Aetna Slowly Bailing out of ACA Public Health Insurance Exchange

[TranquilMind]

http://www.msn.com/en-us/money/healthcare/aetna-to-cut-back-70percent-on-obamacare-plans-in-2017/ar-BBvFIOq?li=BBnb7Kz

 

I wonder how fast the others will follow.  Humana is also cutting way back.  

 

This is clearly not sustainable. Time will tell. 

 

 

 

 

 

 

Edited August 16, 2016 by TranquilMind

[hjffkj]

Isn't united healthcare also cutting back? I know they are staying in the Medicaid program but I recall seeing they are backing out the exchange in many states

[Mergath]

Hopefully this will be yet another step toward single-payer healthcare. 

[maize]

Hopefully this will be yet another step toward single-payer healthcare.

Yeah, I really don't think the for-profit model works if you want to insure an entire population.

 

I'd be happy with single payer plus top-up plans.

 

But the insurance industry will fight that tooth and nail.

[umsami]

Yes, will hopefully push for Medicare for all.  For-profit health insurance really has no business existing.  Aetna had $790 million in net income Q2 this year.  They're doing fine IMHO, but are greedy. 

[TranquilMind]

Hopefully this will be yet another step toward single-payer healthcare. 

 

Single payer healthcare is fine, so long as we retain privacy.  How do we do that?  Until the past couple of years, you could go to the doctor and keep your business to yourself if you wanted.  You can still go to private doctors and do this. 

 

I just don't want the government dictating that all 40 year olds need to do or get this, or all 60 year olds must follow this protocol.  It's none of their business what a person and his doctor decides to do.

 

It's already horrendous with insurance.  We had - wouldn't you know - the insurance company well known to be draconian about demands to be met to cover tonsil removal.  It demanded some ridiculous number of documented cases of strep (there are other very legitimate reasons to remove tonsils, such as ongoing swelling, sleep apnea, etc.).  We were told we should make our kid suffer another year or two  or ten or however long it took to get documented cases of STREP (specifically).

 

Screw you, insurance company.   We paid out of pocket.    Our kid is well now.  The insurance company was happy to take tens of thousands of dollars over time to "cover" us, only to never really cover anything useful or expensive. 

 

Lots of parents don't have that option and so they just get to suffer.  We need to eliminate insurance companies and minimize single payer role to merely administrative, if we go that way. 

 

Insurance industry, like all entities, will resist extermination, so I'm not sure how it will try to take over in some other way to sustain itself, but it will happen. 

 

So over it.

In some countries, you just do your thing, the docs make recommendations which you may or may not decide to take, and everything is covered. 

 

Edited August 16, 2016 by TranquilMind

[Lanny]

Yes. I'd read about that this morning. There is at least one county in the Phoenix area that will not have anyone willing to write coverage in 2017 on the exchanges.  The State of Arizona is trying to tempt other companies into writing  coverage in that county.  

 

The officers of the insurance companies have a fiduciary responsibility to the stockholders and if they are in a business that is not sustainable, they must cut their losses and end that business. If they don't do that, they are liable to the stockholders.  

 

The problem seems to be that a majority of people enrolling via the Exchanges have extremely expensive medical problems and that at the current premium rates, the insurance companies are losing a lot of money in the exchanges.

 

There are no easy answers to complex problems. 

[TranquilMind]

Yes, will hopefully push for Medicare for all.  For-profit health insurance really has no business existing.  Aetna had $790 million in net income Q2 this year.  They're doing fine IMHO, but are greedy. 

 

Amen!  So TRUE. 

That's just obscene.

 

[Lady Florida.]

Yeah, I really don't think the for-profit model works if you want to insure an entire population.

 

I'd be happy with single payer plus top-up plans.

 

But the insurance industry will fight that tooth and nail.

 

Yep. The insurance industry is part of the reason ACA kept getting watered down until it was barely recognizable from its original form.

 

Yes, will hopefully push for Medicare for all.  For-profit health insurance really has no business existing.  Aetna had $790 million in net income Q2 this year.  They're doing fine IMHO, but are greedy. 

 

Exactly. And they keep getting greedier. Greed is the reason for pulling out. It's so obvious that there should be no question about that. 

Edited August 16, 2016 by Lady Florida.

