The Affordable Care Act II - Because Mr. Obama Loves You All

[Nanker]

1 hour ago, plenzmd1 said:

I must admit a am a true neophyte when it comes to this health care mess we are in. Such a huge part of our economy, I really should understand more than I do and have a firmer grip on the realities, not the talking points.

 

Having said that, thought i would share with the board that my wife recently had surgery to remove about a 10-inch section of her colon( not cancerous, but had to go). Thought she would be hospital 3 days, ended up being 6. Received the statement from the hospital today.

 

IV Tylenol for pain.                                                                                        $600/pop

Fluids/saline IV..                                                                                            $400 a pop

Sterile Items( not sure what that is                                                             $2000

Tums                                                                                                                 $60

 

All told, $58,000 for a 6 day hospital stay(surgeons fee not included, that was an additional $6K in separate bill) that was all about pain management. Never in ICU, never any additional scans/tests after the surgery outside of blood work to make sure no infection...they just wanted her there as her pain was greater than they expected.

 

WOW..we are on an HSA High Deductible and had already hit deductible so we pay $0..but Aetna paying them $43K..holy moly.

 

Something wrong somewhere

I've said this before, but it bears repeating again. 

I had a knee joint replaced and when I was rehabbing I spoke with the surgeon's PA about the PA's charges being rejected by my insurance carrier. 

He said to me that he would get paid (probably directly from the surgeon's practice), but went on to explain the charges on the invoice I showed him. 

Essentially, "no one" with insurance pays the full bust-out-retail charges that the health care providers charge. They ALWAYS want to know if your situation is because of 1. An accident or 2. Is it a Worker's Compensation case. 

THOSE cases get the fully charged amounts - because either the lawyers or the law says they can and do get the full amount. THAT's where they really make money.

 

Any insurance cases usually handle the submitted charges and "negotiate" a discount. It goes something like this:

You see your doc and he puts a splint on your broken finger.

Your insurance company sends you a bill that states, "Your Dr. charges $298.00 for his services. We negotiated their fee down to $65.00 of which we paid $54.00. You owe the doctor $11.00 and you will be billed by them for that amount. 
 

Same with hospitals, and other health care givers. People who don't have HC insurance don't have the intermediating (evil) insurance company to get the lower negotiated rates. 

[plenzmd1]

19 minutes ago, Nanker said:

I've said this before, but it bears repeating again. 

I had a knee joint replaced and when I was rehabbing I spoke with the surgeon's PA about the PA's charges being rejected by my insurance carrier. 

He said to me that he would get paid (probably directly from the surgeon's practice), but went on to explain the charges on the invoice I showed him. 

Essentially, "no one" with insurance pays the full bust-out-retail charges that the health care providers charge. They ALWAYS want to know if your situation is because of 1. An accident or 2. Is it a Worker's Compensation case. 

THOSE cases get the fully charged amounts - because either the lawyers or the law says they can and do get the full amount. THAT's where they really make money.

 

Any insurance cases usually handle the submitted charges and "negotiate" a discount. It goes something like this:

You see your doc and he puts a splint on your broken finger.

Your insurance company sends you a bill that states, "Your Dr. charges $298.00 for his services. We negotiated their fee down to $65.00 of which we paid $54.00. You owe the doctor $11.00 and you will be billed by them for that amount. 
 

Same with hospitals, and other health care givers. People who don't have HC insurance don't have the intermediating (evil) insurance company to get the lower negotiated rates. 

its carzy..even with negotiated rates Aetna( well really her employer) paid 43K for a 6 day hospital stay!!!!

[Nanker]

1 minute ago, plenzmd1 said:

its carzy..even with negotiated rates Aetna( well really her employer) paid 43K for a 6 day hospital stay!!!!

True. But someone has to pay for the emergency room visits of the uninsured... "It's the LAW!" 

[boyst]

Aetna and others still may likely under pay for the services.

 

I pay out of pocket whenever I can. I can go to PT for out of pocket if I have any work needing done for $50. Or I can use insurance, limit myself to 4 specs of their treatment options over 8 sessions and cost over $150 more of my own money after insurance.

[B-Man]

 

Trump signs bills lifting the ‘gag clauses’ on pharmacists for revealing drug prices

https://legalinsurrection.com/2018/10/trump-signs-bills-lifting-the-gag-clauses-on-pharmacists-for-revealing-drug-prices/

 

 

The "evil" continues.

[Koko78]

1 hour ago, B-Man said:

 

Trump signs bills lifting the ‘gag clauses’ on pharmacists for revealing drug prices

https://legalinsurrection.com/2018/10/trump-signs-bills-lifting-the-gag-clauses-on-pharmacists-for-revealing-drug-prices/

 

 

The "evil" continues.

 

Always found it interesting that certain elements of the health care industry want to keep their pricing structures a secret until after service has been rendered (and the patient is forced to pay.)

