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Out of network premiums have been around for YEARS, long, long before Obamacare.
Stop trying to make people think it is something new.
Yes. Getting sick or injured outside of one's covered area has always been a worry for Americans. The other thing that happens is balance billing for services one thinks are covered (a surgery in a network facility, for example) only to find that one or more of the services were provided by an out of network provider. The patient is never told this and is surprised and often financially burdened. The ACA did address these issues to some degree, but did not go anywhere near far enough in solving the problem.
Just another day with the greatest healthcare system on earth, right guys!?!?!?
Suppressed Evidence Intentionally failing to use information suspected of being relevant and significant is committing the fallacy of suppressed evidence. This fallacy usually occurs when the information counts against one’s own conclusion.
I'll give people the facts that your refuse to give people.
The American Hospital Association created the "Out-of-Network" clause in 1939 to force non-member hospitals out of business or to force them to join the AHA. These hospitals were mainly were members or affiliated with the American Medical Association or were independent private hospitals.
In 1946, the American Hospital Association launches the Blue Cross insurance company. The "Out-of-Network" clause is the cornerstone, barring competition against the Blue Cross.
Later, during the 1980s, EMTALA was enacted to prevent the American Hospital Association/Blue Cross from dumping patients.
The American Hospital Association with help from State and federal governments created the "greatest healthcare system on earth."
The many State laws governing insurance regulation were enacted through the lobbying efforts of the American Hospital Association, so you cannot blame insurance companies.
Not only does the American Hospital Association have monopoly control over US hospitals, it is gaining monopoly control over "health insurance" companies.
I'm amazed by how much you Americans THINK you know about our health care, and how often you are wrong.
But then you think the Global Warming Fairy is real.
Quote:
Originally Posted by bobtn
That is why I want to hear a GOP plan to repeal if they find ACA inferior with concurrent replace at rates equal to or lower than ACA subsidized, with coverage superior to ACA, and with the vast majority of the uninsured finding it possible realistically to obtain said coverage. Not repeal stand alone (the old system was broken!!), repeal, concurrent replace..meeting EVERY spec listed.
That's a fallacy.
Questionable Premise If you have sufficient background information to know that a premise is questionable or unlikely to be acceptable, then you use this fallacy if you accept an argument based on that premise.
Medical care is intra-State commerce. Cite those Supreme Court decisions that you believe contradict this Truth & Reality.
Health plan coverage aka "health insurance" is intra-State commerce. Cite those Supreme Court decisions that you believe contradict this Truth & Reality.
Neither the president nor Congress have the power to repeal State laws. If you believe otherwise, cite the Supreme Court case to support your claim.
Finally, explain why your old system was broken, and cite evidence.
Just another stomping with Reality....
This kid was so sick that she had been in a vegetative state for weeks. Do you really think insurance companies should pay thousands to millions of dollars for a patient who is unlikely to have a good outcome? Americans are going to eventually have to figure out that everyone can't have every available procedure done.
Dr. Kavorkian is that you? They're going to die anyway so lets not even try to save them? Wow.
She would not have been in a vegetative state for weeks had the insurance company approved her surgery in a timely manner.
Quote:
Originally Posted by pommysmommy
I have been in this business over 30 years. I have never seen an insurer refuse to cover emergent claims at in network rates upon appeal.
I find that hard to believe. The article I just posted proves you are wrong.
According to this industry veteran turned whistleblower this kind of thing happens all the time.
Wendell Potter (born July 16, 1951) is an American expert on, plus outspoken insider-turned-critic of, the U.S. private health insurance industry -- particularly HMOs, and the sometimes-hidden tactics insurers can use to increase their profits by creatively denying policyholders their healthcare benefits when needed the most.
