Fun with the Healthcare Exchange

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F0nzie

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So since I am almost fully transitioned into private practice, I dropped my employer insurance plan I have been going through the healthcare exchange. My experience so far has been very bad. I was overcharged 2 months of coverage that I never used, my autopay was discontinued without my authorization (did not change credit cards), I received no notification that my health insurance coverage was discontinued....Customer support has no records of withdrawing money from my bank account. My insurance directs my inquiries to the exchange, and the exchange directs them back to the insurance company. I have a huge lapse in insurance coverage and could face penalties from the Federal Government.

All the low deductible Platinum plans for 2016 have disappeared except for one that is terrible.... Now I hear more mergers are taking place....what a disaster....what is this garbage???

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That's the ACA. My brother and a few friends have been dealing with this crap since it opened

Maybe I should rethink the whole locum thing. Heh.

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So since I am almost fully transitioned into private practice, I dropped my employer insurance plan I have been going through the healthcare exchange. My experience so far has been very bad. I was overcharged 2 months of coverage that I never used, my autopay was discontinued without my authorization (did not change credit cards), I received no notification that my health insurance coverage was discontinued....Customer support has no records of withdrawing money from my bank account. My insurance directs my inquiries to the exchange, and the exchange directs them back to the insurance company. I have a huge lapse in insurance coverage and could face penalties from the Federal Government.

All the low deductible Platinum plans for 2016 have disappeared except for one that is terrible.... Now I hear more mergers are taking place....what a disaster....what is this garbage???

We are with the government and we are here to help.
 
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Hanging onto my employed benefits with both hands
 
So since I am almost fully transitioned into private practice, I dropped my employer insurance plan I have been going through the healthcare exchange. My experience so far has been very bad. I was overcharged 2 months of coverage that I never used, my autopay was discontinued without my authorization (did not change credit cards), I received no notification that my health insurance coverage was discontinued....Customer support has no records of withdrawing money from my bank account. My insurance directs my inquiries to the exchange, and the exchange directs them back to the insurance company. I have a huge lapse in insurance coverage and could face penalties from the Federal Government.

All the low deductible Platinum plans for 2016 have disappeared except for one that is terrible.... Now I hear more mergers are taking place....what a disaster....what is this garbage???

Why exactly are you buying through the exchange anyway? You make enough that you won't get a subsidy so you're introducing an unnecessary middleman into the process. You can shop on the exchange to compare plans and then sign up with the insurer you want outside of the exchange itself.

The only reason to use the actual exchange is if you're going to receive a subsidy.
 
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Why exactly are you buying through the exchange anyway? You make enough that you won't get a subsidy so you're introducing an unnecessary middleman into the process. You can shop on the exchange to compare plans and then sign up with the insurer you want outside of the exchange itself.

The only reason to use the actual exchange is if you're going to receive a subsidy.

That's weird. I tried but they wouldn't let me sign up and told me I had to go through the exchange. lol
 
Are you in a state or the federal exchange? Some of the state ones are run better than others. I heard Oregon had a particularly bad one, for example.
 
So since I am almost fully transitioned into private practice, I dropped my employer insurance plan I have been going through the healthcare exchange. My experience so far has been very bad. I was overcharged 2 months of coverage that I never used, my autopay was discontinued without my authorization (did not change credit cards), I received no notification that my health insurance coverage was discontinued....Customer support has no records of withdrawing money from my bank account. My insurance directs my inquiries to the exchange, and the exchange directs them back to the insurance company. I have a huge lapse in insurance coverage and could face penalties from the Federal Government.

All the low deductible Platinum plans for 2016 have disappeared except for one that is terrible.... Now I hear more mergers are taking place....what a disaster....what is this garbage???

If this is how we feel and we are physicians, imagine how patients feel..
 
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I think patients who have Medicaid now who previously had no access to healthcare are pretty happy.

Those who are getting subsides for private insurance are probably pretty happy.

For those whom the ACA does not help in affording insurance are probably not very happy.
 
And yet this was voted in because it would keep costs down, help those uninsured, and you could keep your plan and your doctor.
 
I have a friend who's getting a $7 subsidy. Another friend, a divorced mom of one, can't find a plan with a deductible of under $13K. My brother is trying to pick a plan, but every time he logs on the options are different. Not kinda different. Drastically different. It's a mess. I don't see who it helps besides the insurance companies. And perhaps some people with pre-existing conditions.


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Everyone with pre-existing conditions. That change to the law alone is worth billions.
 
