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ObamaCare Only Thread

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User avatar

achilles

Fagorstorm

Postby achilles » Mon Oct 28, 2013 10:41 pm

S.F. Jude Terror wrote:Achilles - I have a Kaiser HMO and it is pretty awesome because A) Kaiser has everything you could need in-house, including a pharmacy and B) It's all paid for.

That being said, the Obamacare HMO is kind of shitty because it has PPO style copays and deductibles for everything. So it's not really like an HMO should be.

If you could get a decent HMO with low deductible and copays, then it would be better than a PPO for the money IMO.


Since I use care fairly often, I'm looking at a platinum plan, which would offer no deductible with 10% copays on things like hospitalizations or low copays for other services. This BTW is true of the HMOs, PPOs, and the EPOs under the platinum plan.

With the HMO, I'm a little concerned since I do have a surgery that I want, a fairly complex and specialized inpatient one, but one that would be elective. Basically, I wonder if they can deny me since the medical necessity isn't clear, it's more a lifestyle thing that would lessen some pretty severe chronic pain. Also I wonder how long it would take to get up the ladder from the GP to the specialist surgeon. As opposed to simply choosing my own surgeon. Though I do have the same concerns that they might not approve the surgery in the PPO.

Which leads to another issue. By ObamaCare law, state exchanges are required to post the ratings of these plans by 2016, so that consumers can tell how good they are. Most states aren't posting them yet, including California. According to the Fox News story, this is due to lobbying by the lower rated plans. Kaiser California BTW is rated #7 nationally, according to the story, while Blue Shield of California, which offers PPO and EPO, and IIRC also an HMO, is rated #414 nationally. Anthem Blue Cross of California, which I'm also interested in wasn't mentioned, nor do I know how to find those ratings.

I should mention here that the Covered California website is acting up a lot, and features are being taken off line periodically, making it very hard to compare the plans for which you qualify for subsides.

I really am going to have to schedule an appointment with one of those counsellors to figure out which plan I can afford, and which is the best.
User avatar

Spektre

rubber spoon

Postby Spektre » Mon Oct 28, 2013 11:15 pm

ReturnoftheMack wrote:
Please educate me how this is illegal.

EDIT: Also, the Republicans wanted to delay the law. This just extends the time frame to sign up. Not the same thing.


A Republican offer during the stalemate, offered to fund everything but put off the individual mandate for one year. Exactly the same thing.

As to how it is illegal: A President is bound by oath and law to uphold the laws passed. A small exception has been carved out recently for laws the President believes are unconstitutional, but otherwise, if it is the law, the president may not choose edit it unilaterally.

Granted, he acts more like a monarch than a president, but you asked for an explanation.
User avatar

S.F. Jude Terror

OMCTO

Postby S.F. Jude Terror » Mon Oct 28, 2013 11:28 pm

achilles wrote:
Since I use care fairly often, I'm looking at a platinum plan, which would offer no deductible with 10% copays on things like hospitalizations or low copays for other services. This BTW is true of the HMOs, PPOs, and the EPOs under the platinum plan.

With the HMO, I'm a little concerned since I do have a surgery that I want, a fairly complex and specialized inpatient one, but one that would be elective. Basically, I wonder if they can deny me since the medical necessity isn't clear, it's more a lifestyle thing that would lessen some pretty severe chronic pain. Also I wonder how long it would take to get up the ladder from the GP to the specialist surgeon. As opposed to simply choosing my own surgeon. Though I do have the same concerns that they might not approve the surgery in the PPO.

Which leads to another issue. By ObamaCare law, state exchanges are required to post the ratings of these plans by 2016, so that consumers can tell how good they are. Most states aren't posting them yet, including California. According to the Fox News story, this is due to lobbying by the lower rated plans. Kaiser California BTW is rated #7 nationally, according to the story, while Blue Shield of California, which offers PPO and EPO, and IIRC also an HMO, is rated #414 nationally. Anthem Blue Cross of California, which I'm also interested in wasn't mentioned, nor do I know how to find those ratings.

I should mention here that the Covered California website is acting up a lot, and features are being taken off line periodically, making it very hard to compare the plans for which you qualify for subsides.

