The end of Obamacare...

[Tinykong]

If it's not emergency care, it's not covered by the rules covering emergency care. The name of the facility isn't part of it.

The "emergency care" topic is really just a red herring. There are plenty of other situations in which you can be balanced billed into bankruptcy, even while insured. The article I linked about the Florida law has a few examples of people caught in similar situations.

There is no Federal law prohibiting balance billing. It happens in many states, and can happen in many different circumstances, which was the original point.

[Wolfheart9]

Perfect example of a way we can reduce cost of care. Yet nobody cares about that end. Even a single payer system will still the problem of costs.


They only leech when they dont pay. Otherwise that is the cost of their treatment. It is not their fault the hospital charged them less.

One of the many, many issues..

[Tinykong]

this is the one i was talking about for 1/2 your issue
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA)

This has nothing to do with what is being discussed.

most insurance companies have hold harmless clauses in their plans, where if its a emergency as defined by the federal govt they will pay the non-network provider of service in full. If you are being billed then you need to call your insurance company and have them fix it. I have not seen a plan in many years that did not have this.
they will however try to negotiate a lower rate with the provider of service and sometimes the provider messes up and does not write off the difference.

Balance billing is legal in many states, and happens every day. It's not rare. 30 seconds of google searching will probably turn up thousands of cases.

[Felya]

It only falls on the hospital if you actually go there. Plenty of people from the ages of 18-30 will never go to the hospital, or receive anything other than routine care.

Yes, another thing people in those age groups don't see, is the building of problems that end up spiking everyone's cost. That diabetes you had been building for years, will be saved until you can spike insurance prices. That cancer you never got checked for, will spike costs. Som yes... If you live in a vacuum where nothing bad ever happens, lucky you... But, in the real world, you are being irresponsible and are directly responsible for increased costs through hospitals, then if you make it that far, increased cost for Medicare.

Health care shouldn't be a business, then.

No shit...

[Tinykong]

Yes, another thing people in those age groups don't see, is the building of problems that end up spiking everyone's cost. That diabetes you had been building for years, will be saved until you can spike insurance prices. That cancer you never got checked for, will spike costs. Som yes... If you live in a vacuum where nothing bad ever happens, lucky you... But, in the real world, you are being irresponsible and are directly responsible for increased costs through hospitals, then if you make it that far, increased cost for Medicare.

Getting check ups is routine care. They are usually only yearly, and relatively inexpensive. That's a very small amount of medical care compared to paying $200/month in premiums.

[Zan15]

This has nothing to do with what is being discussed.




Balance billing is legal in many states, and happens every day. It's not rare. 30 seconds of google searching will probably turn up thousands of cases.

and why would it not? if they have no contract, why would they accept anything less then billed?

again, most insurance plans have this covered. If you have no control over your provider of service they will pay it under the "hold harmless" clause in your health insurance contract...and if need be they will pay the full billed charges as they do with most anesthetist services in the ER for example. Or your ambulance ride after you smash into a tree, almost every ambulance company in this country is not contracted with insurance companies including some of the biggest like AMR.

outside of this, if you choose to go to a non network/contracted provider....at your choice...then you owe the balance.

if you don't have a plan that has this, then you have the worst plan in america. congrats. Been doing this for almost 30 years on every side of the insurance/hospital/provider coin, its very rare to see this. ACA has this covered in every plan.

Most of the issues are mistakes that can easily be fixed with a phone call.

[Wolfheart9]

Getting check ups is routine care. They are usually only yearly, and relatively inexpensive. That's a very small amount of medical care compared to paying $200/month in premiums.

And if we switched to a "socialist" healthcare system of it being in the taxes, it would be a fraction of that, but because it helps everyone, it's bad.

[Tinykong]

and why would it not? if they have no contract, why would they accept anything less then billed?

again, most insurance plans have this covered. If you have no control over your provider of service they will pay it under the "hold harmless" clause in your health insurance contract...and if need be they will pay the full billed charges as they do with most anesthetist services in the ER for example. Or your ambulance ride after you smash into a tree, almost every ambulance company in this country is not contracted with insurance companies including some of the biggest like AMR.

outside of this, if you choose to go to a non network/contracted provider....at your choice...then you owe the balance.

if you don't have a plan that has this, then you have the worst plan in america. congrats. Been doing this for almost 30 years on every side of the insurance/hospital/provider coin, its very rare to see this. ACA has this covered in every plan.

Most of the issues are mistakes that can easily be fixed with a phone call.

Hold harmless is not a legal requirement, so saying "most insurance plans have this" without providing proof is pretty irrelevant. Balance billing is legal in many states, and people are balanced billed all the time. I've provided several examples, there are thousands of others.

It happens to a lot of people, despite your anecdotal experiences.

You can also wind up being inadvertently balanced billed because a doctor working at an in-network facility is out of network. Hence the Florida law.

Just because you've never encountered it doesn't mean it isn't happening in a lot of other situations.

[petej0]

Yes, another thing people in those age groups don't see, is the building of problems that end up spiking everyone's cost. That diabetes you had been building for years, will be saved until you can spike insurance prices. That cancer you never got checked for, will spike costs. Som yes... If you live in a vacuum where nothing bad ever happens, lucky you... But, in the real world, you are being irresponsible and are directly responsible for increased costs through hospitals, then if you make it that far, increased cost for Medicare.

Yes, but alot of these problems will still exist. Just because someone is covered does not mean they will see a Doctor. That diabetes a person has been building for years will go unnoticed until they start having circulation or eye issues.

