I believe he is sincere.
I believe he is sincere.
My friend is such a fucking idiot he decided to wait and get cancer until after he'd graduated from college and was working 2 part time jobs in positions related to what he studied cus that's all the market had to offer. It's awkward and I feel bad for him because every time he posts about the treatment he's getting as he's trying to cure himself all I can think about it what a loser he is that the care he's getting comes via his parent's plan.
3% of the population is a tough number for RODG to comprehend.
About to turn 36 and I am stil insured under my mother, through her company, since I was declared disabled before my 23rd birthday. It allows me to have amazing health care I would not otherwise have thanks to this pre-existing condition. I would be stuck with Medicare and California's GHPP. I am such a leech for wanting the best. Do you know the first thing they ask, look into, when listing for lung transplant? What insurance you have. Do you know the relief I felt when I could tell them the answer? The relief they had when they heard the answer?
Last edited by JustSteve; 11-19-2013 at 10:09 AM.
How affordable is the Affordable Care Act? Not very, it would seem for Washington state resident Jessica Sanford.
The self-employed single mother was cited last month as an ObamaCare success story by President Obama in the Rose Garden. But according to Washington State Wire, she's now finding out she doesn't qualify for the tax credits she was originally told she'd get.
Sanford, who told the news site she hasn't had health insurance in 15 years, initially said she was excited by the prospect of purchasing a policy for her and her son under ObamaCare. Before ObamaCare, Sanford was getting health insurance rate quotes of about $500-$600 a month. That was too steep for the freelance court reporter.
But she wrote a letter to Obama about the new health care overhaul and what it would mean to her. Her son has ADHD, requires regular doctor visits and must take medication that costs $250 a month.
Obama quoted from Sanford’s letter during an Oct. 21 speech at the Rose Garden, where he was pitching the merits of the new health care law.
“Now, that is not untypical for a lot of folks like Jessica who have been struggling without health insurance,” the president said. “That is what the Affordable Care Act is all about.”
Sanford’s home state of Washington is one of 14 that opted to create its own online health care exchange rather than use the glitch-ridden federal one. Sanford enrolled in a “gold”-level health plan offered by Premera Blue Cross. Due to a tax credit, she got a $452 discount -- and a plan for just $169 a month.
Sanford, though, reportedly then got a letter from her state health exchange that said they had made an error in the tax-credit calculations. The mistake affected 4,600 policies and covered 8,000 people – including Sanford.
Sanford went back with her health care broker and tried again, according to the article. This time she qualified for a lower tax credit. She signed up for Premera’s “silver” plan – which meant higher copays and deductibles for her.
Still, it was lower than what she had been paying.
And then, she reportedly got another letter. This one said she didn’t qualify for any type of tax credit.
Apparently this happened because the state-run insurance plan told her that her income was low enough that she could enroll her son in Apple Health, the state Medicaid program for children of low-income families.
To do that, she’d have to pay a low monthly premium of $30. She signed up her son. However, because she did, she would not be able to count him toward a tax credit for her. She got a third letter last week saying her income is too high to qualify for subsidies, according to the report.
“I thought this was a total mistake, they’re going to correct this – this isn’t true,” she told Washington State Wire. “How could I not qualify for a tax credit? I make under $50,000 a year. There’s got to be something. So I got ahold of my broker, and a couple of days later he called me back, and he told me that no, it was true."
"Some people just need a hi-five in the face."
Let's continue that story! Whole thing here.
Medicaid Eligibility Becomes Problem
The hitch was that the website told her that her income was low enough that she could enroll her son in the state Medicaid program for children of low-income families, known as Apple Health. For that she would have to pay a premium of just $30 a month. She could enroll him right away, and she did. But that created a problem. When she enrolled Ryan in Medicaid, she couldn’t count him toward a tax credit. Not that the website mentioned it. In fact, it gave her the opposite impression.
Once the new health insurance policy kicked in on Jan. 1, the premium was supposed to be $280 a month, plus, she assumed, the Medicaid premium. But after she signed up for a policy, and after she gave her credit-card information, she got a letter from the state last week saying that her income was too high to qualify for subsidies – the cutoff is $44,680 for a single adult, 400 percent of the federal poverty level. So she would get no help from the feds at all.