I really am going to have to schedule an appointment with one of those counsellors to figure out which plan I can afford, and which is the best.



I have Kaiser and I think they're pretty amazing. Prior to that I had Blue Shield PPO and it was kind of shitty, with a lot of stuff not paid for and a lot of deductibles and copays. I had my surgery on Blue Shield, and I'm still paying for it. Still needed to wait for specialists, and in fact still needed referrals for them.

Kaiser, on the other hand, has all the specialists you need in one of the three or four huge medical facilities and hospitals that they seem to operate in most areas, around here at least. So the wait and difficulty to get to see a specialist is not bad at all, possibly even better than Blue Shield PPO.

The thing is that Kaiser is not just an insurance provider, they are also the hospital/doctors. It's very efficient, and I think free of most of the problems most people find with HMO plans. It's more like getting a subscription to a network of doctors and hospitals.

This is, of course, Kaiser here in the bay area. It could be different down by you.
User avatar

habitual

Silly French Man

Postby habitual » Tue Oct 29, 2013 12:37 am

S.F. Jude Terror wrote:

I have Kaiser and I think they're pretty amazing. Prior to that I had Blue Shield PPO and it was kind of shitty, with a lot of stuff not paid for and a lot of deductibles and copays. I had my surgery on Blue Shield, and I'm still paying for it. Still needed to wait for specialists, and in fact still needed referrals for them.

Kaiser, on the other hand, has all the specialists you need in one of the three or four huge medical facilities and hospitals that they seem to operate in most areas, around here at least. So the wait and difficulty to get to see a specialist is not bad at all, possibly even better than Blue Shield PPO.

The thing is that Kaiser is not just an insurance provider, they are also the hospital/doctors. It's very efficient, and I think free of most of the problems most people find with HMO plans. It's more like getting a subscription to a network of doctors and hospitals.

This is, of course, Kaiser here in the bay area. It could be different down by you.



Kaiser's quality has dramatically increased over the last decade.

Hab
User avatar

Frag

REAL OFFICIAL President of the Outhouse

Postby Frag » Tue Oct 29, 2013 12:56 am

Spektre wrote:A Republican offer during the stalemate, offered to fund everything but put off the individual mandate for one year. Exactly the same thing.


If you think it's the same thing then you totally misunderstood what happened.

Delaying the mandate for one year =/= extending the enrollment period by six weeks. The mandate is still in effect by the time taxes need to be filed.

As to how it is illegal: A President is bound by oath and law to uphold the laws passed. A small exception has been carved out recently for laws the President believes are unconstitutional, but otherwise, if it is the law, the president may not choose edit it unilaterally.

Granted, he acts more like a monarch than a president, but you asked for an explanation.


This is debatable.

http://www.washingtonpost.com/blogs/won ... hat-legal/
User avatar

Spektre

rubber spoon

Postby Spektre » Tue Oct 29, 2013 8:58 am

ReturnoftheMack wrote:
If you think it's the same thing then you totally misunderstood what happened.

Delaying the mandate for one year =/= extending the enrollment period by six weeks. The mandate is still in effect by the time taxes need to be filed.



This is debatable.

http://www.washingtonpost.com/blogs/won ... hat-legal/


Did you read the article? It is debatable in the same sense that it is debatable if water is wet, or fire is hot.
User avatar

achilles

Fagorstorm

Postby achilles » Tue Oct 29, 2013 9:40 am

I yelped the local Kaiser hospital, and while the overall rating was good, four out of five, there were some troubling ones. Mostly about rude doctors and staff, and a wonky ER that didn't function right.

So I'm interested, but still wary. I do like the idea of everything being in one place.
User avatar

achilles

Fagorstorm

Postby achilles » Tue Oct 29, 2013 11:31 am

I knew this was going to happen, but the extent seems very worrying. :-(
User avatar

Frag

REAL OFFICIAL President of the Outhouse

Postby Frag » Tue Oct 29, 2013 12:55 pm

I come from a family of doctors, but I fucking hate doctors.

“OBAMACARE is a disaster. I have already seen denial of medication, denial of referrals,” one doc said.


How is this possible when it hasn't started yet? Coverage begins on January 1.
And they worry that stingy payments for medical services offered by insurers could put some doctors out of business and force others into retirement.

