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Thread: Health Insurance........WTF!

  1. #201
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    You want to see a stupid $#@!ing look on an ER doctor's face. Ask them to verify that they are in-network the second they walk in the room. Hopefully you don't bleed out while they check.

  • #202
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    I paid in-network rates last time I had to take my daughter into the ER for a hospital that was in-network. Reasoning is that ER doctors aren't in network with anyone, and in an emergency you can't pick and choose your doctors.

  • #203
    Quote Originally Posted by Anastasis View Post
    You want to see a stupid $#@!ing look on an ER doctor's face. Ask them to verify that they are in-network the second they walk in the room. Hopefully you don't bleed out while they check.

    What's really funny is that it's not just the doctor who doesn't know that info, there's a good chance the $#@!ing insurance company doesn't know either.

  • #204
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    Ya'll should just pay cash.

  • #205
    asshat Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73's Avatar
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    (cross post from the Obamacare thread)

    Need some help here. My sister is chronically ill (can't work) and has a team of doctors that treat her. POS husband bailed on her and she lost her insurance. She claims that she does not qualify for disability or Obamacare subsidies. Living in Houston, she's being told her only real options are BCBSTX HMO, which will result in her losing her doctors and will compromise her care, or a direct PPO policy through Memorial Hermann, which at least has some out-of-network coverage.

    Anyone have any experience with the Memorial Hermann plan? Anyone know of any other options in the Houston market? I'm sure I know the answer to that, but throwing everything against the wall to see if anything sticks.

    Thanks

    Edit: Link to MH Plan: http://healthplan.memorialhermann.org/individuals/
    Last edited by Solamente73; 12-15-2016 at 12:48 PM.

  • #206
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    Quote Originally Posted by Solamente73 View Post
    (cross post from the Obamacare thread)

    Need some help here. My sister is chronically ill (can't work) and has a team of doctors that treat her. POS husband bailed on her and she lost her insurance. She claims that she does not qualify for disability or Obamacare subsidies. Living in Houston, she's being told her only real options are BCBSTX HMO, which will result in her losing her doctors and will compromise her care, or a direct PPO policy through Memorial Hermann, which at least has some out-of-network coverage.

    Anyone have any experience with the Memorial Hermann plan? Anyone know of any other options in the Houston market? I'm sure I know the answer to that, but throwing everything against the wall to see if anything sticks.

    Thanks

    Edit: Link to MH Plan: http://healthplan.memorialhermann.org/individuals/
    Did you ever get an answer on this? When I was looking, I checked a few other options. If she didn't get anything in time, she can still sign up this month for coverage next month. Scott-White has a pretty decent plan from what I've heard, but no idea if they do Houston. It's an HMO though and you have to go through a broker to get it.

    Aetna actually had an off-exchange plan, just one. Normal bull$#@! with high deductibles and out-of-pocket, but IIRC it was still an EPO.

    I'm pissed at Aetna now though. Since they cancelled our own plan, we moved on to something else as I mentioned above. Well, I got a couple bills from late December. They processed and covered it, but something didn't look right, so I called Aetna. Despite my being able to log into their system online, they could not find me or my daughter anywhere in the system. Made sure they were checking for 2016. Gave them the $#@!ing member number. Its like as far as their customer service is concerned, we simply don't exist.

  • #207
    asshat T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall might be a clever chap. or know the right people. know what i mean, nudge nudge? T'Boo Ted Marshall's Avatar
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    Just thought I would vent on our renewal. Our agency premiums went up about 22% on average. However mine and my 2 kids, wife is on her policy through school, went up 50%. I'm now 42 and in good shape with good numbers. Kids are 4 and almost 2 with no issues.

  • #208
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    Quote Originally Posted by T'Boo Ted Marshall View Post
    Just thought I would vent on our renewal. Our agency premiums went up about 22% on average. However mine and my 2 kids, wife is on her policy through school, went up 50%. I'm now 42 and in good shape with good numbers. Kids are 4 and almost 2 with no issues.
    Yup. Ours would have been a minimum 50% increase if I hadn't done the temporary plan. My wife just got a job offer that has benefits. I don't expect it to be cheap, but at least hers will be covered and we'll have access to better plans.

  • #209
    asshat Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73's Avatar
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    Quote Originally Posted by Hellraiser97 View Post
    Did you ever get an answer on this? When I was looking, I checked a few other options. If she didn't get anything in time, she can still sign up this month for coverage next month. Scott-White has a pretty decent plan from what I've heard, but no idea if they do Houston. It's an HMO though and you have to go through a broker to get it.

    Aetna actually had an off-exchange plan, just one. Normal bull$#@! with high deductibles and out-of-pocket, but IIRC it was still an EPO.
    No, I didn't. She was in-and-out of the hospital last month and with brokers going on vacation, she never had a chance to sign up (she doesn't internet, so that doesn't help). She should sign up this month in time for Feb 1 coverage, but she'll be paying cash for anything and everything this month.