“I was dumbfounded,” she said. “I thought this was a total mistake, they’re going to correct this — this isn’t true. How could I not qualify for a tax credit? I make under $50,000 a year. There’s got to be something. So I got ahold of my broker, and a couple of days later he called me back, and he told me that no, it was true.”
Now she says her health-insurance dream has gone bust. Without a tax credit she has to consider the cheapest “bronze” level plans, but the deductibles are so high that couldn’t afford to purchase prescription medication. “I was like, forget that – I’m not going to pay.”
So now she is looking forward to no health insurance at all. Under the terms of the Affordable Care Act, she will have to pay a penalty of $95.
Customers Get Runaround
The strange thing about the story is that there may be a third mistake involved, says Tumwater insurance broker Vernon Bonfield. He says Sanford’s son should never have been enrolled in Medicaid in the first place. The Apple Health program is supposed to be offered only to those who make less than 300 percent of the federal poverty level. Sanford makes 316 percent. Yet for some reason, he says the state website seems to be enrolling children in Medicaid who don’t qualify for it. “It could very well be that there is another calculator error – I made them aware of it last week, and they said they would look into it.”
Error or not, it points up another big problem with the state system, Bonfield says – the state website makes it easy to sign up a child for Medicaid, but it doesn’t explain the drastic consequences for the tax-credit calculation, and after a child is enrolled, it doesn’t allow customers to change their minds. And while there is a procedure allowing people to disenroll their children in Medicaid, Bonfield says it is hard enough for brokers to get answers about it – imagine what it must be like for a consumer. “It is just mind-boggling.”
The way the program works is a bit complicated. When households with incomes up to 200 percent of the federal poverty level sign up for health insurance at the state exchange, their children are automatically enrolled in the Medicaid program – there is no choice about it. Those who make between 200 and 250 percent of the federal poverty level can enroll their children with a premium of $20 a month per child, with a maximum of $40. Those who make between 250 percent and 300 percent pay a premium of $30 a month.
Those who make between 200 percent and 300 percent are supposed to be able to opt out of the program. But the process isn’t explained anywhere online, and it wasn’t until last week that Bonfield found someone to explain it to him. Customers have to call the state Health Care Authority’s toll-free number, 1 (855) 623-9357 and ask to have their children disenrolled, wait for a day for the website to update, then go back to the health-exchange website and re-enroll in a qualified health plan.
In practice it doesn’t necessarily work that way. Bonfield has had other customers in the same boat. He tells of one who called the state Health Care Authority to disenroll her child. “The lady on the phone said ‘No, you can’t do that, and you won’t get any tax credits if you do,’ which is the opposite of what I told her. And then she was told she had to call the Healthplanfinder – they’re the ones who can do that. Then she called the Healthplanfinder and they said, no, you have to call the Health Care Authority – they’re the ones who run Apple Health. And she said, they are the ones who just sent me to you. And then the person from the Healthplanfinder sent her to the Office of the Insurance Commissioner, and of course the OIC’s answer was, ‘we don’t have anything to do with the Healthplanfinder, at least when it comes to complaints.’ “
But Bonfield says he has one customer last week who managed to get through on the phone to the Health Care Authority to disenroll his children — so it must be possible.
No Beef With Obama
Sanford has been trying to flag the state’s attention – she posted a note on the state Healthplanfinder Facebook page Friday, sent letters to every state official she could think of. She has gotten at least one response so far, a public note from the Healthplanfinder staff on its Facebook page that says, “Jessica, we are very sad and disappointed that the tax credit miscalculation affected you so heavily.”
She says she wants to make it clear she has no beef with Obama and Obamacare. She still believes in the Affordable Care Act. “I don’t want this to be a political thing,” she says. “I don’t want to be bashing the president. I don’t want to be bashing the ACA. I don’t want to come across as saying that. I am a big Obama fan.