[ktgrok]

Yes. I'd read about that this morning. There is at least one county in the Phoenix area that will not have anyone willing to write coverage in 2017 on the exchanges.  The State of Arizona is trying to tempt other companies into writing  coverage in that county.  

 

The officers of the insurance companies have a fiduciary responsibility to the stockholders and if they are in a business that is not sustainable, they must cut their losses and end that business. If they don't do that, they are liable to the stockholders.  

 

The problem seems to be that a majority of people enrolling via the Exchanges have extremely expensive medical problems and that at the current premium rates, the insurance companies are losing a lot of money in the exchanges.

 

There are no easy answers to complex problems. 

 

They are totally sustainable. Overall they are making HUGE profits. They just want ever more. It's greed, not lack of sustainability. 

[Mergath]

Single payer healthcare is fine, so long as we retain privacy.  How do we do that?  Until the past couple of years, you could go to the doctor and keep your business to yourself if you wanted.  You can still go to private doctors and do this. 

 

I just don't want the government dictating that all 40 year olds need to do or get this, or all 60 year olds must follow this protocol.  It's none of their business what a person and his doctor decides to do.

 

It's already horrendous with insurance.  We had - wouldn't you know - the insurance company well known to be draconian about demands to be met to cover tonsil removal.  It demanded some ridiculous number of documented cases of strep (there are other very legitimate reasons to remove tonsils, such as ongoing swelling, sleep apnea, etc.).  We were told we should make our kid suffer another year or two  or ten or however long it took to get documented cases of STREP (specifically).

 

Screw you, insurance company.   We paid out of pocket.    Our kid is well now.

 

Lots of parents don't have that option and so they just get to suffer.  We need to eliminate insurance companies and minimize single payer role to merely administrative, if we go that way. 

 

Insurance industry, like all entities, will resist extermination, so I'm not sure how it will try to take over in some other way to sustain itself, but it will happen. 

 

So over it.

In some countries, you just do your thing, the docs make recommendations which you may or may not decide to take, and everything is covered. 

 

 

All the privacy in the world isn't going to make much of a difference if I die because I can't afford the only medication that works on my seizures, or an epipen for my food allergies.

[TranquilMind]

All the privacy in the world isn't going to make much of a difference if I die because I can't afford the only medication that works on my seizures, or an epipen for my food allergies.

 

I agree.   Does your insurance now make it affordable?   Some drugs are, especially if you have to buy them over and over.  Anything I ever use is usually not much cheaper with insurance (like antibiotic, a valium before a recent dental surgery, etc).  There is one pharmacy here that will give a person antibiotics free IF you can use that kind (I can only use one class, so it doesn't work for me).  That helped out once. 

 

I have read that Americans get gouged for drugs you can purchase inexpensively almost anywhere else.  But of course if you try to do that, you get dire warnings about how you will DIE from all those unsafe drugs in Mexico or Canada or elsewhere. Yeah, right.

 

[Leav97]

Single payer healthcare is fine, so long as we retain privacy.  How do we do that?  Until the past couple of years, you could go to the doctor and keep your business to yourself if you wanted.  You can still go to private doctors and do this. 

 

I just don't want the government dictating that all 40 year olds need to do or get this, or all 60 year olds must follow this protocol.  It's none of their business what a person and his doctor decides to do.

 

/snip

 

Are people on medicare and Tricare currently forced to do things?

[TranquilMind]

They are totally sustainable. Overall they are making HUGE profits. They just want ever more. It's greed, not lack of sustainability. 

 

You know, I wondered about that.  How are they allowed to just drop out because instead of making 100 Billion, they made only 100 Million last year?  What's up with that? Were there no requirements placed on these insurance companies to take all this new business that was to be funneled to them thanks to the ACA? 

 

[kewb]

I haven't purchased aetna in 3 years in my state through the exchange because they were always the most expensive. They are pulling out because they are not making enough profit

 

To be honest, all the insurance companies are the same. Deny, make people appeal, don't cover the compounded medications dh takes.

 

When you treat people like profit margins this is what you get. Profits over people. The big insurance companies are not suffering. Less profit, probably but still boatloads of profit.

[TranquilMind]

Are people on medicare and Tricare currently forced to do things?

 

I don't know.  Probably not.  My mom did what she wanted, and every time she followed her own judgment instead of what she was told to do, she got better.  

