Is it a fact that a colonoscopy is only covered if they don't find polyps? Because that part of the procedure is about 10 seconds per polyp. The getting knocked out, giant tube up your ass part is the labor intensive bit. What is the point of a colonoscopy if they don't see polyps?
I was paying more than that (for family coverage) 10-12 years ago. My son also had pre-existing conditions and had to have his own policy. While self employed, I was paying 10k a year for family coverage 10 years ago, and rates were going up 10%+ each year. Obamacare is not the cause of rate hikes, they have always been there. Insurance companies are the cause of rate hikes, and they will take advantage of every opportunity to claim that circumstances are forcing them to raise rates.
Sure - but that would be a money-loser for the insurer. You're complaining about a lot of things and blaming Obamacare - but Obamacare has nothing to do with any of things you have issues with (outside of the very small penalty).
It is still covered, just not as a preventive procedure. If they find polyps or you've ever had polyps then it is a diagnostic procedure and is not covered at 100%. It is covered as a standard diagnostic procedure in your plan. *this is a standard setup. Plans can of course have specific setups that vary from this. This is just explaining what is mandated.
How is this brilliant? If this was offered, it would have received support from both sides. This is no different than what many others have suggested. This was sold as ACA ... affordable health care. It was promised to bring down rates and control the insurance companies. Its done the complete opposite. Sure, its helped those who were deemed uninsurable. And that isn't to say we should forget those people. There was much better ways to handle healthcare reform than this steaming pile of crap. I still stick to this system was designed to fail. A single payer system was not going to pass. In a decade, everyone will be begging for a single payer system. Unfortunately, when this happens, this will further the gap between the rich and the poor.
Sure it is logical. It's how doctors and insurance companies define preventive/diagnostic. If all colonoscopies were always free even if you had polyps then you'd be paying even more in premium. They are very expensive procedures.
i'm confused by this....you have an insurance plan with a deductible. you didnt meet the deductible...but still got bloodwork done that only cost you $6? am i wrong how deductibles work? don't you have to meet the deductible before insurance will pay for any of it? how is it you got to have that reduced rate?
Where is your evidence that plans across the board have increased in cost higher than the yearly average increases over the last 10 years?
Why would it be a money loser? I would think it would be a big winner if you could provide healthy people with catastrophic coverage. If someone in a given year has 1 in a 1000 chance of needing it, then at $100/mo, the insurance company would pull in $1.2 million dollars per 1,000 people. Seems like that is workable. Problem with Obamacare is that it really didn't address the ridiculousness of health care costs. It promised us lower premiums. And we got lower premiums and higher deductibles. I mean, you seriously think that's not true, but how else do you explain how insurance companies are paying for accepting pre-exisiting conditions?
You still benefit from the insurance negotiated discounts before you meet your deductible. Here is how it works: You have a plan with a $500 deductible and then you pay 20% after that and the insurance company pays 80% until you've paid $1500 total and then the plan pays 100%. You go to the doctor and end up needing an MRI. You are billed as follows for the MRI which applies to your deductible: Billed Amount: $2750 Insurance Discount: $1250 Allowed Amount: $1500 Your responsibility: $700 ($500 deductible plus 20% of remaining $1000) The billed amount represents the actual charge that the facility charges to use their machine. However, as a member of the network they can only get paid the negotiated rate. The reason most people don't know this is because they don't ever see it. Next time you have a procedure done, look at your Explanation of Benefits. You will either receive one in the mail or you can get it online through your insurance company's website by registering. It will breakdown what you area actually being billed and what the insurance company did behind the scenes to reduce the cost.
Insurance negotiate costs of every procedures with provider. Without ins, provider charge you an arm & leg. It's very backward as those w/o ins are usually those that can't afford it in the first place and yet they get charged 2-10x more. Those w/o ins that KNOWS about this actually can work (negotiate) with the provider to lower their costs (before or even after the procedure) --- not all provider are willing thought. This is probably an overall issue with a population of many uninsured or under-insured while medical care (ER) is something they must provide by law. It's part of the "broken" US Health system.
Most people would not buy these plans. You think you can afford medical care without insurance, but reality is that most people can't anymore. An MRI would cost you thousands of dollars. Medicine would be through the roof. The actual cost of medical procedures has exploded in America and most Americans don't realize it. They blame insurance companies for everything, but the reality is that the insurance companies are fighting a losing battle against the rising cost of healthcare, but they do fight it. Nobody wants to pass a law that says doctors and hospitals and facilities can't charge as much as they do.
I may be wrong here, but... - pre-existings condition MUST be covered by group insurance, the one you usually obtain through you employment (employer provided). This i'm pretty sure of as I have provided group ins through my family busn. - yet, prem has typically been (maybe still?) cheaper through employer provided ins (large employer) than in the individual ins So, why is that the case? Larger buyer power would be my guess. Thus, I don't really get or understand why obamacare (which group buyers through the exchange) would cause ins to cost more as compare to what was previously provided by employer (esp large one). There might be other factors with obamacare that does that (coverage and min requirement), but in general, I don't really get or understand why covering for pre-existing condition would raise prem.
Yet, that might be the ONLY way out. Single payer. Costs is just r****ded. An ER with a few scans cost 5-10k to the insurance co easily. You know how much it would cost an individual w/o insurance --- and of course they wouldn't (couldn't) pay.
Pre-X raises cost IF the insurance pool doesn't grow the way ACA expects it to The big cost drivers are the mandates to the plan/minimum requirements.
There are some that do and they know very well what they are getting. A problem is many that bought that in the past have no idea what coverage they are buying. Catastrophic plans should be available but as an exception (if it's not already) for "advanced" buyer.
There are catastrophic plans still available for young people, but there are still limitations that make theme expensive.
But we know it's not viable based on the actual pricing of these plans and the mandated spend on health care costs. Insurers have to spend something like $0.80 or $0.85 of every dollar they bring in on actual health care costs for their clients. If they are charging you $400/mo for a plan, it means that the average person buying it is probably costing them $320ish/mo (this is a bit simplified, but you get the idea). As justtxyank said, insurers are not ripping you off - they aren't pricing plans unfairly or wrongly. The real issue is the actual cost of the health care itself. Insurers are just the middlemen in the process. The same way your $450 group plan that you loved did it - by expanding the pool. Individual insurance couldn't work that way because you could just buy it when you got sick. But if you're required to have it even when you're not sick, you get more healthy people paying into the system. And by eliminating the uninsured. In my bloodwork example above, a lot of uninsured people won't ever pay up because they can't. In the end, the hospitals/doctors raise their prices and end up charging more to insured patients. The big flaw in our health care system was that insured people were subsidizing uninsured ones. If you eliminate the uninsured, then insured people can pay less. It's why you see premiums doing MUCH better in states that expanded Medicaid vs those that didn't. Texas, for example, walked away from $2B per year in federal Medicaid money. Those people will still get sick and still go to doctors and hospitals - but in the end, the insured people of Texas will eat most of that cost. Where premiums go in the future is still to be determined - there is a LOT in ACA to cut costs, but much of it is experimental and is being rolled out over time. So it's unclear what impact it will have. Keep in mind that the starting point for this is that no one on either side actually knows how to cut real costs of procedures/etc (outside of price controls aka single payer). There are lots of theories, but no substantial evidence - so much of what was thrown in there was taking ideas that have worked elsewhere in small scales and trying to experiment and expand them if they work when duplicated.
