"if you like your doctor we don't give a ****."

txflyer

txflyer

En-Route
Joined
May 3, 2013
Messages
4,509
Location
Wild Blue Yonder
Display Name
Display name:
Fly it like you STOL it ♦
Found out last week BCBS of Texas is cancelling ALL ppo network plans for individuals and slamming us with an HMO.

They even picked our doctor for us already with no input from us. .... :mad2:

We're losing our doctor of twenty years.
 
A couple of our local doctors went concierge this year, charging patients $3000/year for "unlimited office visits".
 
As Bill said, I feel your pain.
 
I have no facts to back this up, but I can't help but believe that concierge medicine will eventually be regulated out of existence, if not banned outright. It's not part of The Plan.
 
No other insurance provider options in TX? talk about a crap deal y'all got on this one.
 
ETres said:
I have no facts to back this up, but I can't help but believe that concierge medicine will eventually be regulated out of existence, if not banned outright. It's not part of The Plan.
Click to expand...

Except for a few concierge docs in DC to take care of Congress and their staff - they just can't be bothered with the same type of medical care as the surfs.
 
Flymeariver said:
No other insurance provider options in TX? talk about a crap deal y'all got on this one.
Click to expand...


It's up to your specific area now.

In our area, there are exactly two PPO providers left. Scott & White and Humana. Both are outrageously expensive to force people to go HMO.
 
txflyer said:
It's up to your specific area now.



In our area, there are exactly two PPO providers left. Scott & White and Humana. Both are outrageously expensive to force people to go HMO.
Click to expand...



Why is HMO evil?

Why is PPO preferred?
 
How often do you have to see your doctor? Would it be cost prohibitive to pay out of pocket a few times a year?
 
txflyer said:
Found out last week BCBS of Texas is cancelling ALL ppo network plans for individuals and slamming us with an HMO.

They even picked our doctor for us already with no input from us. .... :mad2:

We're losing our doctor of twenty years.
Click to expand...

We had just 2 ACA providers here in Wyoming.. Winhealth and BCBS.

Last month Winhealth was screwed by Obamacare for not funding the obligation they promised.....

So Winhealth announced they are pulling out of the market place... Why Obama calls it a "marketplace" is a joke in itself....:mad2:..

So, my new rates for a Silver II plan is around 2 grand a month..:yikes::mad::mad:...


Ps... I HATE Obama /Pelosi/ Reed and all the rest who voted for the PPACA...
 
JoseCuervo said:
Why is HMO evil?

Why is PPO preferred?
Click to expand...


HMO (health maintenance organization) you must have one preferred provider. Your primary care physician. You must go to him for all you health needs before going to anyone else.

Take impaling a nail in your foot for instance. You cannot go to a podiatrist without going to your pcp first and getting a referrel. How this saves money according to the providers I've never figured out.

And up until now, the ppo network had many more doctors to choose from. I suspect those numbers will be changing. The last reason is our doctor does not accept any HMO's so we're screwed.
 
Van Johnston said:
How often do you have to see your doctor? Would it be cost prohibitive to pay out of pocket a few times a year?
Click to expand...


Therein lies the devil in the details.

You cannot go without health insurance in this country anymore. period. I've thought about just saying shove it and take our chances but they will get you on the back end. If you don't play their game, the IRS will levy a fine of either 2.5% of your gross income or charge you per individual what a standard bronze rate plan costs per month whichever is higher. And they will grandfather it back.

So if you just say shove it, go without insurance and pay cash, you will owe the IRS what it would have cost you for a bronze insurance plan anyway for the whole year. So you will pay one way or another. So you would be stupid not to just buy insurance.
 
N801BH said:
We had just 2 ACA providers here in Wyoming.. Winhealth and BCBS.

Last month Winhealth was screwed by Obamacare for not funding the obligation they promised.....

So Winhealth announced they are pulling out of the market place... Why Obama calls it a "marketplace" is a joke in itself....:mad2:..

So, my new rates for a Silver II plan is around 2 grand a month..:yikes::mad::mad:...


Ps... I HATE Obama /Pelosi/ Reed and all the rest who voted for the PPACA...
Click to expand...

Just point of fact, it was the newly elected republican congress who voted to rescind the "risk corridor funding" that was to finance the ACA transition period when they passed the 2014 Cromnibus spending bill, not the Obama administration reneging on promises.
 
I blame this on our sitting RINO's and the DEMS.

ACA was just a blind blanket tax when you get down to brass tacks.
 
txflyer said:
I blame this on our sitting RINO's and the DEMS.

ACA was just a blind blanket tax when you get down to brass tacks.
Click to expand...

You don't have to "get down to brass tacks" to reach that conclusion; it is a tax, pure and simple.
 
