ObamaCare Info

[robinb]

I can't speak for New Jersey, as I am in CT, but from what I understand, any policy that is 'non compliant' the the new requirements set forth by the ACA can no longer be offered for sale. I have a very good HMO policy (which I like, except for the high cost) but my plan is 'non compliant' because it doesn't include dental care for children and maybe some other things as required by the ACA (and one of the things it doesn't have is high deductibles and coinsurance charges), so as of January 1, 2014, I am no longer allowed to have my policy because Blue Cross isn't allowed to offer it anymore. SO much for 'if you like your your insurance you can keep your insurance'. I think the people on this board who are in New Jersey are talking about the same situation that I am facing.'

I think the people who are noticing this happen the most are those of us who are self-employed and buy our policy directly from the insurance company.

Thanks! But doesn't that mean that BCBS can't offer that plan anywhere? I would think that they would adjust their plans to meet the requirements.

 

[Traveliz]

Thanks! But doesn't that mean that BCBS can't offer that plan anywhere? I would think that they would adjust their plans to meet the requirements.

They are adjusting the plans and that is resulting (in part along with the fact that everyone is paying for everyone else as well) in the plan rates skyrocketing. I am not in NJ and my BCBS plan (which I liked ok) is no longer compliant and the new version is double in price.

Liz

 

[j's m]

Thanks! But doesn't that mean that BCBS can't offer that plan anywhere? I would think that they would adjust their plans to meet the requirements.

BCBS of NJ eliminated all existing individual and small group plans because they did not comply with ACA. Our small group plan has had unlimited dollar coverage for probably 20 years, it had coverage to age 26, it had totally free labs (participating provider) and free radiology, 30 and 50 co-pays for doctors, 2500 in network deductible, 5000 out, but had a very high deductible for prescriptions and no dental or eyglass coverage for children. It was a nationwide PPO so my DS away at school was covered.

Instead of making adjustments to the plans, they eliminated them and ONLY are offering EPOs with no out of network coverage, limited participating providers and not nationwide coverage. They are not offering a comparable product at any price.

Aetna and Cigna are not on the exchange. Amerihealth has I think one HMO and 3 POS, no PPO. The third company is a brand new co-op non profit that I never heard of.

First the ACA screwed us, followed by NJ BCBS.

 

[spacemountain1971]

W
The United Methodist Church recently announced that "clergy and lay employees" would be losing their coverage.

I appreciate your list of concerns but this is NOT a true statement. The denomination does not function in any manner to make such a unilateral comment.

 

[njcarita]

Day 15 still cant get on!!!!!!!!!!!!!!!!

 

[deedisneydream97]

Well I did finally get some kind of info for one of my offspring. Someone made a comment to me on here about "since my offspring were underemployed, why not let THEM navigate thru the system". Underemployed is not unemployed. The jobs they are working at do NOT allow them to sit in front of a computer all day...nor are they allowed to constantly check their phones. They do need to eat, sleep and attend degree program classes....which, BTW, they are getting NO financial assistance for......go figure.

Anyway....here in NJ one offspring apparently qualifies for a medicaid-type plan since his income is so low....and our local dr.'s office was listed. HOORAY...right? Until we find out today that now this office will not be accepting any new medicaid patients or apparently some of the other "affordable" plans. Is this mentioned on the website? Nope. Heard it straight from the dr. The nearest place that will accept is over 45 minutes away. Can you imagine how this place with be swamped with people? what kind of "care" will be provided? How long will it take to get an appointment? Unbelievable. So much confusion and misinformation.

 

[Robbi]

Well I did finally get some kind of info for one of my offspring. Someone made a comment to me on here about "since my offspring were underemployed, why not let THEM navigate thru the system". Underemployed is not unemployed. The jobs they are working at do NOT allow them to sit in front of a computer all day...nor are they allowed to constantly check their phones. They do need to eat, sleep and attend degree program classes....which, BTW, they are getting NO financial assistance for......go figure.

Anyway....here in NJ one offspring apparently qualifies for a medicaid-type plan since his income is so low....and our local dr.'s office was listed. HOORAY...right? Until we find out today that now this office will not be accepting any new medicaid patients or apparently some of the other "affordable" plans. Is this mentioned on the website? Nope. Heard it straight from the dr. The nearest place that will accept is over 45 minutes away. Can you imagine how this place with be swamped with people? what kind of "care" will be provided? How long will it take to get an appointment? Unbelievable. So much confusion and misinformation.

