Yeah, About That Keep Your Doctor Thing

[VolnJC]

That's the way it's headed, but most preventive care costs $0.

My wife and I asked both of our doctors(same medical group) about the preventive exams on our plan..both said they would check but every time we went we had to pay copays...and whats weird is that even though we had the same insurance my wife would have to pay more even though it was basically the same type of visit.

This is what you get when you type in the link for the preventive ACA services
https://www.healthcare.gov/preventive-care-benefits/adults/

Sorry, we can't find that page
on HealthCare.gov
We've recently reorganized our site, and that may explain it.
It's also possible that you typed the address incorrectly.

 

[slobberknocker]

My wife and I asked both of our doctors(same medical group) about the preventive exams on our plan..both said they would check but every time we went we had to pay copays...and whats weird is that even though we had the same insurance my wife would have to pay more even though it was basically the same type of visit.

This is what you get when you type in the link for the preventive ACA services
https://www.healthcare.gov/preventive-care-benefits/adults/

Sorry, we can't find that page
on HealthCare.gov
We've recently reorganized our site, and that may explain it.
It's also possible that you typed the address incorrectly.

I just went on healthcare.gov and searched for "preventive care", all the procedures were listed and you should never have to make co-pays for those. You should ask for a refund from your docs. A lot of front office employees have no idea what they are doing.
But if you went to the doc for other issues or annual physical you would have a co-pay.

 

[VolnJC]

I just went on healthcare.gov and searched for "preventive care", all the procedures were listed and you should never have to make co-pays for those. You should ask for a refund from your docs. A lot of front office employees have no idea what they are doing.

Thanks, I'll try it. I just followed the link and didn't search. Wish it was more like Medicare..took my mom and they had a sheet of what was free without the copay and it was very easy.

 

[slobberknocker]

Thanks, I'll try it. I just followed the link and didn't search. Wish it was more like Medicare..took my mom and they had a sheet of what was free without the copay and it was very easy.

Medicare is definitely better, most of what I do is working with seniors on med supps and medicare advantage plans. I start on Medicare next month.

 

[volinbham]

The Swiss have a very homogenous pool and good overall health. Their system works because the pool is small, normally distributed, and healthy. Their entire population is like the cream of the cream of our country. So no, it won't work here. The larger the population is, the more exponential the complexity becomes.

It could certainly still work here. It is an insurance model. In one aspect it is like single payer in that all insurers must offer the "basic" coverage. A difference is that they can find different ways to price the basic coverage so someone with a particular situation may find a better rate on the basic coverage.

The fact we are less healthy just means the costs of the basic coverage would be higher (same is true now and would be true with single payer).

The advantage is that robust competition allows people to add to basic plans to fit their unique situation and for insurers to specialize for particular populations.

The kicker is that since you pay for it (directly or subsidized) you are incentivized to minimize your healthcare costs.

It is a good blend of consumer driven care and basic coverage for all.

The only controversial part to me is the mandate but I believe that ship has already sailed in the US.

 

[volinbham]

Naturally, the problem is magnified because Medicaid pays crap, and most PCP's cap their TN-care enrollment (or don't see any), which makes it difficult for many to find a decent provider.

Which is why single payer would be fundamentally problematic (at least in the short - medium term). The cost structure of our HC system relies on a payer mix. If most reimbursement goes to the lowest payer (Medicaid) many providers will fold since their costs are often locked into equipment and personnel that will not immediately come down in cost.

 

[volinbham]

I'm hearing more and more of my friends tell me that they can afford only the bronze plan but won't be able to use it unless it's an emergency. I thought that the ACA was supposed to focus on good preventive care and was to get rid of those "terrible" catastrophic plans? That's what the bronze plans are, but now they are twice as expensive.

It created the "race to the bottom" that Obama complained about. The irony is choice is being reduced so you only have one or two options for crap plans.

 

[volinbham]

Medicare is definitely better, most of what I do is working with seniors on med supps and medicare advantage plans. I start on Medicare next month.

Medicare is better than Medicaid. Still, providers often cap Medicare patients since the reimbursement rate is still low. The Medicare Advantage and other supplemental insurance programs help.

 

[slobberknocker]

Medicare is better than Medicaid. Still, providers often cap Medicare patients since the reimbursement rate is still low. The Medicare Advantage and other supplemental insurance programs help.

When I was doing provider contracting in the rural counties of the SE US, especially TN and SC, anywhere from 70-80% of practice revenue came from medicaid/medicare. Docs in those areas loved me since I was bringing them commercial business, even though fee schedules were about 110-120% of medicare.

 

[Carl Pickens]

Would our future single payor system look like the current VA system?

It would......except it would be an even bigger cluster ****. One of epic proportions...... Health care DMV style

 

[Orangedogsrule]

It would......except it would be an even bigger cluster ****. One of epic proportions...... Health care DMV style

I'm curious if they will continue to allow ER visits for anything. If they stopped that now, and forced these large group medical providers owning many hospitals nationwide to provide (as you say DMV care-I'll call it "Sick Call Rooms"-like in the Army) non-Emergency and even non-"Critical Care" pathways for general internal, ENT type medicine; the savings would be astronomical.

Have a sign on entrance to the hospital parking:

Emergency => Copay $50.00
Non-Emergency <= Copay $20.00