Kidmd
12 years ago

This is not the first time I have heard this. My child's pediatrician foresaw this a few years ago. He told me that he was considering retiring (he's about 50 now). He said that he was having to see more and more patients to make a decent living. Costs were going through the roof in terms of added staff to complete paperwork, file claims etc....

Abrignac wrote:



What do ya think KIDMD stands for?

Think about it...:-k
😉

BTW the kaiser foundation is a very liberal group...kinda out of touch..
Abrignac
12 years ago

What do ya think KIDMD stands for?

Think about it...:-k
😉

BTW the kaiser foundation is a very liberal group...kinda out of touch..

Kidmd wrote:




You have to really love children. If you did it for the $$$ you would have chosen something different. Kudos to you.

BTW, FIL is a retired Orthopod and BIL is a GS.
jackconrad
12 years ago

I don't know how "factual" this is, but considering the Kaiser Family Foundation is a sorta unofficial cheerleader for this here are some examples. The complete document can be found here:

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8303.pdf 


A bronze plan with 20 percent coinsurance – a typical level under coverage today – and an out-of-pocket cost-sharing limit of $6,350 would have a single deductible of $4,375. Increasing the patient coinsurance level to 40 percent would lower the deductible by $900 to $3,475. Under both scenarios the deductibles are significant and would be considered catastrophic plans, particularly for people without significant personal savings. These plans would also meet the requirements for tax-preferred Health Savings Accounts.

The deductibles are more modest for silver plans with the same coinsurance and out-of-pocket limits. A silver plan with 20 percent coinsurance and an out-of-pocket cost-sharing limit of $6,350 would have a deductible of $2,050. Increasing the patient coinsurance level to 40 percent would lower the deductible to $650.

Seems REAL affordable to me.

Abrignac wrote:




I know you mean well but not only dod you have your plans mixed up

Bronze = 60/40

Silver (Considered standard)= is a 70/30

Gold = 80/20

Platinum ( I am almost afraid to say that here ! = 90/10

Those big deductibles you talk about are not in fact deducible but out of pocket maximums

Also almost all preveative , wellness and checkups are no co-pay .

And also remember that most private insurance plans have a 1 to 2 million dollar maximum life time payout and these plans are limitless maximums.


I am a long time Insurance professional and have seen the plans and in spite of what you might hear in the Media they are simple to understand.
HockeyDad
12 years ago
There is an out-of-pocket max.
There is a deductible.

What are the amounts for bronze, silver, gold, platinum.
teedubbya
12 years ago

There is an out-of-pocket max.
There is a deductible.

What are the amounts for bronze, silver, gold, platinum.

HockeyDad wrote:



I'd have to look it up (OOP Max). I think deductable, coins, copay etc. can vary because it's based more on actuarial value.

"Bronze - 60% AV (the QHP issuer pays, on average, 60% of the cost of EHB coverage) Silver - 70% AV (the QHP issuer pays, on average, 70% of the cost of EHB coverage) Gold - 80% AV (the QHP issuer pays, on average, 80% of the cost of EHB coverage) Platinum - 90% AV (the QHP issuer pays, on average, 90% of the cost of EHB coverage)

The health plan category a consumer chooses affects the total amount he or she will likely spend on EHB during the year. Consumers who choose a plan in a higher health plan category (e.g., Gold or Platinum) will pay higher monthly premiums on average, but will pay less for cost-sharing expenses (e.g., deductibles, coinsurance, and copayments). For example, if a plan has an AV of 70%, on average, the consumer would be responsible for 30% of the cost of covered benefits. However, consumers could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on their actual health care needs."
HockeyDad
12 years ago

I'd have to look it up (OOP Max). I think deductable, coins, copay etc. can vary because it's based more on actuarial value.

"Bronze - 60% AV (the QHP issuer pays, on average, 60% of the cost of EHB coverage) Silver - 70% AV (the QHP issuer pays, on average, 70% of the cost of EHB coverage) Gold - 80% AV (the QHP issuer pays, on average, 80% of the cost of EHB coverage) Platinum - 90% AV (the QHP issuer pays, on average, 90% of the cost of EHB coverage)

The health plan category a consumer chooses affects the total amount he or she will likely spend on EHB during the year. Consumers who choose a plan in a higher health plan category (e.g., Gold or Platinum) will pay higher monthly premiums on average, but will pay less for cost-sharing expenses (e.g., deductibles, coinsurance, and copayments). For example, if a plan has an AV of 70%, on average, the consumer would be responsible for 30% of the cost of covered benefits. However, consumers could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on their actual health care needs."

teedubbya wrote:




but Jack says we got deductibles and out of pocket mixed up and you say these things can vary.
teedubbya
12 years ago
I'm no expert, just referring to the navigator training. I beleive they can. I think thre are a lot of variables but it all boils down to the AV.... there are multiple ways of designing a benefit plan to get to the same place.