I heard a report where a doctor said he will have to see at least 40 patients per day. Even working a 10 hour day, that's 4/hour or 15 minutes per patient.
My BIL is a pediatrician and his best friend is a neurosurgeon. They had a distllliery built for making rum and vodka because they don't anticipate staying in the medical field.

 

[Judyat]

Let's start with "I heard a report." Really you heard a report. Doesn't matter if it's fact or not does it? Don't believe everything you "hear." There's a lot of "hearsay" here. I like facts not "hearsay."

 

[johde]

Well day 15 and I've taken 2 steps back towards being able to see "real" prices. Last week, because of computer glitches, I had used up my automatic computer identity verifications from Experion. They requested I upload or mail in a copy of some form of identification. For 2 days the upload would work. Late last week, I was finally able to upload some ID. Over the weekend, it was saying ID verification pending. Today, it went back to ID failed please upload or mail a copy of your ID. This website is the joke. Fortunately, I have most of the information to make an informed decision. But unfortunately, it going to eventually fighting through this mess of a website to get back to the price I was paying before.

 

[WebmasterKathy]

EVERYONE---

We're trying to keep this conversation going so people can discuss the healthcare changes and how it will affect us.

But remember that we do not permit political discussions here.

If you make a post overtly political by such things as expressing your opinions about politicians or political parties, or otherwise making what we determine to be political comments, you may find your post deleted and your ability to participate here restricted.

So discuss this topic that affects many of us, but keep it factual and leave the political opinions for another place.

Thanks!

 

[manning]

I heard a report where a doctor said he will have to see at least 40 patients per day. Even working a 10 hour day, that's 4/hour or 15 minutes per patient.
My BIL is a pediatrician and his best friend is a neurosurgeon. They had a distllliery built for making rum and vodka because they don't anticipate staying in the medical field.

For a minute there I thought you where going to say to help get thru the day.

 

[goob]

A bit off topic but wow, after reading this thread it really opened my eyes to the whole American healthcare system and issues. As someone living in a country with universal healthcare (very blessed!), I've never given it much thought but I'm beginning to understand why it is such a divisive issue. Good luck to all those sorting it out!

 

[Robbi]

For a minute there I thought you where going to say to help get thru the day.

Well now that sounds like an excellent idea!

 

[Robbi]

Let's start with "I heard a report." Really you heard a report. Doesn't matter if it's fact or not does it? Don't believe everything you "hear." There's a lot of "hearsay" here. I like facts not "hearsay."

My BIL and his friend as I posted are both doctors who have opened a new business because of obamacare. Right about 1/3 of other doctors in our town are considering early retirement. This is from their mouths to my ears. The hospital and medical center in our town are the 2nd largest employers second only to the university. We used to get a new influx of doctors every year. The past 2 years we've had a total of only 10 new doctors move to town. If the doctors who are talking about retirement do leave the profession, the hospital and medical center will have to let people go. It will have a snowball effect not just on our city's economy but on those in the surrounding towns as well.

The economic downturn experienced by a large majority of the country did not impact our area. This new healthcare threatens our economy.
Those are facts. We surely cannot be the only area in the country whose economy depends on the healthcare profession.

My brother owns insurance agencies. The new healthcare is hiring navigators. This will impact his business negatively as it will thousands of other agencies throughout the country. He might have to let some of his staff go. This is fact.

My husband and I might not have medical insurance anymore depending upon how the healthcare affects the business. We've had it for the 33 years that we've been married. A $12000+ deductible just doesn't make sense for us. That is fact. We can't be the only ones in the country in this position.

For those who will have healthcare insurance that couldn't before, I'm happy. This is fact.

 

[Muushka]

I personally will from now on call it the UCA.

 

[manning]

Here is an article from the Chicago tribune that may help explain the differences in levels.

http://my.chicagotribune.com/#section/530/article/p2p-77669894/

 

[Muushka]

I hope that something good comes of all of this.

Hopefully people will be forced to look at the price of healthcare. Not just the insurance premiums, but at the actual cost of medical care.

For example, once people meet their deductible, they don't care what things cost, it's going to be covered by insurance. But now with these high deductibles, it will take much longer to meet it and people will be paying out of pocket until it is met.