Chip Sylverne said:
Just point of fact, it was the newly elected republican congress who voted to rescind the "risk corridor funding" that was to finance the ACA transition period when they passed the 2014 Cromnibus spending bill, not the Obama administration reneging on promises.
Click to expand...

So Obama didn't sign it?
 
Our Doc went concierge, as well. . .he does print the claim form for BC/BS, and we're reimbursed for out of plan. Funny thing is, it now makes sense to see him MORE often, to get the reimbursments to offset his annual fixed fee. . .
 
txflyer said:
HMO (health maintenance organization) you must have one preferred provider. Your primary care physician. You must go to him for all you health needs before going to anyone else.

Take impaling a nail in your foot for instance. You cannot go to a podiatrist without going to your pcp first and getting a referrel. How this saves money according to the providers I've never figured out.

And up until now, the ppo network had many more doctors to choose from. I suspect those numbers will be changing. The last reason is our doctor does not accept any HMO's so we're screwed.
Click to expand...

Well, considering you don't need to go to a podiatrist for a nail in your foot, that can be handled by a non-specialist just fine initially. If you want to see a podiatrist on your own nickel thats fine. And your PCP under HMO would be doing their job if they told you you didn't need the specialist.

I'm not all cuckoo for cocoa puffs over obamacare and healthcare reform they way its playing out, but this is a private insurer making a business decision, NOT an exchange plan on the healthcare marketplace. These business decisions were happening before ACA. It may not be apples and oranges here, but more like oranges and tangerines. They are still different.

Before ACA, insurance providers managed the expense of the insured by excluding pre-existing conditions. Now, since that exclusion no longer exists, insurance providers are managing costs by forcing the insured into HMO's (which have lower costs to them overall) and pricing PPO's out of reach for the common man..

You are quite entitled to be mad over these changes. But dont be hoodwinked into blaming the wrong villians..
 
txflyer said:
Therein lies the devil in the details.

You cannot go without health insurance in this country anymore. period. I've thought about just saying shove it and take our chances but they will get you on the back end. If you don't play their game, the IRS will levy a fine of either 2.5% of your gross income or charge you per individual what a standard bronze rate plan costs per month whichever is higher. And they will grandfather it back.

So if you just say shove it, go without insurance and pay cash, you will owe the IRS what it would have cost you for a bronze insurance plan anyway for the whole year. So you will pay one way or another. So you would be stupid not to just buy insurance.
Click to expand...

I wasn't suggesting going without insurance. I'm suggesting that if you don't have a chronic illness that requires lots of visits, keep going to your doctor, and pay him out of pocket. Don't you have a large deductible anyway? He would probably prefer cash, and give you a discount for it.
 
txflyer said:
I blame this on our sitting RINO's and the DEMS.

ACA was just a blind blanket tax when you get down to brass tacks.
Click to expand...

In fairness, ONLY Dems voted for this atrocity. Why they're not held accountable for it is a testament to the growing percentage of stupid people in our country.
 
txflyer said:
HMO (health maintenance organization) you must have one preferred provider. Your primary care physician. You must go to him for all you health needs before going to anyone else.

Take impaling a nail in your foot for instance. You cannot go to a podiatrist without going to your pcp first and getting a referrel. How this saves money according to the providers I've never figured out.

And up until now, the ppo network had many more doctors to choose from. I suspect those numbers will be changing. The last reason is our doctor does not accept any HMO's so we're screwed.
Click to expand...

In short, it's PRO CHOICE.

I thought the Leftists were on-board for that concept?
 
Doggtyred said:
Before ACA, insurance providers managed the expense of the insured by excluding pre-existing conditions. Now, since that exclusion no longer exists, insurance providers are managing costs by forcing the insured into HMO's (which have lower costs to them overall) and pricing PPO's out of reach for the common man.. .
Click to expand...

Before ACA, a competing insurer would have offered a low cost PPO to pick up those consumers. With the restraint on yhe market created by the misnamed 'marketplaces', there is no incentive for a insurer to do so.
 
Zeldman said:
It has only just started.
Click to expand...

Started? it sure has my premiums in 2014 when I bought my own health insurance was $830/mo. , then I got forced into Obama care and for 2016 the same plan is $,1856. but I get eye and dental, for children, mental and substance abuse coverage, birth control by murder, my kids are grown, I do not drink smoke, or do drugs. and do not kill. But I pay for that coverage.
I did get to keep my Doc for now. but told me he is thinking about retiring early due the BS.

The real screwing is coming with the tax credits, no one knows what household income really means and many will be getting big surprises when the IRS says you got too much credit. this is a cluster screwing
 
As a disabled Veteran, I see the doctors at the VA clinic twice a year. It's NOT FREE. I paid dearly for what they do to keep me going. But, thanks to healthcare being run by the IRS, I still pay for health insurance that I never use. Got to blame the Dems for screwing all disabled Veterans.
 
txflyer said:
Well excuse the **** out of me for using a coloquialism. :dunno:
Click to expand...