[ALF]

Sky-high prices for air ambulances hurt those they are helping

 

"But he was told that [the air ambulance] was necessary. They never told him why it was necessary or how much it cost, but they insisted I had to go by air ambulance," Anderson said. "But it's so odd there is nothing in the record that indicated it was time-sensitive or that I needed to be airlifted."

For that one helicopter ride, to a hospital farther away in Bismarck, records show that Valley Med Flight charged Anderson $54,727.26. Sanford Health Plan, her insurance, paid $13,697.73. That left Anderson with a $41,029.53 bill.

 

https://www.cnn.com/2018/11/26/health/air-ambulance-high-price/index.html

[BringBackOrton]

On 10/9/2018 at 12:50 PM, plenzmd1 said:

its carzy..even with negotiated rates Aetna( well really her employer) paid 43K for a 6 day hospital stay!!!!

Imagine that, when you socialize medicine (even just a tiny bit) the costs explode for those who can afford it. 

Edited November 26, 2018 by BringBackOrton

[boyst]

22 minutes ago, ALF said:

Sky-high prices for air ambulances hurt those they are helping

 

"But he was told that [the air ambulance] was necessary. They never told him why it was necessary or how much it cost, but they insisted I had to go by air ambulance," Anderson said. "But it's so odd there is nothing in the record that indicated it was time-sensitive or that I needed to be airlifted."

For that one helicopter ride, to a hospital farther away in Bismarck, records show that Valley Med Flight charged Anderson $54,727.26. Sanford Health Plan, her insurance, paid $13,697.73. That left Anderson with a $41,029.53 bill.

 

https://www.cnn.com/2018/11/26/health/air-ambulance-high-price/index.html

I've been calling air ambulance the biggest scam in health care.  I live along side a treacherous part of i85 and us64. I hear it almost 2 times a day and wonder why.

[BringBackOrton]

25 minutes ago, ALF said:

Sky-high prices for air ambulances hurt those they are helping

 

"But he was told that [the air ambulance] was necessary. They never told him why it was necessary or how much it cost, but they insisted I had to go by air ambulance," Anderson said. "But it's so odd there is nothing in the record that indicated it was time-sensitive or that I needed to be airlifted."

For that one helicopter ride, to a hospital farther away in Bismarck, records show that Valley Med Flight charged Anderson $54,727.26. Sanford Health Plan, her insurance, paid $13,697.73. That left Anderson with a $41,029.53 bill.

 

https://www.cnn.com/2018/11/26/health/air-ambulance-high-price/index.html

HAHA the 60 year old hit his head and lost consciousness. There’s a high suspicion for a brain bleed. GTFOH you know nothing slobs.

 

Imagine her brain herniated on the “hour long” drive to the hospital. And she goes brain dead and dies. At least she saved 40k for the funeral expenses. 

Edited November 26, 2018 by BringBackOrton

[boyst]

3 hours ago, BeginnersMind said:

If you use the search function, you will see this topic has been covered elsewhere.

 

I thought his place was the Wild West. I’ve deleted 7-8 threads, not just those on the topics mentioned in Azalin’s post. I don’t delete to be mean—I just do it when it’s spun way off topic or devolved into just an attack thread (not just on me but others). Which that one did. 

 

I’m proud that deleting a thread about building positive online community brought us all together. We can work on the positivity but ... baby steps!

 

With love and kisses to you all and Season’s Greetings to everyone except LSH who doesn’t want to celebrate the earth’s revolution around the Sun.

 

 

I wonder what kind of brain bleed the above person has.

[BringBackOrton]

4 minutes ago, Boyst62 said:

I've been calling air ambulance the biggest scam in health care.  I live along side a treacherous part of i85 and us64. I hear it almost 2 times a day and wonder why.

The know-nothing party is alive and well.

Just now, Boyst62 said:

I wonder what kind of brain bleed the above person has.

Fixed delusion disorder has a very poor prognosis.

[boyst]

Just now, BringBackOrton said:

The know-nothing party is alive and well.

Fixed delusion disorder has a very poor prognosis.

Yeah, but, you also forgot you have to have blood flow to your brain to generate a brain bleed.  But l, it's clear by his posting in PPP he wants attention so I'm helping him.  See!!!!

 

3 hours ago, BeginnersMind said:

If you use the search function, you will see this topic has been covered elsewhere.

 

I thought his place was the Wild West. I’ve deleted 7-8 threads, not just those on the topics mentioned in Azalin’s post. I don’t delete to be mean—I just do it when it’s spun way off topic or devolved into just an attack thread (not just on me but others). Which that one did. 

 

I’m proud that deleting a thread about building positive online community brought us all together. We can work on the positivity but ... baby steps!

 

With love and kisses to you all and Season’s Greetings to everyone except LSH who doesn’t want to celebrate the earth’s revolution around the Sun.