“But to me there is a big problem with the way the state is handling it. It is like a big machine – you put your stuff in there and once you do it, it is impossible to do anything. You can’t get through to them [on the phone], the website is really limited. So you are stuck on this big treadmill of bureaucracy, and you know, it feels very out of control.”
I don't think I'm hosting a 2016 collaborative playlist.
So the story here is that there are glitches in the Washington state system as well.
And that once her son is back on her plan she'll be back to getting a discount.
I don't think I'm hosting a 2016 collaborative playlist.
Hoping more stories about people who are finding the system successful start emerging. (http://queenofspainblog.com/author/admin/)
Yup. The entire family just ditched my husband’s employer provided health insurance* and as of January 1, 2014 we’ll be on a plan with a different insurance company. One that, unlike Aetna, decided to go after our business and compete in the marketplace.
easy to sign up
Our old plan had deductibles, and the out-of-pocket costs were 6k for individuals and 12k per family. This new plan from Blue Shield of California? No deductibles. Lower out-of-pocket maximums. Lower copays. Lower drug costs.
All of our doctors are in-network minus one. But that’s why I got the PPO. It’s also a 90/10 which means we pay 10% of things normally not totally covered like hospital stays and MRIs and what not. Our old plan? 80/20 in network and 60/40 out of network. Keeping in mind just about EVERYTHING for me was out of network.
After doing all the math, just to start, we’ll be saving $18,900 per year. That is without knowing if I will be hospitalized in 2014, or need surgery or any of those things. In 2013 I was hospitalized once in July and the bill is still sitting on my desk. I’ve been making payments.
If the judge from my Social Security Disability case rules in my favor, that means I’ll be eligible for Medicare as well. IF that happens, that will mean we may not have much out of pocket at all.
This makes me shake and cry.
We are one of those families who have been buried in medical debt since I got sick. We’re one of those families the President talks about…the ones who are so close to losing everything because Mom got sick. We’ve re-financed our mortgage using the HARP/HAMP plans with JP Morgan Chase. It wasn’t easy or pretty, but we managed to save some money per month to keep our home.
Now we are utilizing Obamacare. And yeah, go ahead and call it Obamacare, because without the President we wouldn’t have this opportunity.
I realize many of you are getting hit with higher premiums, but understand they have been higher EVERY YEAR FOR YEARS. This is WHY we all wanted health care reform in the first place. Premiums were going up and up, deductibles were going up, care was a pain to get at best and you had to fight your health insurance company for every drug your doctor prescribed and for every test they wanted done. Please understand this is why we went down this path and supported President Obama at every turn. Because the industry needed change, but more importantly Americans deserved better. No one should be as afraid and stressed as we are/were while battling an illness. In the greatest country on earth people lose their homes, they lose their jobs, they lose their insurance because the company tries REALLY HARD to kick you off the policy…they lose their MINDS because they are sick. All they should be doing is healing and getting bettering and following doctor’s orders. I know this first hand. I have lived nothing but THIS for nearly three years.
In my case, the stress was so great I tried to go back to work several times. It made me sicker. Had I not tried, I might not be as sick. I might not have as many problems. I might have a home that isn’t adjusting to a new normal but simply going about life as usual.
I came up with a plan. It had to include disability that was solid. So I used my employer given benefits and I fought Mutual of Omaha at every turn. After 9 months of denials and questioning and all out war, I received long term disability. Part of my policy states I MUST apply for SSDi and I MUST appeal any denials and use their lawyers.
It’s fine though. I now get a check. It essentially pays our mortgage. If I do get SSDi, my income won’t change, but SSDi will pay part of that check and Mutual of Omaha long term disability will pick up the rest. It’s being eligible for Medicare that will really change the game. Never mind that Mutual of Omaha still puts me through tests. They currently are seeking another rheumatologist for another (it would be my fifth) opinion. At least that’s what their letters tell me. However my guess is they are having trouble finding someone I haven’t already seen within a 100 mile radius.
My plan also had to include affordable health care. That meant joining the chorus of supporters for the Affordable Care Act and whenever I was physically able I had to make sure it passed. Then, once it passed, it had to stay law. Something the Right is still trying to overturn. So I continue to fight, even while hooked to an IV.