But if Medicare covers all 325 million of us on single payer, then there are going to be some demands and hoops to jump through, I would think.  I hope not though. 

 

Lots of doctors are dropping Medicare now.

 

This was interesting (ack on perforating the colon!)

 

http://www.aarp.org/health/conditions-treatments/info-2014/choosing-wisely-medical-tests-to-avoid.html

 

Here is a very interesting article.  You are forced into Medicare at age 65 if you want to get social security even if you don't want Medicare. 

 

Why Am I Being Forced into Medicare at Age 65?

Every American aged 65 years old or older is eligible for Medicare. Once you hit 65, you become automatically eligible; it is unavoidable. Those who receive Social Security benefits are automatically enrolled in Medicare. There is no way to opt out of Medicare once you are 65 if you receive Social Security. Either you enroll in Medicare Part A, or you forfeit your Social Security benefits. Most individuals are unwilling to forfeit their Social Security benefits, and thus accept the enrollment into Medicare.

 

There is a great deal of speculation as to why the system is set up in this manner, but unfortunately, there is no clear or direct answer. Perhaps this policy was initially instituted to make it easier for seniors to enroll in Medicare once they reached they age of 65, but was never discontinued when private coverage became more commonplace.

 

 

 

 

 

 

 

 

Edited August 16, 2016 by TranquilMind

[Mergath]

I agree.   Does your insurance now make it affordable?   Some drugs are, especially if you have to buy them over and over.  Anything I ever use is usually not much cheaper with insurance (like antibiotic, a valium before a recent dental surgery, etc).  There is one pharmacy here that will give a person antibiotics free IF you can use that kind (I can only use one class, so it doesn't work for me).  That helped out once. 

 

I have read that Americans get gouged for drugs you can purchase inexpensively almost anywhere else.  But of course if you try to do that, you get dire warnings about how you will DIE from all those unsafe drugs in Mexico or Canada or elsewhere. Yeah, right.

 

 

I'm transitioning from private insurance to the much more affordable and better state insurance right now (paperwork, yay) but on the private insurance the epilepsy med was affordable, the epipen was not. They basically gouge us on anything that isn't a pill. Dh still has the private insurance and they only cover a few dollars on his inhalers and nebulizer meds.

[TranquilMind]

I'm transitioning from private insurance to the much more affordable and better state insurance right now (paperwork, yay) but on the private insurance the epilepsy med was affordable, the epipen was not. They basically gouge us on anything that isn't a pill. Dh still has the private insurance and they only cover a few dollars on his inhalers and nebulizer meds.

 

That's crazy. What you need is very serious and for life-threatening stuff. 

 

But more money for them if they gouge you, eh?

[Haiku]

The problem seems to be that a majority of people enrolling via the Exchanges have extremely expensive medical problems and that at the current premium rates, the insurance companies are losing a lot of money in the exchanges.

 

Oh, you mean the ones who couldn't get coverage before the ACA, the same ones the insurance companies promised to cover in their panic to defeat single-payer insurance?

 

There's no problem here. Only greed.

[Mergath]

That's crazy. What you need is very serious and for life-threatening stuff. 

 

But more money for them if they gouge you, eh?

 

Yep. Apparently they need huge profits for the stockholders more than we need to buy food.

[Lady Florida.]

I'm transitioning from private insurance to the much more affordable and better state insurance right now (paperwork, yay) but on the private insurance the epilepsy med was affordable, the epipen was not.

 

Yep. A dear friend's daughter has a deadly peanut allergy and I was shocked when I found out how much her epi-pens cost. They have an excellent private insurance plan through her dh's employer and it's still not affordable. 

 

The thing about epi-pens is that you don't want to use them. For many people needing to use one means they came close to death. And yet epi-pens expire. So you don't want to use it but you have to pay a ridiculous amount for it, and when it expires you have to toss it in the trash and buy another expensive epi-pen that you hope to not need. 

[JumpyTheFrog]

Our health insurance company is owned by Aetna. Does that mean that the company will be pulling out of my state? I think that may leave only Blue Cross Blue Shield if Coventry One and United Healthcare both pull out. 

 

ETA: Humana is currently in my state. If they pull out, it looks like that leaves only Blue Cross. Grr! That company raised rates 30%+ for several years in a row.

