JRZane t1_j1u8kj0 wrote
Reply to comment by OkBid1535 in Why are NJ doctors, especially those in family medicine all joining for-profit, multi-specialty medical groups? Those groups do are deteriorating the good doctor and patient communication/relationship that use to exist. by Eastcoastpal
what year was this? What state was your coverage based??
regulation for this has improved over the past few years. specifically 2010 ACA and 2011 parity law made some huge improvements (pre-existing conditions, mandatory coverage for various services like mental health, catastrophic coverages, etc), its such a shame SOME (not mentioning names to make this political) politicians did their best to tear those laws down. If they just worked to IMPROVE instead of REMOVE we really could have been close to having a system that works.
An existing problem that still exists is that insurance is regulated state by state. I live in NJ and the same plan from Horizon BCBS costing $700/month for a couple (2500 deductible, $20/$50 copays) costs $1500 in Delaware with Highmark BCBS because of the difference in income-driven costs. We all know the best way to keep premiums down is to enlarge the pool of customers. One way the insurances ruin that strategy is to hack us into groups (not allowing cross-state plans).
While I see myself as socially liberal, the Democrats' incompetence has cost us progress as well. However finally allowing CMS to negotiate drug prices for Medicare/Medicaid should be a big improvement for some older and poorer folks.....or maybe Im being naive and the crooked PBM and insurance companies will find a way to sidestep that too....
Sorry, I can go on all day about this shit. drives me crazy.....
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Edit: another rant: another thing people dont realize is their employer HR manager negotiates with insurance brokers for your plan. If you work for a company (especially smaller companies) with older employees op high-utilization folks (read: sicker), it WILL affect the cost of YOUR premiums. Working for a larger, younger company equals lower premiums.
OkBid1535 t1_j1u8per wrote
It’s based in NJ and has been consistently an issue since 2020
JRZane t1_j1ua074 wrote
obviously I dont know your issue, but there's something odd going on here. The only way a company can legally "drop" a customer mid-year (not during open enrollment ie. end of the benefit year) is bc of not paying the premium. Even then, there's a grace period where if a person catches up on premiums it's as if no lapse in coverage occurred. They also MUST send out letters stating premiums are behind and provide a deadline date.
At my practice we get these letters all the time. like, weekly. Patient A has been coming in and we receive a letter stating "Patient A hasn't paid their premium, if its not paid by Date X claims from (date to date) won't be paid."
Please dont read this as not believing you, what im saying is knowing the regs a little bit gives you some leverage so you aren't surprised as you mentioned. There are also programs to cover kids, even if you have reasonable financial means (CHIP), and it's backdated. So if your kid didn't have coverage starting Feb 1 and he/she I admitted into hospital Feb 15, CHIP will cover the costs 90 days PRIOR to claim. Most hospitals have a social worker that will help with application. Now, its a low-paying plan and they will still try and get you out quickly (hospital soperate in the red with CMS rates and need commercial plans to stay afloat), but you won't be on the hook for monster bills.
OkBid1535 t1_j1utvgy wrote
When we were in the hospital absolutely no one there was willing to work with us or discuss other options. No one even mentioned CHIP to us. We had NJ family care years ago but since priced out of it basically.
We again had auto pay set up and paid our premiums. We’ve had to pay hundreds and thousands out of pocket and certain appointments after finding out we’d lost insurance.
It’s been hell. And the worst part is, it isn’t just us. We’ve multiple self employed friends using BCBS, set up for autopay and same thing. Punished for paying on time and coverage is dropped. There was even a huge lawsuit circulating for people to sue horizon because it’s been getting so bad.
Babhadfad12 t1_j1uqkz3 wrote
> I live in NJ and the same plan from Horizon BCBS costing $700/month for a couple (2500 deductible, $20/$50 copays) costs $1500 in Delaware with Highmark BCBS because of the difference in income-driven costs.
What are income-driven costs? I have not seen differences that big between states.
https://www.kff.org/health-reform/state-indicator/average-marketplace-premiums-by-metal-tier/
> We all know the best way to keep premiums down is to enlarge the pool of customers. One way the insurances ruin that strategy is to hack us into groups (not allowing cross-state plans).
This was not because of “the insurances” by the way, this was upper middle class and pretend upper middle class people that forced this issue. White collar workers that worked for well funded and established businesses balked at their insurance premiums going up to pay for poor and unhealthy people.
People are, unfortunately, very tribal.
JRZane t1_j1uuc8y wrote
Most "marketplace" plans take into account income to determine how much insurance plans are subsidized. Each state determines their own scale. In NJ and DE, the scales are significantly inconsistent with one another. These numbers are made up, but just for illustrative purposes, a person making 100k in NJ may qualify for 25% subsidies while that same 100K qualifies for 5% subsidy in DE.
And to your other point about this being class driven, I have no doubt there was that type of mentality in there, sure. BUT it wouldn't have actually happened if it didn't benefit the insurance company. and it wouldn't have been ALLOWED to happen if legislatures had the good of all people in mind.
We have a mentality that in the USA that people who are poor and underserved are deservedly so, and that it is their own fault for being in that position in the first place. I can point to several social perspectives that boil down to that single factor. Its situation vs disposition phenomena at its finest.
Babhadfad12 t1_j1uxn7p wrote
> And to your other point about this being class driven, I have no doubt there was that type of mentality in there, sure. BUT it wouldn't have actually happened if it didn't benefit the insurance company. and it wouldn't have been ALLOWED to happen if legislatures had the good of all people in mind.
Possibly, health insurance companies are going to benefit regardless if everyone was required to purchase health insurance. Theoretically, it makes no difference to them if an employer is involved.
I just specifically remember people up in arms about removing employers from the equation and being dumped onto healthcare.gov where the risk pool would have caused them to pay more.
People are still upset at health insurance costing more than pre ACA, even though it covers a lot more (no benefit maximum, no denial due to pre existing condition, no underwriting for one’s specific health risks, etc.).
And of course, the fake religious “insurance” that is not really insurance or complaint with ACA had to be allowed, and that was not due to insurance companies.
KaliGracious t1_j1w1sxd wrote
Health insurance is a country is a fucking disaster. Let’s just start at that. It is insane that we cannot get politicians who will come in and fix this disaster. Republicans have absolutely NO solution for this problem and democrats barely know what they are doing.
This is what happens when you have politicians running a county. We need to get money the fuck out of politics.
JRZane t1_j1uwp0e wrote
also, regarding the "average" chart, have you seen a chart showing MEDIAN? this is clearly a situation of restricted range with some folks paying very little and some folks paying the higher end. sure the average may be $400, but that doesn't illustrate the difference between person 1 paying $10/month and person 2 paying $800.
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