Now we have Obamacare. My family is enrolled.
Typing that is almost surreal. We are enrolled in Obamacare. Instead of Aetna we will have Blue Shield of California.
I feel like my armor has been fortified a bit. I’ve been fighting this battle for nearly three years now, and for the first time I feel like we have a real chance to keep our financial lives in order, and I can take away a little stress from this house. For someone who has been nothing but sick, nothing but helpless, nothing but reliant on others…this is huge.
Yes, there are tears streaming down my face as I type this to you. I’m not sure if you can comprehend what true illness and financial stress does to a family. Constant stress is no way to get healthy. All I want is to be healthy. I’m trying so hard. I am doing everything I’m supposed to do and have done everything I was asked by every doctor. I just want to get better and return to LIFE.
I know that is not the case with every American. Not only do they not understand, but they don’t care. It’s MY problem, not theirs and they feel no need to help in anyway, shape, or form and that certainly means Obamacare. I’ve been told this is ‘natural selection’ or ‘survival of the fittest’ and too bad for me. I’ve been told we should have planned better. We should have saved more. We should ask family for money.
Let me be clear- you can plan and save all you want, but when you are chronically ill or in a serious accident or get an unexpected illness, ONE hospital stay can set you back more than your home costs. You can’t plan for that in regular America. We have insurance, we had savings, we have family support and we are still hanging on by a thread.
And then there are those who wanted to keep the health plan they had, but their insurance company didn’t play by the rules. They are finding their state isn’t participating in ACA and denying it’s citizens the funds for Medicare. Or their state isn’t participating so there isn’t’ much to choose from in their exchanges.
To those Americans I would urge you to fight like I did. Fight like hell to make sure your state and your politicians LISTEN and do what is BEST FOR YOUR FAMILY. Make them take the Medicare money and make them participate! You have the power. You have a voice and it’s louder than you think. Look at me. What did I do? I told my story to anyone and everyone that would listen and argued with anyone and everything I found dead wrong.
My family and I told our story to the White House. So can you.
We are now enrolled. We are getting $0 in subsidies. But we are saving at least $18,900 per year. For a family that is swimming in medical debt, with no end in sight, we can now see light at the end of the tunnel.
That light is Obamacare.
It just keep gettin' better and better! (Not.) I hope that none of you think you're going to have unlimited access to the best treatment centers in the country through your Obamacare Plan////unless you're willing to pay even more out-of-pocket, and it looks like some of the nation's "best" hospitals are not going to be accepting ObamaCare-sponsored plans, anyway. At least, that's the way I read it. (See below.) Is it just me, or do the rules pertaining to ObamaCare keep changing day-by-day, week-by-week? Maybe if Congress would have READ the damn thing before they passed it, THEN THEY WOULD NOT HAVE PASSED IT!!! I hope all the politicans in Washington DC have learned a very powerful lesson from this experience:
If you like your hospital, you might not be able to keep it.
In the latest surprise to emerge during the implementation of the Affordable Care Act, people seeking insurance on the ObamaCare exchanges are finding the plans limit access to some of the best-ranked hospitals and cancer centers in the country.
The access problem is a byproduct of the effort to drive down costs of subsidized coverage, prompting insurance companies to shy away from more expensive facilities.
That doesn't necessarily mean someone buying insurance through ObamaCare is locked out of those hospitals. In some cases, patients could go "out of network" in order to use the medical center of their choosing -- but would have to pay more in the process.
According to a former top health care adviser for the White House, that's how the program was designed.
Challenged on "Fox News Sunday" over why Americans are losing access to their current doctors and hospitals, ObamaCare architect Ezekiel Emanuel claimed President Obama did not mislead on that point, despite his refrain that if people liked their doctors and policies they could keep them.
"The president never said you were going to have unlimited choice of any doctor in the country you want to go to," Emanuel said. "He didn't say you could have unlimited choice."
In a remark that has since generated considerable controversy, Emanuel added: "If you want to pay more for an insurance company that covers your doctor, you can do that."