Edited August 16, 2016 by HoppyTheToad

[Mergath]

Yep. A dear friend's daughter has a deadly peanut allergy and I was shocked when I found out how much her epi-pens cost. They have an excellent private insurance plan through her dh's employer and it's still not affordable. 

 

The thing about epi-pens is that you don't want to use them. For many people needing to use one means they came close to death. And yet epi-pens expire. So you don't want to use it but you have to pay a ridiculous amount for it, and when it expires you have to toss it in the trash and buy another expensive epi-pen that you hope to not need. 

 

Many of us have to keep the expired ones and hope they still work in an emergency. That's what I'm doing. My epipen is long expired but the fluid is still clear, so fingers crossed it will work. My shellfish reactions seem to worsen drastically every time I have one. If that holds true, I'm going to need it next time.

[Lady Florida.]

Many of us have to keep the expired ones and hope they still work in an emergency. That's what I'm doing. My epipen is long expired but the fluid is still clear, so fingers crossed it will work. My shellfish reactions seem to worsen drastically every time I have one. If that holds true, I'm going to need it next time.

 

 

:grouphug:  :grouphug:

[Lanny]

<snip>

 

I have read that Americans get gouged for drugs you can purchase inexpensively almost anywhere else.  But of course if you try to do that, you get dire warnings about how you will DIE from all those unsafe drugs in Mexico or Canada or elsewhere. Yeah, right.

 

 

And so they go to Mexico or come down here to Colombia for medical and dental care.  I don't think many, if any, people in Colombia are dying from using drugs manufactured here in Colombia.

 

We had a case months ago, I don't remember what the drug was but it is the only one that works for that particular medical problem and it is *VERY* expensive. I think the manufacturer raised the price. The Colombian government put them on notice that they would ignore the patent and produce it here as a Generic drug if they did not lower the price. They were gouging. I'm not sure what the result of that was...

 

The company we believe produces the highest quality generic medicines was purchased by a Swiss (?) firm a couple of years ago.  The medicine I use shot up in price. I think they wanted to recapture the price they paid for the company, in one year...   

 

But people dying of medicines produced in Mexico, no, I doubt that VERY much.  When I lived in the states, I had medical examinations in Mexico that my insurance in Texas did not cover, and I had to pay for out of pocket.  There was no way I could have afforded those examinations in Texas, where it is very inexpensive, compared to a high COL area like California or NYC.    When I brought the results of the workup to my M.D. in Texas, he told me he was extremely impressed by the quality.

[ktgrok]

Yup, I have a friend having surgery in Mexico right now. And I've ordered stuff from Canada before. Heck, a certain political who didn't win the primary this year has bussed over seniors to canada, to get cancer meds, himself. 

[Spy Car]

United Health Care recently pulled out of some markets, at the same time its CEO awarded himself $66 million in compensation.

 

Something is wrong here.

 

Bill

[Lanny]

Blue Cross Blue Shield of Arizona will not offer coverage on the Exchanges, for 2 counties in Arizona: Pinal and Maricopa.  They are a non-profit and they are losing too much money on the Exchanges.  

 

The only possible solution I see for this would be if somehow, healthy people would sign up on the Exchanges.  There are too few healthy people doing that now, and too many people with expensive medical problems who are signing up.  

 

http://www.foxnews.com/politics/2016/08/15/aetna-to-drop-some-affordable-care-act-markets.html

[Guest]

The exchanges could be merged with other government paid for health plans, which would increase the amount of healthy individuals in the plan. There could also be federal subsidies once care went over a certain dollar amount.

[ktgrok]

Blue Cross Blue Shield of Arizona will not offer coverage on the Exchanges, for 2 counties in Arizona: Pinal and Maricopa.  They are a non-profit and they are losing too much money on the Exchanges.  

 

The only possible solution I see for this would be if somehow, healthy people would sign up on the Exchanges.  There are too few healthy people doing that now, and too many people with expensive medical problems who are signing up.  

 

http://www.foxnews.com/politics/2016/08/15/aetna-to-drop-some-affordable-care-act-markets.html

 

They made 4 million last year, which isn't a lot for a company that size, but considering they are supposedly non profit, seems enough to me. 

