This is my issue. "Prevention Care" is such a b.s. term. They are just basing it on cost not on actually trying to prevent anything from happening.
That's now how it works. You are looking at EPOs most likely which means you are using a provider that is part of the exclusive provider organization. So, you go in and get an office visit and an xray. The actual cost is $150 for the office visit and $750 for the xray. You have no copays so this all goes to your deductible, but, because you have the insurance you pay the negotiated rate, not the actual billed amount. You pay $75 for the office visit and $500 for the xray. You never know this unless you get an EOB, but you are benefiting from the discounts that the insurance company negotiated before you ever stepped in the door.
Well clearly you do have something add or you wouldn't speak now would you? Frankly I find this post a bit offensive and very presumptuous and surprising coming from you. I am actually frustrated with this whole process of having to get insurance or pay a penalty when I find my choices suck. So why does that have anything to do with trolling anyone? Really? I am complaining about my situation not trying to piss anyone off.
LOL, not true. Are you arguing that they should cover everything for free but still you only want to pay your $450?
So you are saying that I am getting a lower rate just by having the insurance plan vs. not having insurance and paying out of pocket? I am confused. Why would a provider quote someone with no insurance rate a price higher than someone with insurance? I will call around and check on that when I have a chance. My main frustration with these insurance plans is that you pay $550/mo - which is pretty expensive if you are self-employed. That's almost $7k a year - post-tax. It's cheaper for me just to pay out of pocket. If I break a leg I am screwed for sure. Bt $7K is a lot of money for "affordable health care". Maybe if I lived in Texas, but not NYC. It simply isn't practical and squeezes freelancers way too hard.
It honestly depends on the place. Some doctors give a cash discount for things like an office visit to people with no insurance. However, anytime you pay for medical services you are paying a negotiated price between the provider and the insurance company. If you get an EOB from your old plan (if you had any claims) you will see it. There is normally a few columns. One will read "Billed amount" the next will read something like "allowable amount" or "insurance discount" or something like and then you will see what you owe. PPOs and EPOs work on negotiated rates that the provider can charge for any service he renders. If you have a copay of say $25, then the insurance company has to pay the provider the difference between your $25 and the negotiated rate. If you don't have a copay and it all goes to deductible, then you will pay the full negotiated rate. If your plan covers office visits at 100%, then the insurance company is paying the full negotiated rate to the provider and you are paying nothing. All PPOs and EPOs work on negotiated rates for services between doctors/providers/facilities that agree to participate in the network. Then you and the insurance company work out a cost sharing arrangement depending on the plan you select. Have you asked any providers what their office vists costs under the various insurance companies? They probably have a different negotiated rate with each one. Now, all of this may be different with this OSCAR plan. I can't quite figure out what it is because they seem to limit your access to information until you actually buy the plan. They may be a discount program where they don't have real contracts with providers. If that is the case, of course the provider loves them.
Yes. This is one of the biggest benefits of insurance - one that you apparently weren't even aware of. For example, I got bloodwork done recently. The doctor billed the insurer about $100. The insurer said it was worth $6. I was responsible for the $6 since I hadn't met my deductible. Had I not had insurance, I would have owed somewhere close to $100 (probably a cash discount that drops it a bit). So by having insurance - even though I didn't meet my deductible - I saved $70+. That's true for just about every single doctor's visit and procedure you have done. As far as your original argument - so your $450 plan was a group plan? That's a totally different market. Why on earth are you trying to compare that to an individual plan today? And how much was your employer contributing to the cost? Odds are the plan itself was far more than $450 if that was your share.
To clarify - the blood work on a cash rate is probably lower than that - maybe $30-$50 (just a guess). There are 3 rates: * Cash rate * Rate billed to insurer * Rate insurer negotiates down for me That 3rd part is where a huge chunk of the day-to-day savings comes from by having insurance. The $5000 you spend in deductibles would likely be far, far higher if you were paying the cash rate.
No, just that "preventive care" should include things that prevent disease. Why was this stuff covered before and not now? That's my question.
What was covered before and not now???? The medicine lipitor is still covered. The difference now is that where on old plans an annual physical cost you a copay (or whatever billed if you had to meet deductible), now it costs you nothing. Same for other preventive treatments that made the list. The 100% coverage for preventive is new. It did not take away, it added an enhanced level of coverage. Of course, that costs something.
No, I did not know that. The employer didn't contribute anything. The $450 was my cobra payment. Prior to that I paid $70.
Gotcha - group plans are a totally different market than individual plans. The group market isn't affected by Obamacare nearly as much as individual insurance, because that's the one where pre-existing conditions and all that were problematic. If you had tried to buy individual insurance in New York two years ago, your rates would likely have been FAR higher than today for similar coverage. That doesn't apply nationwide, but the NY individual insurance market was completely broken and there were relatively few participants. It was an excellent example of government regulation gone wrong - NY is one of the places benefitting the most from Obamacare.
Sorry if I was a bit rash before. I am just frustrated with this whole process. It's time consuming and I didn't know you get negotiated rates that are a lot cheaper than paying cash. My medical expenses are usually around $500-$1000 a year. So to have to pay $500 a month plus or minus 50 seems a hard bite to take when on top of that it's not even going to save me on the $500 - $1000 I am already paying. I wish there was a plan for people who were healthy and just needed a year check-up and blood work without having to pay so much.
The big cost of the insurance is to protect you from the $100,000 car crash recovery or cancer. If you're only worried about the $500-$1000 per year and don't want the additional safety blanket, honestly, you're not really looking for insurance. Your best bet is to just not get anything and pay the penalty for now (it's tiny right now). However, just be aware that if something bad happens, you're declaring bankruptcy.
Yes, I understand that risk. If there was a super cheap plan that just gave catastrophic coverage and nothing more for say $100 a month, I'd take that. Because that would also get me out of the penalty tax so it would be an even wash.
This leads me to one of my brilliant ideas for Healthcare reform. There should a single payer pool for all catastrophic claims and then preventitive/minor stuff left to the providers. Like everyone pays a flat $100 dollars base which goes into the pool. Government defines what "catastrophic" is and what that pool covers, and negotiates the rates for them. The rest of your plan is non catastrophic and deals with deductables, co pays, preventitive, prescription and so on and so forth.
I have nothing to add to the discussion about plans and insurance because Major and Justxyank have covered that pretty well. Considering your history and that you seem to be so vociferously arguing this now including things that are shown to be incorrect that is a fair question.