To be honest I'm a bit confused by the whole scenario above and question it a bit..... that said they very well could be confusing OOP and ded in this instance...... I dunno. Without actually looking at specifics it's hard to tell but does seem odd given AV must be attached. (Jack's intincts on this one may very well be correct)
HockeyDad
12 years ago
It sounds like we're just going to have to pass this to see what's in it.
teedubbya
12 years ago

It sounds like we're just going to have to pass this to see what's in it.

HockeyDad wrote:



I did that the other day. Turns out I must have eaten corn.
HockeyDad
12 years ago

I did that the other day. Turns out I must have eaten corn.

teedubbya wrote:




I hate when that happens.
Abrignac
12 years ago

I know you mean well but not only dod you have your plans mixed up

Bronze = 60/40

Silver (Considered standard)= is a 70/30

Gold = 80/20

Platinum ( I am almost afraid to say that here ! = 90/10

Those big deductibles you talk about are not in fact deducible but out of pocket maximums

Also almost all preveative , wellness and checkups are no co-pay .

And also remember that most private insurance plans have a 1 to 2 million dollar maximum life time payout and these plans are limitless maximums.


I am a long time Insurance professional and have seen the plans and in spite of what you might hear in the Media they are simple to understand.

jackconrad wrote:




Actually I copied and pasted from this which was the third line in the post you quoted.:

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8303.pdf 

Having been a licensed agent myself who, among other plans, sold health insurance, I'm capable of reading a plan document. Problem is a cursory search on the net didn't reveal one. This was the best I found. But, I would love a link to actual plan documents if you have one. I would guess these plans are going to follow the same type of logic the NAIC used when crafting basic health insurance policies, medicare supplements and long term care policies.
Abrignac
12 years ago
https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/ 

All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover.

The essential health benefits include at least the following items and services:
•Ambulatory patient services (outpatient care you get without being admitted to a hospital)
•Emergency services
•Hospitalization (such as surgery)
•Maternity and newborn care (care before and after your baby is born)
•Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
•Prescription drugs
•Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
•Laboratory services
•Preventive and wellness services and chronic disease management
•Pediatric services

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.


No mention is made at all regarding whether or not there is a co-pay any for these services.

The search continues....
bloody spaniard
12 years ago

Actually I copied and pasted from this which was the third line in the post you quoted.:

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8303.pdf 

Having been a licensed agent myself who, among other plans, sold health insurance, I'm capable of reading a plan document. Problem is a cursory search on the net didn't reveal one. This was the best I found. But, I would love a link to actual plan documents if you have one. I would guess these plans are going to follow the same type of logic the NAIC used when crafting basic health insurance policies, medicare supplements and long term care policies.

Abrignac wrote:



I didn't know you dabbled in insurance as well. Very cool. So did I.
Great speaking with you today, Abri.

Wonder if Obamacare will eventually just become a more expensive (and limited) mishmash version of the Medicaid/care with private carriers that we currently enjoy?
Abrignac
12 years ago
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html 

Coverage of Preventive Services



PHS Act section 2713 and the interim final regulations[5] require non-grandfathered group health plans and health insurance coverage offered in the individual or group market to provide benefits for and prohibit the imposition of cost-sharing requirements with respect to, the following:

■ Evidenced-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) with respect to the individual involved;
■ Immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved;
■ With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); and
■ With respect to women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by HRSA, to the extent not already included in certain recommendations of the USPSTF.[6]

If a recommendation or guideline does not specify the frequency, method, treatment, or setting for the provision of that service, the plan or issuer can use reasonable medical management techniques to determine any coverage limitations.[7]

These requirements do not apply to grandfathered health plans
Abrignac
12 years ago
http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm 

Grade Definitions After July 2012

What the Grades Mean and Suggestions for Practice

The USPSTF updated its definition of and suggestions for practice for the grade C recommendation. This new definition applies to USPSTF recommendations voted on after July 2012. Describing the strength of a recommendation is an important part of communicating its importance to clinicians and other users. Although most of the grade definitions have evolved since the USPSTF first began, none has changed more noticeably than the definition of a C recommendation, which has undergone three major revisions since 1998. Despite these revisions, the essence of the C recommendation has remained consistent: at the population level, the balance of benefits and harms is very close, and the magnitude of net benefit is small. Given this small net benefit, the USPSTF has either not made a recommendation “for or against routinely” providing the service (1998), recommended “against routinely” providing the service (2007), or recommended “selectively” providing the service (2012). Grade C recommendations are particularly sensitive to patient values and circumstances. Determining whether or not the service should be offered or provided to an individual patient will typically require an informed conversation between the clinician and patient.