    She has about 10 doctors. No matter which plan, she will lose 50% of her doctors, will not be able to be seen at her preferred hospital, and will be paying high deductibles, premiums, and co-insurance out the ass. If she goes with the HMO, she will get to keep 1 doctor (her heart surgeon) but that's it. If she goes with MH, she'll get to keep 4 other doctors but not her heart surgeon. She's trying to figure out what the best move is for her. She might need another bypass this year, so I know she's weighing that heavily.
    Last edited by Solamente73; 01-11-2017 at 04:57 PM.

  • #210
    Quote Originally Posted by Solamente73 View Post
    No, I didn't. She was in-and-out of the hospital last month and with brokers going on vacation, she never had a chance to sign up (she doesn't internet, so that doesn't help). She should sign up this month in time for Feb 1 coverage, but she'll be paying cash for anything and everything this month.

    She has about 10 doctors. No matter which plan, she will lose 50% of her doctors, will not be able to be seen at her preferred hospital, and will be paying high deductibles, premiums, and co-insurance out the ass. If she goes with the HMO, she will get to keep 1 doctor (her heart surgeon) but that's it. If she goes with MH, she'll get to keep 4 other doctors but not her heart surgeon. She's trying to figure out what the best move is for her. She might need another bypass this year, so I know she's weighing that heavily.


    Just so you know the deadline to get a Feb. 1st effective date is Sunday the 15th as in 3 days from now. If she doesn't sign up by then she won't have coverage until March 1st.

  • #211
    I really hope she signed up yesterday......

  • #212
    asshat jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge? jofus might be a clever chap. or know the right people. know what i mean, nudge nudge?
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    just got a bill from a random company. apparently healthcare.gov auto enrolled me. all these reports about record obamacare numbers are inflated from auto enrollments that many people (like myself) will not pay because we got a plan elsewhere.

  • #213
    Quote Originally Posted by jofus View Post
    just got a bill from a random company. apparently healthcare.gov auto enrolled me. all these reports about record obamacare numbers are inflated from auto enrollments that many people (like myself) will not pay because we got a plan elsewhere.
    This happens a ton.

    If you don't cancel your policy they will just move you to a new one. So if a company pulls out of a county or state and members don't cancel that "application" they will be auto moved to another company offering plans in that country state.

    That doesn't even include the number of multiple applications a person can have that never pick a plan that are counted as "enrollments"

  • #214
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    Of course they are going to move you to another plan if you don't cancel. That's why they send you letters telling you they are moving you to another plan or company.

  • #215
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    Quote Originally Posted by Solamente73 View Post
    (cross post from the Obamacare thread)

    Need some help here. My sister is chronically ill (can't work) and has a team of doctors that treat her. POS husband bailed on her and she lost her insurance. She claims that she does not qualify for disability or Obamacare subsidies. Living in Houston, she's being told her only real options are BCBSTX HMO, which will result in her losing her doctors and will compromise her care, or a direct PPO policy through Memorial Hermann, which at least has some out-of-network coverage.

    Anyone have any experience with the Memorial Hermann plan? Anyone know of any other options in the Houston market? I'm sure I know the answer to that, but throwing everything against the wall to see if anything sticks.

    Thanks

    Edit: Link to MH Plan: http://healthplan.memorialhermann.org/individuals/
    I could be wrong here but I don't believe the POS husband can simply drop her from his plan unless there was an "event" that happened such as divorce, other insurance, etc. If they are just seperated, she should still be covered unless he changed plans and didn't add her.

  • #216
    asshat Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73's Avatar
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    Divorce went through, so she's on her own.

  • #217
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    How much has see checked to see if she is or isn't qualified for ACA subsidies? Is she the type that just assumes or actually looks into it?

    I know people like their doctors, but this sounds like she has to learn to like new ones. Or convince the current ones to accept new insurance. Do doctors ever do that for patients?

  • #218
    asshat Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73's Avatar
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    She says over and over that she's looked into Obamacare subsidies, disability, etc. and claims that the government says she's ineligible because she has some level of wealth that she will have to blow through first. Though she can't work, she'll have to exhaust her savings before she can get help.

    With regard to people liking their doctors, she's been unusually sick for an unusually long time and had deep relationships with those who have kept her alive over the decades. The ACA, despite infamous assurances, is making her change most of her doctors and she will have to "deal" with it.

    With regard to doctors changing insurances, yes, they can, but sometimes they can not, apparently. It's just anecdotal, but Mrs. Solamente's OB-GYN told her that he tried to get on BCBSTX HMO since that's really the last available plan on the individual exchange, but BCBSTX would not add him; I don't know the reason.

  • #219
    Quote Originally Posted by BA93 View Post
    How much has see checked to see if she is or isn't qualified for ACA subsidies? Is she the type that just assumes or actually looks into it?