[TranquilMind]

Yep. Apparently they need huge profits for the stockholders more than we need to buy food.

 

That's not right.  Life sustaining stuff should be free, like what you mention, and antibiotics.    Put an extra fee on Viagra or something like that, if they insist. 

 

[Reefgazer]

I currently have Tricare prime for insurance; I'm not forced to do anything. However, if I want something done, I do have to go through their gate keepers first. This is reasonable to me. One thing Tricare does which is asinine is that if I want to go to provider and pay cash for something, Tricare forbids the provider from accepting me as a cash patient if I am covered under Tricare. That is going too far into my business, IMO.

 

Are people on medicare and Tricare currently forced to do things?

Edited August 16, 2016 by reefgazer

[Murphy101]

Blue Cross Blue Shield of Arizona will not offer coverage on the Exchanges, for 2 counties in Arizona: Pinal and Maricopa. They are a non-profit and they are losing too much money on the Exchanges.

 

The only possible solution I see for this would be if somehow, healthy people would sign up on the Exchanges. There are too few healthy people doing that now, and too many people with expensive medical problems who are signing up.

 

http://www.foxnews.com/politics/2016/08/15/aetna-to-drop-some-affordable-care-act-markets.html

Because it's freaking expensive as hell.

 

Our household has one person with chronic health issues - a very healthy type 1 diabetic.

 

In theory, the other 4 healthy adults should have cheap and easy healthcare options, but it's nuts.

Son2 could have had coverage through work, which disqualifies him from other subsidized options, regardless of the fact that his employer coverage would have literally taken 2/3 of his monthly income. Hmm. Go without or maybe go to college. He chose college and I don't blame him. Once a ft student he qualifies for state medical same as our minor children. So he loses coverage every summer break. But truth is, he almost never uses it anyways bc there's such a shortage of Drs who accept it, he tends to just pay cash to see his eye dr and dentist, bc he is healthy, that's all he really goes to.

 

Me? I'm healthy as can be even though I'm pregnant, but the coverage would cost more than what I'm paying in cash and then I'd STILL need to also pay deductibles and copays and so on. So save that premium money and just pay cash or pay the premium and then not have the money to get care bc there's nothing left to cover deductibles and the never ending things that seem to never be covered by the premiums.

 

Will we have a penalty to pay? Sure. STILL cheaper. Heck, double the penalty and it's STILL cheaper to pay it. Also, financial penalties for poor people is just about the most moronic idea ever. Can't get water from a stone, but they just keep passing policies to crunch the stones like somehow if they apply enough pressure, water will spontaneously spout forth.

 

The costs are just insane. Forcing more people to pay insane gouging prices is not going to make this a better system for anyone.

Edited August 16, 2016 by Murphy101

[redsquirrel]

I hate to say it, but good riddance to Aetna.  They were just the WORST when we had an actual health care need. They made the hospital sue them etc etc. Their behaviour taught me a whoooole lot about why health care in the US costs so much. Insurance companies refusing to pay, forcing lawsuits, making hospitals settle... it all makes it cost more for us in the long run.

 

I am quite sure they are making millions in profit, they just don't like having to actually pay for any coverage.

 

I know, I know, not really the point of any of this, but Aetna just makes me so angry.

[justasque]

Blue Cross Blue Shield of Arizona will not offer coverage on the Exchanges, for 2 counties in Arizona: Pinal and Maricopa.  They are a non-profit and they are losing too much money on the Exchanges.  

 

The only possible solution I see for this would be if somehow, healthy people would sign up on the Exchanges.  There are too few healthy people doing that now, and too many people with expensive medical problems who are signing up.  

 

http://www.foxnews.com/politics/2016/08/15/aetna-to-drop-some-affordable-care-act-markets.html

 

As long as our system is set up so that people who have good jobs are not on the Exchange, it stands to reason that the people on the Exchange will be sicker, on the whole, than those who aren't.  Because if you're very sick, it's hard to hold down a job.

 

That's not right.  Life sustaining stuff should be free, like what you mention, and antibiotics.    Put an extra fee on Viagra or something like that, if they insist. 

 

The Brits say "free at the point of use".  Even with single-payer, it's not "free".  We, the taxpayers, pay for it in the end.