Drugs? It is out of hand. Don't even get me started on cholesterol meds. Billions of dollars are spent annually on meds that people could control with lifestyle changes and a just plain 'I'm not going to take cholesterol meds to lower my cholesterol from 210 to 199'. If the co-pay is higher on meds, people will think twice about taking them.

Got a sore throat? Now people run to the doc, get antibiotics. But if there is a big co-pay for both the visit and the drugs, maybe people will wait a day or 2 to see if it will get better. Right now I am teetering on a sinus infection. I am pretty sure it's viral. I am going to wait 1 more day (I've been sick since Saturday, low grade fever to begin with, but none since) before I seek medical attention. I have insurance but I am not one to run to the doc for anything.

And a question. If we have the UCA, why do we still need medicare and medicaid? Why don't they eliminate these programs and put them on the same program as everyone else? Because the medical treatment for these programs is unlimited, people will take advantage. They don't have to pay for it, so why not? People on insurance play the exact same game so I am not just disparaging the needy.

I can remember arguing with people on Medicare about lab work. They would DEMAND that we check their entire blood panel each time they came in for a visit, many for 5 or more times per year. This was back in the 80's before Medicare clamped down on the excessive testing. They said "it's free, why shouldn't I have it"?

Hopefully people will become less likely to have unnecessary procedures done. For example, my husband had a ruptured Achilles tendon. Our doc, not prone to excessive testing, asked my husband if he wanted an MRI. My husband asked if it would affect the treatment in any way. The doc said,' well, no'. So my husband asked 'then why have it?' The doc smiled and said 'all right then!'.

If you look at the price of elective surgery (market driven, cash basis), that is the way I hope regular medical care will become. People will ask about prices, necessity and be savvy when it comes to medical care.

We have a local medical practice that takes no insurance. They have people coming to them who are on medicare and medicaid and regular insurance. These patients find that the prices are low, the time it takes to get an appointment and the care is so much better than the typical clinic, or doc office.http://www.acchealth.com/

At our practice we want to encourage wellness so when you have an Annual Comprehensive Preventative Screening Physical Exam ($449), scheduling of your office visits for the following 12 months will only be a $20 fee and most basic lab work or provider visits will not be any additional charge*
Basic lab work include annual screening labs typically ordered for routine physical exams and for diabetes, hyperlipidemia, and hypertension followups. Specifically: Annual Pap Smear, cholesterol panel, complete blood count, thyroid screen(TSH), Complete Metabolic Panel(glucose, creatinine, liver function tests), urinalysis, Quarterly Hemoglobin A1C for diabetics,and annual PSA(prostate cancer screening test)

I worked in healthcare for 30+ years and I've seen it all. Off my soapbox now.....

 

[disneychrista]

I personally will from now on call it the UCA.

Unaffordable Care Act?

 

[Muushka]

Unaffordable Care Act?

But like I just said above, maybe something good will come from this law.

 

[Muushka]

Oh ugh. I just read that article from the Chicago Tribune and reminded me of something.

They talked about the fact that one of the plans they offered at a higher price had 23K docs on it and the lower priced one only had 10K docs on it.

The differences within a tier can be huge. Blue Cross and Blue Shield of Illinois, for instance, offers some customers its Blue PPO Gold plan for 314.19 a month or its Blue Choice Gold PPO for $234.02. The plans have the same deductible. Same coinsurance. Same copays. So what accounts for the $80.17 difference in monthly premium? One major factor: The higher-priced plan has 54 hospitals in its network, including world-class Northwestern Memorial Hospital, and more than 23,000 doctors. The lower priced plan has 26 hospitals, excluding Northwestern. It has about 10,000 doctors.

That reminded me of my dental plan a few years ago. I had been seeing out of network dentists and got tired of having to pay the extra $$ so I tried going to ones in network. I tried 2 different dentists in-network and they were the most incompetent dentists I have ever gone to. I flew back to my out of network dentists.

And in the long run, I know I have saved myself AND the insurance company a ton of $$.

Between crowns that had to be replaced because the ones they put in were not properly made and the procedures for the 2 crowns gave me TMJ, which to this day, I still suffer the repercussions.
the other dentist insisting I had gum disease and would not clean my teeth unless I signed a contract stating I would have the procedure. Having gone to the same, competent dentist for 10 years and never having gum disease, I knew something was wrong. Shortly after my experience with this dentist, they were sued by a patient for the exact same thing that happened to me.

So remembering my experience with in-network dentists (they accept that low payment for a reason), I would pay the higher premium.