[Felya]

Getting check ups is routine care. They are usually only yearly, and relatively inexpensive. That's a very small amount of medical care compared to paying $200/month in premiums.

Yes, it is. While with the way averaging works through insurance companies, you not paying them extra for the minimal care, means that you will be paying more for the greater care when you do get insurance. You don't actually save in the long run, other than the insurance profit/administration cost on those small check ups. You still end up paying for it as soon as you hit insurance companies, because everyone gets spiked by not having your small check ups counting towards average cost of the insured. What's even worse, is that due to the nature of Medicare and Medicaid, they do not get any cost balancing pools. So, not only will you be paying more later through insurance, because you were not giving them a cut of your small bills. It's in their best interest to provide pain killers, while leaving you to solve the actual problem until you are 65.

[Wolfheart9]

Yes, but alot of these problems will still exist. Just because someone is covered does not mean they will see a Doctor. That diabetes a person has been building for years will go unnoticed until they start having circulation or eye issues.

And if it cost them nothing out of pocket because the system already had it paid for, I know a lot more who would actually go to those regular checkups.

[Thepersona]

why you dont just implement single payer?
private hospitals and insurance companies can (and do) exist, but there is at least a baseline health services for everyone

[Tinykong]

Yes, it is. While with the way averaging works through insurance companies, you not paying them extra for the minimal care, means that you will be paying more for the greater care when you do get insurance. You don't actually save in the long run, other than the insurance profit/administration cost on those small check ups. You still end up paying for it as soon as you hit insurance companies, because everyone gets spiked by not having your small check ups counting towards average cost of the insured. What's even worse, is that due to the nature of Medicare and Medicaid, they do not get any cost balancing pools. So, not only will you be paying more later through insurance, because you were not giving them a cut of your small bills. It's in their best interest to provide pain killers, while leaving you to solve the actual problem until you are 65.

Are you arguing against being uninsured while healthy, and insured while sick? It's pretty hard to make sense of this post.

[Matchles]

Perfect example of a way we can reduce cost of care. Yet nobody cares about that end. Even a single payer system will still the problem of costs.


They only leech when they dont pay. Otherwise that is the cost of their treatment. It is not their fault the hospital charged them less.

It really isn't. I've already explained. It is called "cost shifting" and many times even when the uninsured DO pay, they are charged less and the rest is recouped in higher charges to insured patients leading to higher premiums all around. The uninsured don't escape being a burden on the system simply because they pay their bills.

[Narwal]

People are just talking past each other at this point. The ACA fixed a lot that was wrong with our system before its implementation. It also created new problems. Do the benefits outweigh the costs? For society as a whole, they do. For some individuals PERSONALLY, they don't.

Obamacare did address some issues, but I wouldn't say it "fixed" them. Likewise, it's way too early to know if it efficiently enough addresses the issues to outweight it's costs.

[Wolfheart9]

Obamacare did address some issues, but I wouldn't say it "fixed" them. Likewise, it's way too early to know if it efficiently enough addresses the issues to outweight it's costs.

Without limiting how much of a profit drug companies and so on can make, no system will ever work 'right'.

[Felya]

Yes, but alot of these problems will still exist. Just because someone is covered does not mean they will see a Doctor. That diabetes a person has been building for years will go unnoticed until they start having circulation or eye issues.

Yes, but you would still be paying for the single payer or universal coverage through taxes. Meaning that for the years you pay for your care, but do not use it, you are paying forward. You are just being very stupid... As opposed to just being cunning, in that you pay the small amounts out of pocket, while not paying into the system. Then spiking the cost without the balancing through the years you didn't need it. There would be no spike if you were on insurance and not using it until you need it... or through a public system, where it's included in your taxes...

[petej0]

Yes, but you would still be paying for the single payer or universal coverage through taxes. Meaning that for the years you pay for your care, but do not use it, you are paying forward. You are just being very stupid... As opposed to just being cunning, in that you pay the small amounts out of pocket, while not paying into the system. Then spiking the cost without the balancing through the years you didn't need it. There would be no spike if you were on insurance and not using it until you need it... or through a public system, where it's included in your taxes...

There is a spike because now you have to get a much more expensive procedure then if you had got it taken care of earlier

[Felya]

Are you arguing against being uninsured while healthy, and insured while sick? It's pretty hard to make sense of this post.

I'm not arguing against it, I'm showing you that you waiting to get insurance until you need it, is what increases costs of insurance. If you were paying insurance and not using it, the insurance prices would be lower. That is the exact issue the OP is talking about... Where there isn't enouph healthy people who get insurance, as well as those who only sign up when they need it, while the mandate is not enouph to cover the differance. The issue is that people like you, pay out of pocket, then complain that prices are too high when you choose to get it. As in, you are the reason insurance are so expensive...

- - - Updated - - -

There is a spike because now you have to get a much more expensive procedure then if you had got it taken care of earlier

Yes, but you have been paying for nothing, which avarages the cost down. The spike happens when like TinyKong, you do not pay insurance during healthy years and then start paying during unhealthy. If you paid the whole time, there is not spike, as you have been contributing the whole time you wear dumb enouph to not use it.

[Hablion]

The Affordable Care Act did a lot of harm to people who already had insurance. For example Our Healthcare Premium went up (the cost per paycheck), They raised the deductible from about 500 to 1500 (this includes medication and doctor visit fees) and you do not get any discount and pay 100% until you get above the 1500 deductible. Basically after the ACA we are paying more for less benefits.