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It's a step in the right direction. It doesn't go nearly far enough. And it won't as long as keeping the insurance industry profitable is a must-have. Running health insurance like any other insurance is ridiculous. Your auto, liability and homeowners work and are relatively low cost because most people never hope to need it. Everyone actively uses their health insurance. The point of having it is to go see your doctor and get that paid for. Why do we think the same model that works for your car applies? My auto policy doesn't cover preventative maintenance.

Also the fact that healthcare is linked to employment is ridiculous and doesn't help business be profitable. That's why it continues to surprise me that big business is anti single payer. Once upon a time some companies enticed employees by offering health insurance. Then it became a required thing that everyone takes for granted. It's nuts.

Based on Grover's government comment, I'm guessing we dislike the same law but for very different reasons. I belong to PNHP. And if Sanders doesn't get the nomination, I'm voting for Stein.

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Also the fact that healthcare is linked to employment is ridiculous and doesn't help business be profitable. That's why it continues to surprise me that big business is anti single payer. Once upon a time some companies enticed employees by offering health insurance. Then it became a required thing that everyone takes for granted. It's nuts.

The situation arose largely because health insurance was not covered by the New Deal wage controls that kept employers from offering higher salaries. This just happened to coincide with the beginning of real industrial action, with the NLRB providing a framework for unions to negotiate with some confidence, so naturally they wanted that insurance as well.

Add two decades of minimal foreign competition in many industrial sectors and big firms built around a "lifer" model for employment and suddenly it is the default reference point for everyone's idea of what a "real job" entails.
 
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Agreed. And it doesn't really work all that great anymore. It's like when that Papa John's guy was griping to the press about how he was going to have lay people off and increase the price of pizza. And I'm like, "I agree. You shouldn't have to do this. We should cover everyone through our taxes". I don't think that's what he meant though.

Having said that . . . Medicare and the VA aren't perfect models. Meaningful use is a crock and I think we can expect them to continue to come up with bs regs that don't make sense. But we advocate against that kinda thing. It doesn't mean the overall model is bad.

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Agreed. And it doesn't really work all that great anymore. It's like when that Papa John's guy was griping to the press about how he was going to have lay people off and increase the price of pizza. And I'm like, "I agree. You shouldn't have to do this. We should cover everyone through our taxes". I don't think that's what he meant though.

Having said that . . . Medicare and the VA aren't perfect models. Meaningful use is a crock and I think we can expect them to continue to come up with bs regs that don't make sense. But we advocate against that kinda thing. It doesn't mean the overall model is bad.

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It is a bad model because it emphasizes bureaucracy over quality of care. Measuring metric is limited in the scope as one applies the data. It's the same model where you're practicing now and very unhappy because you've lost control of your practice and forced to see a bunch.
 
I'm not a health policy wonk though I probably should've become one, but I don't think it has to work like that. It could work like that, yes. But it doesn't have to work like that. It really depends on how reimbursement is structured. I'd be curious to see numbers on the prevalence of physician burnout in Canada and northern/Western Europe.

The student loan issue is also huge. I think part of the solution is subsidizing medical education. Then docs wouldn't need to make the huge bucks just to live a comfortable upper middle class existence. Kinda weird that you can get a PhD in physics for free because we've decided that having physicists is important. Family medicine docs? Pediatricians? Not so much. Screw those guys.

Teachers get a raw deal too. Worse than ours in many respects, though also very similar.

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I'm in agreement that health insurance should be separated from income. This also applies to disability, as there are too many patients on social security disablity who are only on there because they need medical insurance. They could theoretically work part time, though they don't because they're afraid of losing their "benefits."

I do think that value-based systems and capitated systems are being primed to force physicians into a "salary pushdown," and will likely collapse on themselves not due to cost, but due to the fact that providers will soon realize that there is no benefit for them to complete additional encounters or to go "above and beyond." The old adage "work smarter," stops applying, and instead becomes "don't work any more than the guy next to you, because there's no financial benefit anyway"
 
The student loan issue is also huge. I think part of the solution is subsidizing medical education. Then docs wouldn't need to make the huge bucks just to live a comfortable upper middle class existence. Kinda weird that you can get a PhD in physics for free because we've decided that having physicists is important. Family medicine docs? Pediatricians? Not so much. Screw those guys.
Yup. Most countries have subsidized medical training. It is more than compensated by having cost savings associated with a public healthcare system.

The handwringing response that comes with that is the loss of freedom of private healthcare, but that's still an option in places with public healthcare (and many people of means do have private healthcare).

But once you make healthcare a public service as opposed to a for-profit enterprise, you lose all the price gouging that makes healthcare so expensive, which reduces the profit for all of the insurance companies, which reduces the reimbursements private insurers pay out to doctors, which reduces doctor's salaries.