“Any doctor who accepts the exchange is just a bad businessman/woman. Pays terrible,” argued one doctor.


You are a doctor, asshole. Yes, you should make money, but fuck off with that shit.

Said another MD, “Can’t imagine any doctors would be willing to work for so little money? All doctors should boycott.”


Again, how does he know? The article says a bunch of times that doctors are flying blind and don't know how much money they are getting paid.

Great reporting, New York Post.

I'm not denying this is true, but the Post really cherry-picked some stuff to focus on.
User avatar

Spektre

rubber spoon

Postby Spektre » Tue Oct 29, 2013 2:09 pm

achilles wrote:I knew this was going to happen, but the extent seems very worrying. :-(


Of course it was. If anyone has ever had to work within the Workers' Compensation system of your state, you understand that government mandated care, even if under the auspicious of private insurance companies, is really the scum on the bottom of the barrel.

Just another of the unintended consequences of liberal utopia fantasies.

HEALTHCARE FOR EVERYONE

From the handful of docs who pick this way of making a living because they washed out of everywhere that still gives an incentive to succeed.
User avatar

Spektre

rubber spoon

Postby Spektre » Tue Oct 29, 2013 2:16 pm

ReturnoftheMack wrote:I come from a family of doctors, but I fucking hate doctors.



How is this possible when it hasn't started yet? Coverage begins on January 1.


Because referrals are often a few months out with current insurance, and I would expect with all the extra regulation they have to pour through, referrals are already being delayed.

And they worry that stingy payments for medical services offered by insurers could put some doctors out of business and force others into retirement.

“Any doctor who accepts the exchange is just a bad businessman/woman. Pays terrible,” argued one doctor.


ReturnoftheMack wrote:You are a doctor, asshole. Yes, you should make money, but fuck off with that shit.


Right. We know best for you how much you should be compensated for your labor. If you don't agree with us, fuck off.

Said another MD, “Can’t imagine any doctors would be willing to work for so little money? All doctors should boycott.”


ReturnoftheMack wrote:Again, how does he know? The article says a bunch of times that doctors are flying blind and don't know how much money they are getting paid.


Because, if he is any kind of businessman, he has READ THE CONTRACT he was signing up for with the CONTRACTED FEE SCHEDULE.

That is unless Obamacare a) Is so completely clueless they don't require such things form their exchanges.
b) just comes right out and says, "You'll get paid what we feel like paying you."
User avatar

Frag

REAL OFFICIAL President of the Outhouse

Postby Frag » Tue Oct 29, 2013 3:18 pm

Spektre wrote:Because, if he is any kind of businessman, he has READ THE CONTRACT he was signing up for with the CONTRACTED FEE SCHEDULE.

That is unless Obamacare a) Is so completely clueless they don't require such things form their exchanges.
b) just comes right out and says, "You'll get paid what we feel like paying you."


Did you read the whole article?

"“This is so poorly designed that a lot of doctors are afraid to participate,” said Dr. Sam Unterricht, president of the 29,000-member organization. “There’s a lot of resistance. Doctors don’t know what they’re going to get paid.”"
User avatar

Frag

REAL OFFICIAL President of the Outhouse

Postby Frag » Tue Oct 29, 2013 3:21 pm

Also, doctors don't take all insurance anyway so why would they participate? I have a doctor who doesn't take my insurance. It happens. :smt102

If your doctor doesn't take the insurance you sign up for with Obamacare and that means a lot to you, then you should use the exchange to find an insurance that he does thane. Not sure what the problem is.
User avatar

achilles

Fagorstorm

Postby achilles » Tue Oct 29, 2013 5:50 pm

It's a bit of a problem for me, since I want a fairly specialized surgery, and I'm not sure if I can find a guy to do it, either on a slimmed-down PPO, or at an HMO like Kaiser. And the doctor/hospital check function on Covered California is off and on again. I never seem to catch it on.
User avatar

The Old Doctor

A Damn Cuddly Beast

Postby The Old Doctor » Tue Oct 29, 2013 5:53 pm

Spektre wrote:
Did you read the article? It is debatable in the same sense that it is debatable if water is wet, or fire is hot.


Fire is burny.

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