Grade

Definition

Suggestions for Practice

A The USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer or provide this service.

B The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Offer or provide this service.

C The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Offer or provide this service for selected patients depending on individual circumstances.

D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service.

I Statement The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.


jpotts
12 years ago

Now Jpotts,
It really isn't national healthcare. The ACA forces people to buy insurance, from insurance companies, and regulates, and in some cases subsidizes those companies. That is nothing like nationalized healthcare. National healthcare, would be fully funded by the government, and would be paid for by taxpayers. As it is, the ACA still requires for profit insurance companies to work.

Dave (A.K.A. Homebrew)🍺

Homebrew wrote:



If they federal government is subsidizing something, they are therefore funding them. They get that money from taxpayers.

And if they force you into buying insurance, that's the same as the federal government dipping into your pocket, taking your money, and giving it to these insurance companies.

And should the majority of those companies go out of business? The federal government will step in and fund those that survive, mainly because they are now vested into funding healthcare insurance for everyone.

You can sit there and try and draw distinctions, but the reality is that those health insurers are de facto government agents, much like state-mandated monopolies that we call "utilities." So we now have nationalized healthcare.

And it will bankrupt this nation.
Bur
  • Bur
  • Herf-A-Holic
12 years ago
You mean like all the states that rely on tobacco settlement money that are now long-term business partners with the cigarette companies?
So for those keeping score at home:

Government colluding with tobacco companies to ensure settlement checks keep coming in while spending money on smoking cessation ads and programs
Government colluding with health insurance companies to ensure "marketplaces" function (pay no attention to classic meaning of marketplace)

Next thing you know the government will fund an organization to foster peace and positive international relations, maybe even give it a martial name like "Peace Corps" while spending trillions on weapons and military. Naw, what am I thinking?

drip, drip, drip
Billman
12 years ago
↑ what? No way man! Our elected officials would never go for something like that!......is the NSA still watching?
Kidmd
12 years ago
IS EVERYONE SUFFICIENTLY CONFUSED?????

No wonder the billing companies are telling me to get a line of credit for the first quarter of 2014.. They are anticipating payment delays to doctors for up to 3-4 months....
What other profession gets paid (maybe) 3 months later? And at a lower rate..

I personally am NOT going to accept patients on these insurances, minimal pay..if you get paid at all....FORGET it!
Abrignac
12 years ago

IS EVERYONE SUFFICIENTLY CONFUSED?????

No wonder the billing companies are telling me to get a line of credit for the first quarter of 2014.. They are anticipating payment delays to doctors for up to 3-4 months....
What other profession gets paid (maybe) 3 months later? And at a lower rate..

I personally am NOT going to accept patients on these insurances, minimal pay..if you get paid at all....FORGET it!

Kidmd wrote:




Seems you are not the only one.

*******************************************************************************


Obamacare Fallout: More Doctors Opting Out of Medicare

Monday, 29 Jul 2013 10:06 AM

By Sandy Fitzgerald


Three times more doctors are refusing Medicare patients than three years ago, many citing Medicare's increasing rules and lowered payment rates.

According to the Centers for Medicare and Medicaid Services, which administers the program, even doctors who still see some Medicare patients are limiting the number of Medicare patients they will treat, reports The Wall Street Journal.

The declines are in addition to the growing number of doctors who won't accept new Medicaid patients, and come just as millions of Americans are poised to become eligible for coverage under Obamacare.

The numbers of doctors refusing both Medicare and Medicaid payments won't completely undermine Obamacare, health experts say, but some patients may have problems finding doctors who will accept their new coverage under the healthcare-reform law.

According to the Centers for Medicare and Medicaid Services, 9,539 doctors who had accepted Medicare payments opted out of the program last year. That seems like a large number, but 685,000 doctors nationally were enrolled as participating Medicare physicians in 2012.

Eight-one percent of them were family doctors, a drop from 83 percent in 2010, the American Academy of Family Physicians reports. The journal Health Affairs, however, reported this month that one-third of primary-care physicians did not accept new Medicaid patients in 2010-2011.

Part of the problem is that Medicare payment rates have not kept pace with inflation, and Medicare reimbursements could be slashed by 25 percent next year unless Congress delays the cuts. In addition, the amount of paperwork and information required from doctors and providers is massive.

"Family physicians have been fed up for a long time and it's getting worse," said Jeffrey Cain, president of the American Academy of Family Physicians.

When doctors opt out of programs such as Medicaid and Medicare, they can practice based on patients' needs instead of worrying about reimbursement rates, he said.


http://www.newsmax.com/Newsfront/Obamacare-Medicare-doctors-drop/2013/07/29/id/517497#ixzz2gnvzi7Hn 

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