At the end of the day, if you took a poll for eliminating all medical school debt and public healthcare in exchange for lower physician salaries, most physicians would vote no.
 
But also with public health entities, like the VA and such, you won't be free to prescribe treatment but in a limited environment where you have to justify your actions to a pharmacist who could deny your prescription. It happens in the VA.
 
At the end of the day, if you took a poll for eliminating all medical school debt and public healthcare in exchange for lower physician salaries, most physicians would vote no.

I don't doubt it. Depending how low, I'd vote yes if 100% student loan debt forgiveness were part of the package.


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I don't doubt it. Depending how low, I'd vote yes if 100% student loan debt forgiveness were part of the package.
If the proposed pay cut for free medical school was $20K/year, you'd still likely be WAY better off financially taking out $250K for medical school and just paying off the loans.
 
It sounds like we all pretty much agree that the current model for medical school is unsustainable. Any ideas on how to pay for education in the future?
 
No, just those who don't have insurance through their employer or who aren't disabled.
Even if you had insurance through your employer, if you were laid off, fired, or underemployed, you could find yourself in the position of having to seek out new insurance with a pre-existing condition (COBRA is only good for so long and is often unaffordable to many Americans who find themselves out of work).

Most-pre-existing conditions did not meet criteria for disability making you eligible for Medicare.

We can have a healthy debate about government-run healthcare and further socialized medicine, but nobody supported the pre-existing conditions clause other than insurance industry shills.
 
If the proposed pay cut for free medical school was $20K/year, you'd still likely be WAY better off financially taking out $250K for medical school and just paying off the loans.

Not if you didn't want to practice medicine anymore. Though of course that begs the question if free medical education creates a service obligation. And if so, how long?


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Not if you didn't want to practice medicine anymore. Though of course that begs the question if free medical education creates a service obligation. And if so, how long?
I don't think it would.

An MD doesn't really give you a whole lot in terms of preparation for another career, so no one is going to use medicine as a stepping stone. Folks who leave the field will leave it because they REALLY don't want to practice anymore. Keeping people handcuffed to the field isn't good patient care.
 
No, just those who don't have insurance through their employer or who aren't disabled.

Also used to be not at all uncommon for anyone with a major psychiatric diagnosis to be straight up denied insurance on the individual market back before this went into effect.

Plus, even if you got insurance, the company could simply refuse to pay for anything connected to a pre-existing condition. Say you had a heart arrythmia that developed before you bought your policy. Well, congratulations, your insurance was not going to pay f*** all for whatever your cardiologist did.

Eliminating this has been huge, though it also calls into question the utility of the insurance model for health care financing.
 
The student loan issue is also huge. I think part of the solution is subsidizing medical education. Then docs wouldn't need to make the huge bucks just to live a comfortable upper middle class existence. Kinda weird that you can get a PhD in physics for free because we've decided that having physicists is important. Family medicine docs? Pediatricians? Not so much. Screw those guys.
this is misleading, most PhD students have to pay their way through their education with a mix of scholarships, teaching fellowships and research assistanships - which is to say they have to pay their own way especially as the number of PhD places have increased. The government is not subsidizing most PhDs and certainly not in their entirety.

The trend is to defund public funding of graduate medical education so it is unlikely we are going to see public funding of undergraduate medical education any time soon. It's not like you can't get a free education to be a family physician or pediatrician (the NHSC scholarships for example).

The economist Uwe Reinhardt has argued that medical education in the US is not a public good and that doctors should not be entitled to public funding for their undergraduate of graduate medical education. He argues people can and do whatever they like with their training once they've finished and this often is of no public benefit. We know that some years ago more people from Yale went into management consultancy than went into primary care specialties, and that at Stanford and UCSF a sizable minority of their medical school classes go into tech each year. If you go to a prestigious medical school there are options available to you to use your MD to escape - not so for people who don't go to a top medical school though. I am a rabid socialist and believe education should be free for those who are able to avail themselves, but I cannot really support an argument that medical training should be free in the US. The old line about how this is why people shun primary care is BS. I can tell you in countries where people don't have to pay as much or have a subsidised education the most popular specialties are still the highest paying and without clever workforce planning the specialties which are in shortage here and also shortage specialties elsewhere.
 
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This is what happens when you contract engineers to cheaply deliver a system they have no investment in. And a complicated system. And they are only filling the terms of their individual piece of the contract, with no investment in integration. And there is insufficient testing until the thing goes live.
 