Potter is also an advocate for major reforms of the industry, and even single payer insurance, in some instances. Until his 2008 resignation, he was vice president of corporate communications for CIGNA,[1] one of the United States' largest health insurance companies. In June 2009, he testified against the HMO industry in the U.S. Senate as a whistleblower.[1][2][3][4] Now a senior analyst at the Center for Public Integrity, a fellow at the Center for Media and Democracy, and a consumer liaison representative to the National Association of Insurance Commissioners, among other positions, he has shared his unique expertise in high-profile interviews with Bill Moyers and other news outlets. Potter also contributes bi-weekly to The Huffington Post, including an "Ask Wendell" feature (in which he responds to readers' health care questions). In 2013 he also began contributing articles to Healthinsurance.org.[5]
No payroll taxes here, and our income taxes are about the same as yours, but I do pay a monthly premium of $69.
Quote:
Originally Posted by sanspeur
I earned over 100,000 last year, and paid about half of that, providing that the pay period was two weeks. I am not an employee, but am incorporated and draw a yearly salary, so it's a bit more complicated.
There are some pretty steep payroll taxes in Cananda, and in BC a 12% sales tax. Plus a BC province tax of 10% on $100k of income. I just plugged $100k into an online calculator for British Columbia and they take about half. It cost you a little more than $69.
I have argued for years that when the progressives are ready to tax their constituents like they do in the countries that idolize then more power to them. A family in the US earning $100k with a couple of kids and a mortgage pays half as much as the comparable family in Canada. The big tax dollars are paid by the $250k+ crowd. You know, the evil 1%'ers.
Canadian taxes are more regressive than the US. It's a trade off. It works for Canada. Good for you guys.
which is why so many didn't like Obamacare. It did absolutely NOTHING to reverse the out of control price of healthcare. There is no other industry I can think of that gets away with not advertising pricing for any services rendered. Could you imagine walking into Best Buy to pick up a TV you think should cost about 500 bucks, only to get a bill 2 months later from a store you've never heard of for 6700 bucks? The equivalent happens daily in the healthcare world, and it should be illegal.
If cost were controlled to a reasonable level, access to healthcare would be a non issue for the vast majority of America.
Instead the lobbyists got super friendly with the democrats and they came up with the abortion that is the ACA.
which is why so many didn't like Obamacare. It did absolutely NOTHING to reverse the out of control price of healthcare. There is no other industry I can think of that gets away with not advertising pricing for any services rendered. Could you imagine walking into Best Buy to pick up a TV you think should cost about 500 bucks, only to get a bill 2 months later from a store you've never heard of for 6700 bucks? The equivalent happens daily in the healthcare world, and it should be illegal.
If cost were controlled to a reasonable level, access to healthcare would be a non issue for the vast majority of America.
Instead the lobbyists got super friendly with the democrats and they came up with the abortion that is the ACA.
Putting one's life in the hands of a for-profit corporate health insurance company seems a bit like playing Russian Roulette to me. Your claim is costing them profits, and they're going to do everything they can to deny and delay your care.
Out of network premiums have been around for YEARS, long, long before Obamacare.
Stop trying to make people think it is something new.
Yeah, there was disbelief offered at that cost by a poster because he/she was thinking out of pocket max would be hit or this was just a crappy policy this woman had. But I pointed out that it was out of network and even Obamacare policies would still allow this same situation to occur.
We were getting ready to leave the area we had been with our Motor Home and he was on the roof and fell 12 foot. It was an emergency situation that resulted in a shattered elbow, broken ulna, broken radius, broken radial head.
Our only choice in this situation was out of network and the amount that is out of pocket cost for us is after the appeal and the services being covered at network rates instead of out of network rates.
Ever policy that I ever had said that an Emergency at an out of service ER was paid the same as any member of the policy would be paid....
They also said if there wasn't a hospital the could treat you for an illness within 50 mile of your home that an out of service hospital could be used and paid just as the member hospital would be paid...
I think you need to get with your state insurance board... Texas requires that the number to the insurance board be posted in the front of the policy...
Second, how much had you paid in payroll and other taxes over your life? It cost you more than $60.
Most likely less than what you paid along side what your employer contributes. Not to mention your FICA-medicare taxes you pay and can't use. Also, lets not forget those state and federal taxes you pay that ends up paying medicaid, VA and Indian Health. The Canadian pays less.
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