    I know people like their doctors, but this sounds like she has to learn to like new ones. Or convince the current ones to accept new insurance. Do doctors ever do that for patients?
    You can't just convince your doctor to accept your insurance, sure they can agree to a cash payment but they would have to negotiate with the insurance company to get added to the HMO network or accept the reimbursement that the insurance company is offering. If they aren't currently covered as in network there is probably a pretty good reason for it.

    That's the trouble with the continued rise in HMO's (increasingly smaller and smaller networks) and loss of true PPO or POS networks to save money. There isn't any juice left in the fruit.

  • #220
    Quote Originally Posted by Solamente73 View Post
    She says over and over that she's looked into Obamacare subsidies, disability, etc. and claims that the government says she's ineligible because she has some level of wealth that she will have to blow through first. Though she can't work, she'll have to exhaust her savings before she can get help.
    Just an FYI this is 100% WRONG.

    Eligibility is based solely on INCOME for 2017. It has nothing to do with savings. So if she is making less than $40K (assuming she's filing single) she would be eligible for some subsidy.

    Also even if she was divorced from her husband she should be eligible for COBRA coverage by law (she has 60 days to trigger it)


    Bottom line for someone as ill as she seems to be getting a lot of wrong info.

  • #221
    asshat Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73's Avatar
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    Quote Originally Posted by JimmyHoffa View Post
    Just an FYI this is 100% WRONG.

    Eligibility is based solely on INCOME for 2017. It has nothing to do with savings. So if she is making less than $40K (assuming she's filing single) she would be eligible for some subsidy.

    Also even if she was divorced from her husband she should be eligible for COBRA coverage by law (she has 60 days to trigger it)


    Bottom line for someone as ill as she seems to be getting a lot of wrong info.
    It would not surprise me if she's either not giving me the whole story or hasn't truly done her due diligence.

    She has income in the form of distributions from IRA and other investment income. Because of her poor health, her cost of living is high and the income she takes is likely over that $40K threshold. She does not have earned income through work.

    Still, subsidies aren't the issue as much as coverage and network. Losing doctors and hospitals are the big deal. Paying cash is prohibitively expensive but is an option if specific care from a specific provider is needed.

    Divorce was a while ago (April 2015?); she exhausted COBRA and now finds herself in this mess.
    Last edited by Solamente73; 01-16-2017 at 04:14 PM.

  • #222
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    Sounds like she needs to get in front of a social worker that can help her understand her options.

  • #223
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    Who was the provider of her plan last year?

  • #224
    asshat Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73's Avatar
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    Quote Originally Posted by Hellraiser97 View Post
    Who was the provider of her plan last year?
    Either Humana PPO or Cigna PPO, I can't remember which. Both are out of the market for 2017.

  • #225
    Quote Originally Posted by Solamente73 View Post
    Either Humana PPO or Cigna PPO, I can't remember which. Both are out of the market for 2017.
    Yeah, PPOs on the individual market are pretty non-existent anymore.

  • #226
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    If someone can decide their income because of investments, could they just take out less to give them subsidies for better plans?

  • #227
    asshat Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73 might be a clever chap. or know the right people. know what i mean, nudge nudge? Solamente73's Avatar
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    Quote Originally Posted by BA93 View Post
    If someone can decide their income because of investments, could they just take out less to give them subsidies for better plans?
    I'm not sure what you mean by "better plans." Do you mean Plat/Gold/Silver/Bronze? Or PPO vs. HMO?

    The problem is that there is essentially one plan, BCBSTX HMO, on the individual exchange; there are no "better plans" on the exchange with regard to network and coverage. This is regardless of metal level. That's why we were looking at Memorial Hermann's direct plan as an option. This is outside of the exchange and, I assume, ineligible for subsidies.

  • #228
    Duke of New York (Exiled) Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97's Avatar
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    Quote Originally Posted by JimmyHoffa View Post
    Yeah, PPOs on the individual market are pretty non-existent anymore.
    Aetna has one but you have to dig for it and it's so bad you'd think they're actively trying to discourage people from signing up


    $#@! OU

  • #229
    Duke of New York (Exiled) Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97 Shaggy Silver Club Hellraiser97's Avatar
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    Quote Originally Posted by Solamente73 View Post
    Either Humana PPO or Cigna PPO, I can't remember which. Both are out of the market for 2017.
    Cigna appears to have both HMO and 'non-HMO' plans in Texas for 2017

    https://www.cigna.com/individuals-fa...ge?city=Harris
    Last edited by Hellraiser97; 01-16-2017 at 09:54 PM.

  • #230
    Quote Originally Posted by Hellraiser97 View Post
    Aetna has one but you have to dig for it and it's so bad you'd think they're actively trying to discourage people from signing up
    I asked that very question to a company rep last year and he responded "you said it, I didn't"

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