thousands more. The more America finds out, the more ALL of us don't want it. And yet it gets crammed down our throat like a ******* Commie sandwich.

How's that for nuance?
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Old 01-29-2014, 04:45 PM   #492
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Same story, different day.

It was broken yesterday and today. It'll still be broken tomorrow.
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Old 01-29-2014, 04:56 PM   #493
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Same story, different day.

It was broken yesterday and today. It'll still be broken tomorrow.
No, actually I now have $3,300 less in my pocket for my family, and yet I have the extra added bonus of now having maternity care and other items I'll never use tacked onto my health insurance.

Yeah, I'm pissed.
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Old 01-29-2014, 05:02 PM   #494
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That's weird. I've never had a health plan that didn't cover maternity care. We don't offer male or female plans. Just plans. Health insurance is pretty unisex.


I think what i was saying is that it's just broken in a new and unusual way now. The only compliment i can give to the big O in all this is that at least he knew it was broken. That said, what he DID about it was ******* stupid, but i guess.... at least we're trying something?

Dunno. Hollow praise. When it gets bad enough i'll defect to Canada or something.
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Old 01-31-2014, 09:00 AM   #495
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A local news station brings viewers inside one Pennsylvania company as the employees there learn about their new health care plans under Obamacare:

"Look at the numbers," says the reporter of two employees. "Jeff and Dave used to have a $1,250 deductible. Since Obamacare went into effect, it's now jumped 60 percent to $2,000. That's nothing compared to Brian, Kristi, and Judy who have kids. they are going to pay twice that, four grand." The reporter adds that co-pays are being increased, too.

"I don't know how President Obama thinks he's helping us because we can't afford this, we can't afford to pay these co-pays, to pay these deductibles on what we're making," says one of the workers.

Another worker adds, "They call it the affordable health plan. There's nothing affordable about it. I can't afford it."

...

you gotta pass the law to find out how much it ***** you to be a stupid solicalist.
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Old 01-31-2014, 09:22 AM   #496
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I'd be interested in seeing the premium difference. I'm sure it doesn't mean they're saving money, but just having a higher deductible alone and not outlining the rest of the changes does not good reporting make.

I like the worker's quote, though. The Bah Humbug in me wants to point out that i could have chosen a plan that had a $5000 deductible for 2014 that would have actually saved me money throughout the year. But, you know... "i couldn't afford it." But i could afford to spend more throughout the year for a "better" plan!


Ok, but seriously, i'm just rambling.

I want to see the premium differences.
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Old 01-31-2014, 09:52 AM   #497
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If you watch the video, it says how much each persons monthly premium increases each month. One lady's went from $900 to $1300 a month.
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Old 01-31-2014, 09:53 AM   #498
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Ain't nobody got time for that. Finish quoting the whole thing so i can be bothered to read it.
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Old 01-31-2014, 10:02 AM   #499
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The whole point is that you watch the common person react to voting democratic and hating themselves for it.
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Old 01-31-2014, 10:09 AM   #500
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So kindof like ---- sex?
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