Indeed, The Financial Times reported that most plans being sold on the exchanges in New York, Texas and California do not offer access to some of the top medical centers in those states.
New York's Memorial Sloan Kettering, Houston's MD Anderson Cancer Center and Los Angeles' Cedars-Sinai Medical Center are left out of most plans -- meaning those who want to go there would likely have to pay more.
Watchdog.org, in a recent report, found that 11 of the top 18 hospitals (as ranked by U.S. News & World Report) were connected with just one or two insurance carriers on the exchanges. In Ohio, for instance, the Cleveland Clinic was connected with one insurance company.
Asked about the shifting policies under ObamaCare and their impact on choice, a representative with The University of Texas MD Anderson Cancer Center released a statement to FoxNews.com saying, "all patients deserve access to top tier cancer care" -- and that while not everyone needs to come to MD Anderson, "we believe both insurance providers and our health care system must work together to ensure patients have that option so that all of us have the best chance of beating cancer."
Though some complain about these centers' high costs, the statement argued that "our country's leading cancer centers help bring down the cost of care for all patients by conducting research that leads to new and better treatments, better cancer fighting strategies and increased efficiencies that lead to cost savings."
"We're very concerned," Thomas Priselac, president of Cedars-Sinai Health System in California, told The Financial Times. "[Insurers] know patients that are sick come to places like ours. What this is trying to do is redirect those patients elsewhere, but there is a reason why they come here. These patients need what it is that we are capable of providing."
It's not just the insurance companies that are deciding to drop certain hospitals from their plans. In some cases, the hospitals themselves are opting out, unwilling to go along with proposed lower rates.
Robert Zirkelbach, spokesman for America's Health Insurance Plans, defended the insurance industry's move to trim costs where it can -- noting that the law's benefit requirements end up raising costs.
"Establishing high-value provider networks is one way health plans can help make coverage more affordable for consumers, which is particularly important at a time when costs are increasing due to the new health insurance tax and minimum benefit requirements included in the health care reform law," he told FoxNews.com.
Emanuel, though, said "the issue isn't the selective networks."
"People are going to have a choice as to whether they want to pay a certain amount for a selective network or pay more for a broader network," Emanuel said.
Under the law, people who do not have insurance have until the end of March to sign up in order to avoid a penalty. For those wishing to get new coverage by Jan. 1, the deadline to sign up is Dec. 23.
Despite problems with HealthCare.gov and other state-based exchanges, officials say they're improving the websites and making progress in signing more people up as the deadlines near.
Last edited by RODGERRAMJET; 12-09-2013 at 02:43 PM.
"Some people just need a hi-five in the face."
when I need to go to the hospital, I always travel to the best ones in the country for whatever it is I need.
I just checked. I still have access to the best treatment in the country. HAHA HA HA RAMJET! I win.
This is maybe the dumbest article Rog has posted yet. Do the existing health insurance plans of most Americans give them access to special cancer treatment at the nation's top research hospitals? The article is actually an argument against managed care, and more specifically against the market forces that managed care uses to reduce costs. You know, the very thing that libertarians celebrate as the primary organizing value of the political economy.
Again, Rog demonstrates that he doesn't understand how health insurance works.
Today I finally signed up for health insurance through Covered California. Feb 15th was the deadline to get coverage starting March 1st. I make too much money to qualify for any subsidies and selected a bronze plan from LA Care for around $190 a month. I get three doctor's visits a year and am responsible for a $60 copay for each visit. My deductible is $5000 and I don't think I get any prescription drug coverage, but for a healthy 32 year old it should be sufficient. Before the ACA went into effect I'd gotten a quote from Blue Shield for a plan that was almost identical to this one and they'd quoted $260, pending the results of a physical, so in this instance it appears that the new exchange helped me cut some costs. The woman from Covered CA that I spoke with was very nice and helpful, although I was on hold for 1 hour and 20 minutes.
I haven't had health insurance since I returned from a trip to Asia in 2010. When my coverage kicks in on March 1st I will have gone 47 months without insurance. During that time I've resorted to obtaining my blood pressure medication via on online pharmacy in Belgium. I've ordered contact lenses from the United Kingdom. I've had four incidences that definitely required medical attention in which I made the decision to treat myself to the best of my abilities.