[Leav97]

I currently have Tricare prime for insurance; I'm not forced to do anything. However, if I want something done, I do have to go through their gate keepers first. This is reasonable to me. One thing Tricare does which is asinine is that if I want to go to provider and pay cash for something, Tricare forbids the provider from accepting me as a cash patient if I am covered under Tricare. That is going too far into my business, IMO.

 

 

How does the provider know you have Tricare if you are paying cash?

[Ravin]

Blue Cross Blue Shield of Arizona will not offer coverage on the Exchanges, for 2 counties in Arizona: Pinal and Maricopa.  They are a non-profit and they are losing too much money on the Exchanges.  

 

The only possible solution I see for this would be if somehow, healthy people would sign up on the Exchanges.  There are too few healthy people doing that now, and too many people with expensive medical problems who are signing up.  

 

http://www.foxnews.com/politics/2016/08/15/aetna-to-drop-some-affordable-care-act-markets.html

 

Note: These are the two largest counties in Arizona, population wise, encompassing  the entire Phoenix Metro area and the entire Tuscon area and everything in between them.

[TranquilMind]

I currently have Tricare prime for insurance; I'm not forced to do anything. However, if I want something done, I do have to go through their gate keepers first. This is reasonable to me. One thing Tricare does which is asinine is that if I want to go to provider and pay cash for something, Tricare forbids the provider from accepting me as a cash patient if I am covered under Tricare. That is going too fart into my business, IMO.

 

 

And that is exactly my concern. 

 

 

[redsquirrel]

As long as our system is set up so that people who have good jobs are not on the Exchange, it stands to reason that the people on the Exchange will be sicker, on the whole, than those who aren't.  Because if you're very sick, it's hard to hold down a job.

 

The Brits say "free at the point of use".  Even with single-payer, it's not "free".  We, the taxpayers, pay for it in the end.

 

I think of it that way as well. And I'm good with that. We pay for it by being tax payers or by paying higher overall costs. Either way, we pay.  I prefer it to be 'free at the point of use'

 

And yes, I've known many lower income people with untreated health care problems that make it difficult to hold down work, or find work they are qualified for etc.  It makes perfect sense. That is why I'd rather just expand medicare to everyone, or really, whatever, beyond keeping for profit health care providers in the mix. They've had their turn and have made oceans of money. Meanwhile, we are sicker and poorer. 

 

I'm in a mood today, aren't I, lol.

[Guest]

Hopefully this will be yet another step toward single-payer healthcare.

Yes, it is but that is going to take 1.5 bazillion years. And, while we wait, the current system crumbles around us.

[ChocolateReignRemix]

And that is exactly my concern.

Tricare and other similar programs due not allow contested providers to offer covered services to Tricare customers for cash for a variety of reasons, including fraud prevention (double dipping).

 

Unless the Tricare rules differ from Medicare/Medicaid, non covered services can still be purchased from a Tricare provider, and covered services would be available from non-Tricare providers.

[Mergath]

I think of it that way as well. And I'm good with that. We pay for it by being tax payers or by paying higher overall costs. Either way, we pay.  I prefer it to be 'free at the point of use'

 

And yes, I've known many lower income people with untreated health care problems that make it difficult to hold down work, or find work they are qualified for etc.  It makes perfect sense. That is why I'd rather just expand medicare to everyone, or really, whatever, beyond keeping for profit health care providers in the mix. They've had their turn and have made oceans of money. Meanwhile, we are sicker and poorer. 

 

I'm in a mood today, aren't I, lol.

 

Or at least make it easier to get approved for disability so you can get Medicare. It shouldn't take a lawyer, two years, and several appeals for someone with a serious medical condition. 

[Murphy101]

How does the provider know you have Tricare if you are paying cash?

If the provider is using a network, your name pulls up your information, medical and billing.

 

Also, maybe you see your usual provider and while discussing treatment options your provider actually does something crazy - he tells you ALL your options, not only the ones your insurance will cover. So you maybe decide okay, I know my insurance doesn't cover it, but we really think this other option is the best one for our situation, so okay I'll pay cash for this non-covered option. The provider is then in a catch 22. His contract says he cannot give you cash service, soooo. Usually the dr just never recommends care that isn't covered to avoid it coming up at all. Bc if you decide you want the uncovered option, he would have to refer you elsewhere to keep his contracted agreement with your insurer.