I'm not a health policy wonk though I probably should've become one, but I don't think it has to work like that. It could work like that, yes. But it doesn't have to work like that. It really depends on how reimbursement is structured. I'd be curious to see numbers on the prevalence of physician burnout in Canada and northern/Western Europe.

The student loan issue is also huge. I think part of the solution is subsidizing medical education. Then docs wouldn't need to make the huge bucks just to live a comfortable upper middle class existence. Kinda weird that you can get a PhD in physics for free because we've decided that having physicists is important. Family medicine docs? Pediatricians? Not so much. Screw those guys.

Teachers get a raw deal too. Worse than ours in many respects, though also very similar.

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I disagree with your assessment regarding PhD's. If we are going to make comparisons, a PhD is the equivalent of residency not of medical school. In the US you do also take courses, but the majority of your time is spent toiling in a lab. In many countries a PhD "student" is employed with a salaried position and a contract, and I believe that's way it should be everywhere, otherwise you're at higher risk for abuse. Anytime you're doing a job and offering a service, it be should an employed position. So no, PhDs aren't having it better than MDs, not by any stretch.

As for the discussion regarding public vs private, usually socialized medicine comes with a package. Doctors will have lower salaries, but they also will have free health care and high quality free education for their kids all the way to university. That's huge if you want a family. And the hours are indeed cushy relative to the US. In Germany for example, you're not allowed to work more than 44 hours a week, and if you take a weekend call, it should be exchanged with a day off and I believe these are now the standardized EU regulations everywhere in Europe. That also includes residency. On the other hand, a more liberal system would foster more competitiveness, and even though the average probably doesn't turn out as well, it's the reason why the US has the top hospitals and universities in the world. Which is better I guess depends entirely on each individual's situation and aspirations.
 
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I disagree with your assessment regarding PhD's. If we are going to make comparisons, a PhD is the equivalent of residency not of medical school.
ha! this thread is becoming more and more of a joke. Although I disagreed with sunlioness' assessment as i wrote above, this is patently not true. residents are not students. though i agree that an MD degree is intellectually bereft, it is telling that even in european countries where the hours are technically better (I say technically because it is well known many people work over the 48hrs the EWTR allows which is at any rate averaged over 6 months), that junior doctors in those countries often do a PhD to "have a break" from doing "real work" - a stance that tends to irritate their non-medical PhD student colleagues.
 
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I've seen a couple of my cousins in Sweden get a PhD and I'm not entirely convinced it's as grueling as it in the US. Sweden is a country of about 10 million people where everyone is the best something in the world (I'm saying that sarcastically--people tend to use the superlative "world's best" a lot in Sweden and with a small population it seems everyone has a fairly good reputation). Now I'm not down on it. But I could see how getting a PhD in Sweden would be considered a break. From the time you enter college you're paid to be in college--you get housing and an income just for being in college. One of my cousins did a semester abroad at NYU all paid for by the Swedish government. He was put in an apartment that I guarantee no professor at NYU could afford to live in, and I still am not quite sure what the justification for his study abroad was--it wasn't like he was taking unique classes you couldn't take in Sweden. Again, not down on it. Maybe as we say in Swedish I'm a bit svartsjuk (jealous--literally translates as "black sick").
 
ha! this thread is becoming more and more of a joke. Although I disagreed with sunlioness' assessment as i wrote above, this is patently not true. residents are not students. though i agree that an MD degree is intellectually bereft, it is telling that even in european countries where the hours are technically better (I say technically because it is well known many people work over the 48hrs the EWTR allows which is at any rate averaged over 6 months), that junior doctors in those countries often do a PhD to "have a break" from doing "real work" - a stance that tends to irritate their non-medical PhD student colleagues.

Well, the point that I am trying to convey actually is that even a PhD should be treated as a job, hence why it's more similar to the residency portion training not the medical school part. In many places, it is an employed position. Not that residents are students.

I also suspect what you're talking about is not a PhD but a doctor title which in many countries requires the submission of a thesis, and often needs minimal work without publications.
 
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ha! this thread is becoming more and more of a joke. Although I disagreed with sunlioness' assessment as i wrote above, this is patently not true. residents are not students. though i agree that an MD degree is intellectually bereft, it is telling that even in european countries where the hours are technically better (I say technically because it is well known many people work over the 48hrs the EWTR allows which is at any rate averaged over 6 months), that junior doctors in those countries often do a PhD to "have a break" from doing "real work" - a stance that tends to irritate their non-medical PhD student colleagues.

Oh, a PhD is not all that much work if you are simply trying to fulfill the minimum requirements for graduation.