1) While surfing, I suffered a laceration to the side of my leg that required stitches. I opted for self-applied butterfly clamps.
2) While surfing, I suffered a severe laceration to my foot that required stitches. Again, I opted for butterfly clamps and replaced the fins on my surfboard. After a couple of weeks the huge vagina-shaped wound finally closed and I managed to avoid amputation.
3) On Halloween, I attempted to pop the cap off of a beer bottle with a lighter. My hand slipped and I sliced my thumb open. The wound was very deep and required stitches, but since everyone was too drunk to drive to the hospital I walked to 711, bought a tube of superglue and a bottle of rubbing alcohol and my roommate helped me glue the wound shut with a pair of tweezers.
4) After experiencing an awful throbbing pain in my back and shoulder area that persisted for several months, I finally consulted a chiropractor and was diagnosed with a herniated disc in my neck. I was told I could consult a doctor and pay $3500 for an MRI to confirm the diagnoses, but this seemed like a huge waste of money. I opted to pay for chiropractic care and massage therapy and my disc was healed within a year. I never took a single prescription pain killer.
Between 47 months of health insurance premiums and some of the costs associated with the injuries listed above, I estimate that I saved anywhere from $10,000-$15,000. I also realize that I am extremely lucky that I was able to avoid hospitalization and/or surgery during that time. One of my friends that joined me on that trip to Asia did the same thing as I did - didn't renew his health insurance when he returned the country. Within a week of being back in the US he broke his ankle and had to have surgery to repair the fracture. $15,000 out of pocket. Unfortunately he didn't learn his lesson and ended paying out of pocket to have his gall bladder removed a year later. I think that ran him over $20,000 and he put it all on his credit cards. I just need to avoid something like that for the next 15 days and then I can put an end to this experiment.
(^Holy Jesus, dude.)
I haven't had insurance since I've been on my parent's plan in college. I feel so lucky to have been relatively healthy during the time I've spent without insurance. I've paid out of pocket for a few doctors visits but they let me pay on a sliding scale. It turned out each visit was about $20 and I had to pay for my own prescriptions.
I successfully signed up for health insurance through Covered California. My coverage started Jan. 1st of this year. I haven't been to my PCP yet for my Initial Health Exam but am planning on it soon. I have no chronic health problems so I don't really feel pressed to go.
Is this becoming common?
This email is to ensure all of our Blue Cross and Blue Shield patients that the ONLY insurance plans we will not be taking as of August 1st are the plans under THE AFFORDABLE CARE ACT, COVERED CALIFORNIA, AKA OBAMA-CARE. We are still contracted with ALL OTHER Blue Cross and Blue Shield plans.
For patients who have been changed to Covered California plans, you can still see Dr ____ as an out of network provider, and submit your bill to your insurance for reimbursement. If you have any questions or confusion about your plan, or letters you are receiving from your insurance company, please call our office so we may assist you.
___ Medicine Team
That sounds like a hoax. Is that a real thing?
It's sounds like a hoax:
A) the categorical statements and use of all caps.
B) it says "OBAMA-CARE"
and, it's clearly aimed to spread right-wing propaganda.
It is (hypothetically) plausible that it could come from a right-wing propagandist physician's office. But even that I doubt -- Blue Cross wouldn't contract with a provider for some plans but not others.
Also, in California, Blue Cross is a very different organization from Blue Shield; they are competitors. So why single out those two plans and not HealthNet, Kaiser, etc etc?
yes, this has to be a hoax.
Last edited by TomAz; 06-30-2014 at 12:48 PM.
Nobody uses a dash to break up the two words. it is nearly always referred to as "ObamaCare."
8/7/16 - Sufjan Stevens @ Hollywood Bowl // 8/8/16 - Radiohead @ Shrine // 8/8/16 - Boris @ Regent
9/14/16 - Wilco @ Theatre at Ace Hotel // 9/18/16 - Kraftwerk @ Hollywood Bowl