Health insurance premium increases (surgeon, California, ER, companies)

[baileyvpotter]

Originally Posted by modhatter

And I don't think people want "everything done" necessarily. Unnecessary or questionable procedures are generally at the recommendation of doctors, not patients. Reminds me again of a story I have told here before.

When visiting with a new Neurologist concerning my extensive neuropathy after chemo, he suggested another test (that I had recently had in the hospital) that measures the degree of damage to the nerves. I asked him if anything could be done to improve my current condition and he answered no. So then I said to him. "Then why have another test?" He answered me by saying. "Why did I care, Medicare was picking up the tab, not me." Of course you have to understand that the doctor had all the equipment in his office and would be doing the procedure himself. (and benefiting from it) Did not go back to that doctor.

Originally Posted by Robyn55

I have excellent access to my PCP and health care in general because I'm in a concierge practice. Also - because of my Medicare/Medigap coverage - I pretty much pay nothing "extra" out of pocket no matter how much healthcare I "use". Still - I don't go to the doctor unless necessary. And - like you Modhatter - I always ask what a doctor will do on the basis of a test result before agreeing to get a test. Because a fair number of tests are uncomfortable - have various risks - etc. I don't believe in "treating the chart".

^^^Glad some mentioned about additional procedures and tests. modhatter gave an excelllent
example of what many health care providers request. There have been doctors who have suggested
or recommended certain tests but patients need to become more proactive and educated if those
tests are really necessary. For example, one doctor suggested a stress test and the doctor's
answer was "well you do have insurance." I agreed, however he really did push the nuclear.
I told him no, I would do the basic test. He rewrote the order and after further research
I found out both were just as effective (in my case) but the nuclear test cost at least 2-3 thousand
dollars more. That is one out of many examples and reasons why health care costs and insurance
rates are high.
As for concierge practitioners, there is yearly fee a patient pays and those physicians
only have a limited number of patients. I also had an excellent specialist who switched to a concierge
practice but his annual fee is over $3,000.00 a year and he does take insurance. Not everyone
can afford a boutique doctor.


https://www.medicare.gov/coverage/concierge-care.html

[Robyn55]

Originally Posted by modhatter

That might be true, but I would not be one to encourage young people to opt out of carrying a policy. It could have devastating consequences that would mar their entire future. Even the lowest costing bronze plan with a high deductible is a much better alternative to going bare.

Agreed about not going bare. I was just trying to explain how the penalty works for people who decide to go bare.

Well, then you are fortunate, wherever you live. Has not been the case for me in either Florida , Arizona or Nevada. I am sure the availability of doctors to patients has a big play in the matter, as well as the policy you hold and the size of your network.

Our experience in Florida has been similar to yours. We wound up in the Mayo concierge practice when our non-Mayo PCP closed down her office and we were looking for a new PCP. The non-Mayo PCPs in our area that were accepting new Medicare patients were pretty bad in many respects. And Mayo wasn't accepting any new Medicare patients in its primary care department. The only way we could in - through the back door - was by joining the concierge practice (separate from the primary care department). Robyn

[stevemorse]

Originally Posted by KathrynAragon

So in other words, we can just get poor and get government handouts. That's pretty bleak - and really goes against our work ethic and our personal goals.

We have to save for retirement. If we intentionally make ourselves poor enough to qualify for ACA subsidies, we can't save for retirement.

We don't live lavishly. We're comfortable but we're not rich. We're in that upper middle class that gets no break tax wise or subsidy wise. We're not even old enough to qualify for property tax freezes!

Bravo, your a rare bird Kathy. I know several people who run their own business, hide cash and claim a lower income and get a good discount w/ the ACA care act. One guy I know bragged how he makes 100k but hides most of it, covers just enough to pay his bills and gets a great plan with a huge discount. Its sad. I have no way to hide cash, my money is made thru capital gains and dividends so no break for me too. I have to pay full price and pay for the liar. Your a good women to not consider hiding money. Very rare in todays greedy world.

[stevemorse]

Originally Posted by texan2yankee

Of course many of us saw this insurance disaster coming when the ACA was passed. I didn't vote for any of the politicians who pushed this legislation through the Congress. Many of those politicians have been thrown out in the last midterms. I suspect others who passed it will also be removed by the voters in the next election cycle.

Somehow the architect of this mess has remained unscathed. Regardless, we are stuck with Obamacare as it would take a miracle to repeal it.