Note however that coming out of a PhD program in most fields these days without multiple publications already done/in the pipeline is basically career suicide. I am sure that junior doctors in Europe take their PhDs less seriously because in future they will mostly be hired based on their medical training at the end of the day.
 
To start, let's just raise the income limits on tax deductions for student loan interest to something reasonable like $500,000 and also make it deductible for alternative minimum tax purposes.


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The income limit on deducting student loan interest payments is a huge peeve of mine. I try to console myself by saying the cap on payments to social security is also pretty ridiculous and I probably gain from that more than I lose from the other. But I actually wrote to Bernie Sanders when he proposed getting rid of the social security cap to say I was all for it . . . as long as he also got rid of the income limit on student loan interest deductions.
 
Sadly the secular trend is towards doing away with loan-interest tax deductions rather than expanding them. Remember that what exists now is a pale shadow of the universe of deductions possible before the 80s (when essentially all loan interest of any sort was deductible) and there are serious proposals to abolish the mortgage deduction. I am not sure raising those income limits is a viable proposition.
 
The largest bubble on the planet, student loans.
True. A bad combination of universities raising tuitions to ridiculous heights due to government not ponying up, overestimation of the necessity of a college education by employers, and a lack of sacrifice amongst applicants willing to sign up for expensive private schools rather than going community college or state.
 
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True. A bad combination of universities raising tuitions to ridiculous heights due to government not ponying up, overestimation of the necessity of a college education by employers, and a lack of sacrifice amongst applicants willing to sign up for expensive private schools rather than going community college or state.

A missing major factor in this analysis includes the federal government's willingness to make arbitrarily large loan guarantees for tuition, confident in the knowledge that discharging those debts in bankruptcy borders on the impossible. This is what has allowed applicants to be largely price insensitive.
 
True. A bad combination of universities raising tuitions to ridiculous heights due to government not ponying up, overestimation of the necessity of a college education by employers, and a lack of sacrifice amongst applicants willing to sign up for expensive private schools rather than going community college or state.

Not to mention the outright scams that many for profit "universities" are. They show ads during daytime television. I had a patient once who called one. They had her come in and take a test. Told her she'd make a great paralegal and signed her up. Got her some loans. And then pretty much ditched her. People don't graduate from those programs. And if they do, there's no real job placement. No matter what the happy commercial truckers and hvac technicians say on the ads.


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Talking about Government mishandling of the health care system, I don't suggest anyone move to Australia at the moment. Our current Government appears to be doing their level best to destroy not only the mental health system under the guise of 'reform' (it's the usual double speak, buzzwords all of us have heard at one point or another, which basically adds up to stripping funding from programs through stealth by claiming they're 'overhauling' the system for the better), but also the Australian Healthcare System in general. Thankfully RANZCP (Royal Australian and New Zealand College of Psychiatry) have already gotten one parliamentary bill off the table, which would have restricted access to long term psychotherapy programs for patients with complex issues, at least for the time being. The Australian Medical Association along with RACPG (Royal Australian College of General Practioners) are also continuing to co-ordinate and issue protest and information packs for both Doctors and Patients, plus if things continue the way they're going (with the stupid Liberal* Government trying to sneak legislation in through the back door) I wouldn't be at all surprised if we see some more mass rallies of Doctors and other healthcare workers around the country. Don't even get me started on the draconian section of the 'Border Farce Act' that prevents Doctors and healthcare workers from performing their duties with regards to mandatory reporting of child sexual and other abuse offences within the refugee detention centres under threat of possible jail time (not to mention the difficulties placed on mental health workers working with detainees, many of whom are suffering from PTSD, actively suicidal, experiencing trauma related psychoses and/or other serious mental illnesses, causing physical harm to themselves due to increasingly distressed states of mind, but no one seems to be able to do their job properly because the Government is more worried about keeping these workers silent about the abuses that are happening, than giving two hoots about the very real suffering of fellow human beings).

Totally hats off to all the Hospitals, Medical Centres, Colleges of Fellows, The AMA, individual Doctors and any other healthcare associated body and their workers for being prepared to stand up against this BS!

Yeah, I might be a little bit passionate about this. :whistle:

(*FYI, the Liberals in Australia are the right wing conservative party, Liberal in name only).
 
All the low deductible Platinum plans for 2016 have disappeared except for one that is terrible.... Now I hear more mergers are taking place....what a disaster....what is this garbage???
Welcome to ObamaCare.

As for plan options...many insurance companies aren't making the $ they expected, so they have slashed the number of programs offered and the mix of plans isn't as good.
 
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