...not digging at you at all; merely agreeing with extreme prejudice! :yes:
 
cgrab said:
As a disabled Veteran, I see the doctors at the VA clinic twice a year. It's NOT FREE. I paid dearly for what they do to keep me going. But, thanks to healthcare being run by the IRS, I still pay for health insurance that I never use. Got to blame the Dems for screwing all disabled Veterans.
Click to expand...

I thought veterans with VA medical benefits were exempt from Obamacare?
 
Mason said:
So Obama didn't sign it?
Click to expand...

Yeah, he signed it.

Wasn't his program. "Risk corridors" funding was part of Bush's Medicare Part D legislation, not the ACA. The republicans gave, the republicans took away.
 
Chip Sylverne said:
Yeah, he signed it.

Wasn't his program. "Risk corridors" funding was part of Bush's Medicare Part D legislation, not the ACA. The republicans gave, the republicans took away.
Click to expand...

The non-profit ACA plans failing has nothing to do with part D.
 
weilke said:
The non-profit ACA plans failing has nothing to do with part D.
Click to expand...

The risk corridors funding program is a Medicare part D subsection. It was to shield insurance companies from expanded coverage losses, and rebate ny excess profits back to the government.

http://www.ncbi.nlm.nih.gov/pubmed/19124873

The ACA risk corridors were to go away in 2016.
Part D's, I believe, are still in place.
 
Last edited:
cgrab said:
As a disabled Veteran, I see the doctors at the VA clinic twice a year. It's NOT FREE. I paid dearly for what they do to keep me going. But, thanks to healthcare being run by the IRS, I still pay for health insurance that I never use. Got to blame the Dems for screwing all disabled Veterans.
Click to expand...

Talk to your accountant or a counselor at your Veterans' Service Center. I think that anyone enrolled in the VA health care system is exempt from the Obamacare mandate, regardless of eligibility basis or priority level.

If that's true, then even if your VA care only covers treatment for your service-related disability, it may allow you to save some coin by enrolling in a less-expensive, non-conforming plan (assuming that any still exist). Or you may be able to ditch the insurance altogether and receive care from the VA for non service-related problems if you agree to a co-pay and/or deductible for that care.

It doesn't cost anything to ask.

Rich
 
Chip Sylverne said:
The risk corridors funding program is a Medicare part D subsection.
Click to expand...

Those plans didnt even exist when part D was passed. They would have needed funding through the ACA to work but including that funding would have ballooned up-front cost. The HOPE was that someone else would pick up the tab.

How could the people who allocated funding and math for the risk corridor program possibly calculate cost for a system of new health plans that was only created 8 years later ? To blame the demise of the ACA coops on part D shows a typical entitlement mindset.
 
Last edited:
weilke said:
Those plans didnt even exist when part D was passed. They would have needed funding through the ACA to work but including that funding would have ballooned up-front cost. The HOPE was that someone else would pick up the tab.

How could the people who allocated funding and math for the risk corridor program possibly calculate cost for a system of new health plans that was only created 8 years later ? To blame the demise of the ACA coops on part D shows a typical entitlement mindset.
Click to expand...

The coops were promised short-term funding. The short-term funding dried up.
They failed. Where's the mystery?

Without short-term funding, Part D would have failed too. First year the insurance companies were bailed out to the tune of $2.5 billion. In recent years, money has been returned to Medicare because profits exceeded bid projections.

Risk corridors are another name for short term funding.
 
Last edited:
Chip Sylverne said:
Risk corridors are another name for short term funding.
Click to expand...

Should have written the required funding into the ACA. We knew from the medicaid HMO programs that the cheapest option attracts the sickest customers. 'What do you think would happen? '
 
Since turnabout is fair play, I'll pose your question back to you. How are the underwriters supposed to know with exact precision what the loss experience will be until they establish the book and the loss ratio? Actuaries set the rates based on their best estimates, state insurance commissioners approve them.

Nobody starts a business without a line of credit.
 
Last edited:
Van Johnston said:
How often do you have to see your doctor? Would it be cost prohibitive to pay out of pocket a few times a year?
Click to expand...

Just my experience. Small business owner with individual policy. Good health, mid 40's.

I pay $1100/month for 5500 deductible health insurance. Never met my deductible or even come close. Everything was a well visit.

This year, my flight physicial picked up something that turned out to be diverticulitis. Ended up needing surgery.

I never knew how much hospital tx cost until the EOBs started rolling in the mail. My wife said at one point, we had>$50k in claims being processed. I'm guessing we are in the 70-100 range once everything settles.

Two points to my post: 1) you never knew when something major will hit and 2) having insurance reduces the cost for a lot of services. I noticed most of my bills were adjusted down 50-75%. So, it does help a little for regular stuff
 
You must log in or register to reply here.
Back
Top