 

Convoluted and confusing?

 

Welcome to the insurance asylum.

[kewb]

Or at least make it easier to get approved for disability so you can get Medicare. It shouldn't take a lawyer, two years, and several appeals for someone with a serious medical condition. 

 

I agree.  We are still pending waiting for a hearing date.  Dh has been unable to work for 3 years now and it will probably be at least another year before he gets his hearing date which can be a year from when they tell you the date. It is absolutely ridiculous.

[TranquilMind]

If the provider is using a network, your name pulls up your information, medical and billing.

 

Also, maybe you see your usual provider and while discussing treatment options your provider actually does something crazy - he tells you ALL your options, not only the ones your insurance will cover. So you maybe decide okay, I know my insurance doesn't cover it, but we really think this other option is the best one for our situation, so okay I'll pay cash for this non-covered option. The provider is then in a catch 22. His contract says he cannot give you cash service, soooo. Usually the dr just never recommends care that isn't covered to avoid it coming up at all. Bc if you decide you want the uncovered option, he would have to refer you elsewhere to keep his contracted agreement with your insurer.

 

Convoluted and confusing?

 

Welcome to the insurance asylum.

 

That's just all kinds of wrong.

His first duty should be to his patient to "First, do no harm".  Not to his insurance contract.

 

The patient should always come first.  Why do we Americans put up with this nonsense?

 

I mean I do what I can in our family and we often go outside of the norm, but we are only one family.  We can't change anything. 

[TranquilMind]

I agree.  We are still pending waiting for a hearing date.  Dh has been unable to work for 3 years now and it will probably be at least another year before he gets his hearing date which can be a year from when they tell you the date. It is absolutely ridiculous.

 

That is just terrible. 

[redsquirrel]

Or at least make it easier to get approved for disability so you can get Medicare. It shouldn't take a lawyer, two years, and several appeals for someone with a serious medical condition. 

 

expanding medicare universally was a real possibility during Nixon's administration. It was seen as a logical step. The system is already in place and everyone gets enrolled eventually.

 

I'm not saying it's the only answer. If it were to happen tomorrow there would be work to be done first, but it is there to be built on. Much easier than starting from scratch

[Murphy101]

I agree. We are still pending waiting for a hearing date. Dh has been unable to work for 3 years now and it will probably be at least another year before he gets his hearing date which can be a year from when they tell you the date. It is absolutely ridiculous.

My BFF has been dealing with that for FIVE YEARS. No end in sight so far. She doesn't have the $ for a lawyer. So she just keeps filling out and giving paperwork onky to find out they need different paperwork, more paperwork, lost the paperwork, oh no, new caseworker so let's start from scratch again...

 

She has seizures and her mother who has early Alzheimer's just moved in with her.

 

But sure, as soon as her seizure is over and she figures out how much time she has lost and she explains for the empteenth time to her mother than she isn't pregnant, her baby was born 24 years ago, she'll get right to work. And in the mean time, uhhh yeah she'll take off the job to go wait in line to deliver the same damned paperwork and explain the problem again.

[ChocolateReignRemix]

If the provider is using a network, your name pulls up your information, medical and billing.

 

Also, maybe you see your usual provider and while discussing treatment options your provider actually does something crazy - he tells you ALL your options, not only the ones your insurance will cover. So you maybe decide okay, I know my insurance doesn't cover it, but we really think this other option is the best one for our situation, so okay I'll pay cash for this non-covered option. The provider is then in a catch 22. His contract says he cannot give you cash service, soooo. Usually the dr just never recommends care that isn't covered to avoid it coming up at all. Bc if you decide you want the uncovered option, he would have to refer you elsewhere to keep his contracted agreement with your insurer.

 

Convoluted and confusing?

 

Welcome to the insurance asylum.

 

Except none of that is true.  If it is a noncovered service, the provider can accept cash for the service.

 

There are even forms that the patient has to sign acknowledging Tricare is not responsible for the associated fees.

http://www.humana-military.com/library/pdf/non-covered-services-waiver.pdf

[rdj2027]

We usually have Tricare Standard and have been very happy with them.  We are currently covered by Tricare Prime Overseas and get excellent care.  On Standard we pay some co-pays and cost shares but they are quite reasonable.