This coming year my policy's annual premiums goes up to $1154 a month for my spouse and I, my deductible went up $1000 to $6800 for each of us, my drug coverage completely disappeared, in fact all previous benefits disappeared unless we reach our deductible. This year we used our insurance for one $15 drug for ear med, one dr. visit for a swimmer ear infection, and two "free" physical visits for our $12,000 in premium payments. Lucky us!

We basically have a very expensive, catastrophic insurance policy we are required to have by law instead of the one we had previously that fit our needs. To say I'm unhappy, no a better word is angry, is an understatement.

im in the same boat. I could have had a much cheaper plan but it did not meet the ACA requirements.

[Ummagumma]

The problem is that there's no cost control and no measures in place to make sure the doctor / hospital / insurance don't just grossly overcharge you. Yes the insurances are (mainly) non-profit but they tend to belong to for-profit corporations..

You go to a car mechanic, you get a written estimate upfront. You go to a doctor or, God forbid, an emergency room, and they can charge you whatever they want - the sky is the limit - and you won't know until you get the bill.

The entire US medical health industry is built on fraudulent charges. ACA made it worse but it didn't create this situation.

[Qwerty]

Originally Posted by Ummagumma

The problem is that there's no cost control and no measures in place to make sure the doctor / hospital / insurance don't just grossly overcharge you. Yes the insurances are (mainly) non-profit but they tend to belong to for-profit corporations..

You go to a car mechanic, you get a written estimate upfront. You go to a doctor or, God forbid, an emergency room, and they can charge you whatever they want - the sky is the limit - and you won't know until you get the bill.

The entire US medical health industry is built on fraudulent charges. ACA made it worse but it didn't create this situation.

There are cost controls. The first control is the free market and we are seeing that in play with the HSA plans people have and they are shopping around for the best price, like they would do with a car. Before these plans, people mostly blindly went for care without regard for cost because it only "cost" $20 or whatever their copay was. Second is the usual and customary reductions from the insurance companies. A contracted doctor can certainly charge $10,000 for doing a test for strep throat, but the insurance company will only pay $79 or whatever the negotiated rate is for that procedure, which is why you want to stay in network for care. You can also get an estimate, just like you can from your mechanic, but keep in mind it is an estimate and if they find something else, you will be charged for it, just like you would at your mechanic if you go in for an oil change and they find that your timing belt is broken, you can opt not to get the timing belt fixed or pay more for that additional service.

[ansible90]

Originally Posted by KathrynAragon

We own our own company - and are successful at owning our own company. Consequently we pay a lot of federal taxes (in addition to our health insurance costs). We would have to give up our successful business in order to "find a job that offers insurance." Wow, what a great option that is (not).

Two things I'm curious about.

Since you own your own company, is it possible to have the company set up a group plan that you could then be members of? And would that make the insurance premiums tax deductible from the company's bottom line? I don't know how this might affect the rates but it might be worth looking into.

Second. Are you in Texas? Is that one of the states that didn't take the ObamaCare Medicaid expansion? That was supposed to keep the poorer uninsured out of the emergency rooms, and thus lower costs for all across the board. I haven't heard how that is working out (i.e., reducing overall costs) in states that did take Medicaid expansion.

[ansible90]

Originally Posted by aquamarin

I would never ever pay $13,644 per year in premiums. Screw health insurance companies... My suggestion is to look in Obamacare plans for better options.

FYI - The ObamaCare plans ARE from the insurance companies.

But I agree, it's a good idea to look there.

[Qwerty]

Originally Posted by ansible90

Two things I'm curious about.

Since you own your own company, is it possible to have the company set up a group plan that you could then be members of? And would that make the insurance premiums tax deductible from the company's bottom line? I don't know how this might affect the rates but it might be worth looking into.

Second. Are you in Texas? Is that one of the states that didn't take the ObamaCare Medicaid expansion? That was supposed to keep the poorer uninsured out of the emergency rooms, and thus lower costs for all across the board. I haven't heard how that is working out (i.e., reducing overall costs) in states that did take Medicaid expansion.

It's been suggested but she doesn't work and her husband is the only employee and she doesn't want to change that and look into those options.

[KathrynAragon]

Originally Posted by stevemorse

Bravo, your a rare bird Kathy. I know several people who run their own business, hide cash and claim a lower income and get a good discount w/ the ACA care act. One guy I know bragged how he makes 100k but hides most of it, covers just enough to pay his bills and gets a great plan with a huge discount. Its sad. I have no way to hide cash, my money is made thru capital gains and dividends so no break for me too. I have to pay full price and pay for the liar. Your a good women to not consider hiding money. Very rare in todays greedy world.

Well, thank you - and no, I'm not going to lie to the IRS. That crap will catch up with a person in the long run. No thanks!