 

 

 

[B-Man]

WHY IS OBAMACARE ENROLLMENT DOWN? 

 

WONDERS THE NYT. 

 

Turns out it’s expensive, there are better alternatives, people don’t like it, and it isn’t mandatory anymore.

 

 

 

 

.

 

[/dev/null]

1 hour ago, B-Man said:

WHY IS OBAMACARE ENROLLMENT DOWN? 

 

WONDERS THE NYT. 

 

Turns out it’s expensive, there are better alternatives, people don’t like it, and it isn’t mandatory anymore.

 

 

 

 

.

 

 

My money is on the latter

[Swill Merchant]

On 10/9/2018 at 11:13 AM, plenzmd1 said:

I must admit a am a true neophyte when it comes to this health care mess we are in. Such a huge part of our economy, I really should understand more than I do and have a firmer grip on the realities, not the talking points.

 

Having said that, thought i would share with the board that my wife recently had surgery to remove about a 10-inch section of her colon( not cancerous, but had to go). Thought she would be hospital 3 days, ended up being 6. Received the statement from the hospital today.

 

IV Tylenol for pain.                                                                                        $600/pop

Fluids/saline IV..                                                                                            $400 a pop

Sterile Items( not sure what that is                                                             $2000

Tums                                                                                                                 $60

 

All told, $58,000 for a 6 day hospital stay(surgeons fee not included, that was an additional $6K in separate bill) that was all about pain management. Never in ICU, never any additional scans/tests after the surgery outside of blood work to make sure no infection...they just wanted her there as her pain was greater than they expected.

 

WOW..we are on an HSA High Deductible and had already hit deductible so we pay $0..but Aetna paying them $43K..holy moly.

 

Something wrong somewhere

It's very complicated, but at its most fundamental level, the problem with health care costs is the intermediary between buyer and seller. 

 

The immutable laws of supply and demand naturally reign in runaway costs in a free market. When the consumer does not have a personal stake in the price of services it negates those effects.

 

 

[B-Man]

'Stunning': 80% using Obamacare's Medicaid expansion are ineligible, Louisiana report finds

Losses to ineligible beneficiaries could be as high as $85 million

 

 

Louisiana’s legislative auditor wanted to know how the state’s expansion of Medicaid under Obamacare was doing, so he picked 100 people who were deemed eligible under the rules.

 

He found that 82 of them made so much money that they shouldn’t have qualified for the benefits they received.

 

Louisiana may be an outlier. A federal inspector general’s report this year found 38 out of a sample of 150 Medicaid beneficiaries in California were potentially ineligible. Taken statewide, that would mean more than 350,000 questionable customers.

 

Another report estimated nearly 50,000 questionable beneficiaries in New York.

 

The federal inspector general was looking broadly at eligibility, including residency problems and other disqualifications.

 

https://m.washingtontimes.com/news/2018/dec/4/obamacare-medicaid-expansion-beneficiaries-ineligi/

[Buffalo_Gal]

Obamacare Thrown Out by Judge, Raising Insurance Uncertainty
 

Obamacare was struck down by a Texas federal judge in a ruling that casts uncertainty on insurance coverage for millions of U.S. residents.
 

The decision Friday finding the Affordable Care Act unconstitutional comes just before the end of a six-week open enrollment period for the program in 2019 and underscores a divide between Republicans who have long sought to invalidate the law and Democrats who fought to keep it in place.
 

</snip>

 

The Hill

</snip>

The reasoning of the ruling states that in 2012, the Supreme Court upheld the mandate to have coverage because of Congress's power to tax. But, last year, Congress removed the fine for failing to comply with the mandate, which, he argues, means the mandate is no longer a tax and therefore is unconstitutional.
 

</snip>

Edited December 15, 2018 by Buffalo_Gal

[Doc Brown]

Pry goes to the Supreme Court on appeal and law is upheld by Roberts again.  Meanwhile, Trump and the GOP will have to explain how they praised the decision by the judge in Texas which if upheld will result in insurance companies jacking up the premiums or denying those with preexisting conditions.  Something the GOP promised wouldn't happen before the midterms.  Should be interesting to watch.

Edited December 15, 2018 by Doc Brown

[DC Tom]

1 minute ago, Doc Brown said:

Pry goes to the Supreme Court on appeal and law is upheld by Roberts again.  Meanwhile, Trump and the GOP will have to explain how they praised the decision by the judge in Texas which if upheld will result in insurance companies jacking up the premiums or denying those with preexisting conditions.  Something they promised wouldn't happen before the midterms.  Should be interesting to watch.

 

Insurance companies are already jacking up premiums, and deductibles.  This court decision is irrelevant to that.  Really, the most impact would be on the Medicaid expansion.

 

It's academic anyway.  This is just a necessary predecessor to getting it in front of the Supreme Court.  It doesn't change anything.