premiums wont be going down. ACA is not designed to lower premiums. some people will get their healthcare subsidized, but that doesn't mean the premium is going down. Also if you have a medical condition your premiums will by lower.
This is bogus. There are obviously individual anecdotes of people who have had serious issues with insurance companies. I won't say that neither of you experienced that. However, the idea that insurance companies are always going to try to weasel out of paying claims is just flat out false. I've been in the industry for 10 years now (I do not work for an insurance company) and I've never had a client get denied for claims that were covered under the policy. The thing I do see is people lie on an application and then get mad when coverage gets denied, fail to read the policy they buy and not follow it's rules, use a doctor outside of the network and then blame the insurance company, try to get a procedure that isn't covered and never was and say they are being screwed, etc. Insurance is far from perfect obviously, but I can give you well over a hundred referrals of people who will tell you how satisfied they are with insurance they've purchased in the state of Texas. I can direct you to clients with breast cancer who purchased policies and are thrilled at how much money it saved them. Parents of children with developmental disorders that have policies saving them thousands of dollars a month, etc.
Also, for those suggesting that insurance companies just raised rates to increase profits and are just blaming the law because they can get away with, that is also a flat out lie. In addition to what was pointed out by Art in an earlier post, the ACA price fixed the insurance industry for all intents and purposes, setting a maximum amount they are allowed to generate outside of claims expenses. For every $1 you spend in premium they are allowed to use $0.20 to run their company, pay staff, market, etc. and the remainder of the .20 after that is profit. If they go over that .20 they have to return it every year in rebate checks.
My GF sells health insurance. Some people's rates went up, some people's went down. Most people's insurance won't change drastically. And people with preexisting conditions will now actually be able to get coverage. Like every big business I can think of, the health insurance industry sucks. My father was also an insurance agent when he was young, and quit because insurance companies are scum bags that care more about the bottom line than they care about providing the coverage that people pay for. One of her clients went from paying almost $400 per month to $1 per month because they qualified for a subsidy. I don't support the new law in it's current form, but I think it's a small step in the right direction. Hotballa, I'd recommend talking to a few independent insurance agents and see if any of them find something that better suits your needs. Good luck.
I got the most expensive plan for my company and i'm shocked that i'm dealing with this stuff. I work for a big company and my insurance company is probably the biggest one, now they won't pay for certain benefits!
I'm not going into specifics, I was seeing a specialist and the insurance company was paying for it for the whole year, and all of the sudden stopped in september and questioned my need for it. I got my specialist plus my primary to write them. It's nothing too expensive either, but they cut me off. i'm appealing.
No I am pretty sure after looking at the evidence Rocket River has provided that all of the insurance companies have colluded in order to make Obama look bad.
You do realize that means nothing? Its all about how you earmark your money. They can charge whatever they want as long as they can justify it.
One thing I've heard - and I have no idea the validity here - is that because this is all new and its unclear how expensive this will really all be, insurance companies are being conservative in their cost estimates right now, on the assumption that it's better to overcharge people and have to give a rebate than to undercharge and end up eating the costs if its more expensive than projected.
No, they can't. They have to validate every single dollar now, showing total premiums received and total claims paid. They don't get write offs or anything like that.
Thanks for not quite saying my close friends with cancer are "bogus." I'm sorry because I know you work in the industry and seem like a very genuine and decent person. My point is that, when someone is *really* sick, piling up insane five-figure bills every year, it really does take a nearly full-time advocate to help the person navigate the incredibly complex billing/insurance cycle. It's not all on the companies. Doctors and hospitals are doing what they can to massage bills and expenses to maximize profit as well. This is incredibly well-documented. So my post about my friends should have stated that it takes a full-time advocate to call the insurance companies, the doctor's offices (nightmare), and hospitals. The system, in my closely observed experience, can put a lot of pressure on the patient to actually mediate differences between all these players in the industry. Again, what I observed is not invented or even exaggerated. You are probably right that the companies stick closely to the plans (I mean, they would have to), but most plans are pretty complicated for the normal person to read. Such as fine print that says they won't keep covering scans when your cancer is spreading even if the doctors are insisting you get quarterly scans. I'm no expert at all, but I observed some real and ugly frustration from very sick people who would better have put their effort into healing. EDIT: Okay, what has my morning been consumed by? Mrs. B-Bob had an appointment with a specialist yesterday. The specialist no longer handles insurance claims. Mrs. B-Bob calls her primary care person to ask questions about submitting a claim, but that receptionist (after an enormous hold time, hang up, and several call-backs) says that the specialist office has to handle that. This kind of crap happens all the time, and I readily admit, in this specific case, it's not specifically an insurance company. But as a business model, it's totally fubar. What other business transaction works like this? Even buying a car on a lot, which is excruciating, doesn't send you back and forth between the manager and the front-line sales person with neither of them willing to talk to you. In the end, we will eat a $500 bill b/c we (advanced degrees both of us) cannot navigate the system and we don't have infinite time, given very demanding jobs, to keep lobbing phonecalls all over the place. So, to this consumer, it sure seems like part of the business model: frustrate the client until they quit making claims. God knows if this specialist's work would be covered (just a consultation), but everyone told Mrs. B-Bob it would be covered before she went to the appointment.
Why did you put your wife on such a sub-standard insurance plan ? I bet it covers very little . Our family of 3 has been on a company subsidized plan for many years. It's equivalent to a gold plan. We've been paying $5K/ yr and the company said it paid $20K for us / yr. That's a total of $25K. It does include dental and vision but those parts cost little. If the company would just give us the $20K, we could just buy the gold plan on the health exchange with a grand left over.
And it would be taxable income to you that you'd struggle to write off. Not to mention while it may be cheaper for you, for others it would be more expensive. What you are are describing is also against the rules by the way. I'm saying the idea that this is what insurance companies "do" as if it is the norm, that's bogus. The rest of your post is legit, but a lot of the problems you described are doctor related. Your specific claim sounds like a non-network affiliated specialist who has chosen to say they won't help patients because they don't care as long as they get paid. You really should have an insurance broker who can be your advocate. Your company doesn't direct you to the broker/brokerage company/TPA that handles your account? They have no claims assistance program in place for you?
Good point. My wife and I are on different plans (each via our work). Her work just had something called "operation excellence" due to budget cuts, which gutted HR and anything resembling a claims assistance program. Thanks for the reply, seriously. Cheers.
I don't think you understood what he said. He meant: People maybe paying a small amount for the insurance they have now and they think they are good plans but they are not. The plan may or may not cover certain procedures, they may cover a different percentage, anything less than 80% is too little for my taste. Some plans also have a life-time limit. At my workplace, some years ago there was a family who had coverage that had maximum pay-out of 500k or a million. The wife had cancer, medical cost went over and their whole life time saving went out the window. I believe the gold plans today have no maximum limit, that's part of the high cost.
