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#8159079 - 10/15/13 Interesting Obamacare Out-Of-Network question  
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UtahLefty Offline
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related story

Two of the ways insurance companies have attempted to artificially lower the premiums for the lowest (Bronze) Obamacare plans have been:

1) Set the deductibles at max ($12,700 for in-network family, $36,000 for out-of-network family or some plans I've seen don't cover out-of-network at all)

2) Shrink the in-network doctor pool dramatically - something like 10% of the MDs and 30% of the facilities within your zipcode.

here's a screenshot of a bronze plan I was quoted double my current premium:

[Linked Image]


Here's the question:

What happens when you leave your zipcode and need healthcare ?

That's going to be by definition an out-of-network incident and, depending on your plan, you'll have to either meet a $36,000 deductible before insurance kicks in, or in some cases out-of-network isn't covered at all.

brilliant, eh? kinda like a voluntary house arrest, no?


crazy





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#8159095 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: UtahLefty]  
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What amazes me is with those kind of deductibles the premiums are so high.

As to your question being out-of-state doesn't mean out-of-network under private insurance but under The Unaffordable Health Care Act who knows.


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#8159103 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: derby_dude]  
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UtahLefty Offline
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don't confuse the presence with the past DD. wink

The new "networks" are sculpted so narrowly that even two MDs in the same building can be on different "networks".




#8159109 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: UtahLefty]  
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There's no doubt that the government health care is all about making money for the bankers and controlling the population. Reducing mobility is certainly one method of control.


Don't vote knothead, it only encourages them. Anonymous

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#8159111 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: UtahLefty]  
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Originally Posted by UtahLefty
kinda like a voluntary house arrest, no?


crazy



Gotta restrict the movements of the masses don't ya know. Can't have 'em moving about the country freely.

Mike


Always talk to the old guys , they know stuff.

Jerry Miculek
#8159115 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: derby_dude]  
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Originally Posted by derby_dude
What amazes me is with those kind of deductibles the premiums are so high.
Many cannot afford those high deductibles. The government knows this and will own everything that person has at death.

#8159128 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: slg888]  
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The premiums should still be lower than they are for those kinds of deductibles. Under Medicare I have a $2,000 deductible and my premiums are affordable. They only thing I can think of is this is a money collection scheme for the bankers.


Don't vote knothead, it only encourages them. Anonymous

"Never underestimate the power of stupid people in large groups." Anonymous

"Self-reliance, free thinking, and wealth is anathema to both the power of the State and the Church." Derby Dude


#8159169 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: UtahLefty]  
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I'm in Kalifornia
Instead of affordable healthcare it's unaffordable catastrophic coverage that doesn't cover much of anything or so it seems.





Are there any benefits covered for routine care that have a co-pay before you meet the deductible?

#8159175 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: fish head]  
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That's why I think one of it's primary function is to collect money for the bankers.


Don't vote knothead, it only encourages them. Anonymous

"Never underestimate the power of stupid people in large groups." Anonymous

"Self-reliance, free thinking, and wealth is anathema to both the power of the State and the Church." Derby Dude


#8159188 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: derby_dude]  
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Lefty,

Please forgive the ignorance, but is that quote from a state plan? Assuming the national-level site is not operable?

Thanks - Bob


Bob
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#8159197 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: derby_dude]  
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here is another thing that sucks, suppose you have a serious accident just before Thanksgiving and your bills roll into the next year.

You might not meet your deductible in either year, but pay more than your deductible allows in total for a single incident.


I hate the idea of a large deductible. I think $12K for a family is absurd, even for families that are making $40K a year.

Last edited by KFWA; 10/15/13.
#8159232 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: Akbob5]  
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Originally Posted by Akbob5
Lefty,

Please forgive the ignorance, but is that quote from a state plan? Assuming the national-level site is not operable?

Thanks - Bob


that quote is from the only exchange I could get a quote from -- the American Veterinary Medical Association's national (private) exchange.

the insurance company it's from is Assurant, and from what I can tell, they have a labyrinth of different contracted networks nationwide.

I was only able to ID an in-network MD in 3 of the 7 states I travel to and it'd be sheer luck if one was able to find once close enough to drive to on a phone app.




#8159254 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: derby_dude]  
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Originally Posted by derby_dude
What amazes me is with those kind of deductibles the premiums are so high.

Well, where do you think the money's coming from the cover the 30 million uninsured??? Remember the LIC said, 'we'll cover everybody AND your premiums will be reduced by $2500..'

LIES, LIES, and more LIES from this a-hole..



NRA Benefactor member.

Ex- USN (SS) '66-'69
#8159262 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: UtahLefty]  
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in the interests of full disclosure, here's the rest of the quote:

[Linked Image]


so those monthly premiums are for a family of 5, in a very healthy "community rating" community of vets.

whichever one of those you might choose, you're looking at $25,000 to $30,000 a year minimum in premiums + deductible for an in network incident. $40,000 to $50,000 if you had an out-of-network incident.

even if you hand no incident in a year, that's $12,000 to $25,000 in premiums. every year

who in their right mind would do that ??

cray cray!




#8159272 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: UtahLefty]  
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I am not sure why health insurance companies get to stick it to you after you reach your deductible. If you wreck your car, and pay your deductible, the car insurance company picks up the rest of the tab. Why does health insurance make you pay your deductible and then only pick up 80% or so? They should have to pay 100%.


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#8159283 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: dogcatcher223]  
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they really should have a deductible per incident, and then they pick up the rest

break your leg? pay $300 and we get the rest. Cost less than $300, then don't bother filing the claim.

That's how auto works, right?

#8159291 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: Akbob5]  
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Affordable Health Care Act what a Oxymoron . It will be Cheaper to go to the Vet for your Medical Care


A Doe walks out of the woods today and says, that is the last time I'm going to do that for Two Bucks.
#8159842 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: UtahLefty]  
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Originally Posted by UtahLefty
in the interests of full disclosure, here's the rest of the quote:

[Linked Image]


so those monthly premiums are for a family of 5, in a very healthy "community rating" community of vets.

whichever one of those you might choose, you're looking at $25,000 to $30,000 a year minimum in premiums + deductible for an in network incident. $40,000 to $50,000 if you had an out-of-network incident.

even if you hand no incident in a year, that's $12,000 to $25,000 in premiums. every year

who in their right mind would do that ??

cray cray!


That somewhat answers my previous question but what is "Coins %" ?

I understand it's co-insurance but what does it mean and how does that apply?

#8159867 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: fish head]  
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they way that's worked in the past (and I see no reason it's changed) is as follows:

patient #1 incurs costs. Insured pays 100% until the $6,000 individual deductible is met.

With a 75/25 coinsurance percentage policy, the insured then pays 25% of costs from $6,000 to $12,000 and it's not until cost go over $12,000 that the policy pays 100%.

** keep in mind that with a family policy, it's entirely possible for you to have to pay 100% of $5,999 for patient #1 and $5,999 for patient #2 in any give year with the insurance company not having to pay out money at all.**




#8159871 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: fish head]  
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Coins is after you meet your deductible....

say deductible is $5000, then you start the coinsurance not to exceed out of pocket

Any accident coverage available? Generally most ins companies will pay (or at least offer it) 100% of accidents.

Last edited by Stan V; 10/15/13.

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#8159940 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: derby_dude]  
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Quote
What amazes me is with those kind of deductibles the premiums are so high.

What did everybody expect when the insurance company has to sign
everybody up for the same price regardless of pre-existing conditions. It does not make sense to sign up an new patient that may be terminal ill from cancer, at the same price as a 20 year old that is in good health, but that is what the Government is forcing them to do. miles


Look out for number 1, don't step in number 2.
#8160018 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: milespatton]  
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Originally Posted by milespatton
Quote
What amazes me is with those kind of deductibles the premiums are so high.

What did everybody expect when the insurance company has to sign
everybody up for the same price regardless of pre-existing conditions. It does not make sense to sign up an new patient that may be terminal ill from cancer, at the same price as a 20 year old that is in good health, but that is what the Government is forcing them to do. miles


DITTOS.


Don't vote knothead, it only encourages them. Anonymous

"Never underestimate the power of stupid people in large groups." Anonymous

"Self-reliance, free thinking, and wealth is anathema to both the power of the State and the Church." Derby Dude


#8160711 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: Stan V]  
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Originally Posted by Stan V
Coins is after you meet your deductible....

say deductible is $5000, then you start the coinsurance not to exceed out of pocket

Any accident coverage available? Generally most ins companies will pay (or at least offer it) 100% of accidents.


^^^ That's a good question that I'd also like to know the answer to.

#8160750 - 10/15/13 Re: Interesting Obamacare Out-Of-Network question [Re: fish head]  
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Quote
That's a good question that I'd also like to know the answer to.


Insurance companies are in business to make money and Obama and his helpers are trying to legislate that away so they will have the only insurance in town. Subsidized by the taxpayer. miles


Look out for number 1, don't step in number 2.
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