What to expect under ObamaCare

[BALAAM]

My wife has had some serious health issues in the past. She has had several surgeries and on the last one the doctor said it is only a matter of time until you need another one. She has been through the therapy sessions, pain management sessions, drug therapy, shots, the works and surgery is the only option.

Due to the economic conditions we face we lost our group insurance policy and needed to find other insurance. I can get a policy with no trouble but it is impossible for me to get her insured because of a pre-existing condition. Now, due to the Affordable Care Act we found a government run insurance policy that she is eligible for and got her on it. Here is what we experienced:

In all of the literature they said if you get your premium and application in by the 15th of any month you will be covered by the 30th. If we receive it after the 15th you will be covered by the 15th of the next month. It took 3 months to get on the plan. Every time we called they said that they were very busy or it was under review. We have been given 3 different dates when coverage was started. We have a letter saying coverage began 11/15/11. Now after some doctor's appointments in January of 2012 they wrote us saying that these would not be paid because coverage had not begun yet.

Now after 3 different doctors have said that surgery is the ONLY option the insurance company has denied coverage saying that surgery is not warranted. We have had two appeals which were both denied and we are waiting on the third and final appeal right now. They have told us that coverage had not begun yet when we had the doctor's visit even though they needed an okay from the insurance company to do an MRI (which they approved).

When Sarah Palin warned about government death panels deciding who would live and who would die she was not very far off the mark.

 

[T-Bone]

Pappa Obama thinks he knows what's best everyone for everone as long he spends others money to do.

 

[BALAAM]

Pappa Obama thinks he knows what's best everyone for everone as long he spends others money to do.

The problem as I see it is that the average person has the mindset that "The government will care for me". It is a fallacy.

 

[T-Bone]

Pappa Obama thinks he knows what's best everyone for everone as long he spends others money to do.

The problem as I see it is that the average person has the mindset that "The government will care for me". It is a fallacy.

People need to understand the danger of that mindset...the government that has the power to take care or you...also has the power to decide when they will quit taking care of you!

 

[truthdetector]

My wife has had some serious health issues in the past. She has had several surgeries and on the last one the doctor said it is only a matter of time until you need another one. She has been through the therapy sessions, pain management sessions, drug therapy, shots, the works and surgery is the only option.

Due to the economic conditions we face we lost our group insurance policy and needed to find other insurance. I can get a policy with no trouble but it is impossible for me to get her insured because of a pre-existing condition. Now, due to the Affordable Care Act we found a government run insurance policy that she is eligible for and got her on it. Here is what we experienced:

In all of the literature they said if you get your premium and application in by the 15th of any month you will be covered by the 30th. If we receive it after the 15th you will be covered by the 15th of the next month. It took 3 months to get on the plan. Every time we called they said that they were very busy or it was under review. We have been given 3 different dates when coverage was started. We have a letter saying coverage began 11/15/11. Now after some doctor's appointments in January of 2012 they wrote us saying that these would not be paid because coverage had not begun yet.

Now after 3 different doctors have said that surgery is the ONLY option the insurance company has denied coverage saying that surgery is not warranted. We have had two appeals which were both denied and we are waiting on the third and final appeal right now. They have told us that coverage had not begun yet when we had the doctor's visit even though they needed an okay from the insurance company to do an MRI (which they approved).

When Sarah Palin warned about government death panels deciding who would live and who would die she was not very far off the mark.

Contact FOX News.  Seriously.

 

[BALAAM]

My wife has had some serious health issues in the past. She has had several surgeries and on the last one the doctor said it is only a matter of time until you need another one. She has been through the therapy sessions, pain management sessions, drug therapy, shots, the works and surgery is the only option.

Due to the economic conditions we face we lost our group insurance policy and needed to find other insurance. I can get a policy with no trouble but it is impossible for me to get her insured because of a pre-existing condition. Now, due to the Affordable Care Act we found a government run insurance policy that she is eligible for and got her on it. Here is what we experienced:

In all of the literature they said if you get your premium and application in by the 15th of any month you will be covered by the 30th. If we receive it after the 15th you will be covered by the 15th of the next month. It took 3 months to get on the plan. Every time we called they said that they were very busy or it was under review. We have been given 3 different dates when coverage was started. We have a letter saying coverage began 11/15/11. Now after some doctor's appointments in January of 2012 they wrote us saying that these would not be paid because coverage had not begun yet.

Now after 3 different doctors have said that surgery is the ONLY option the insurance company has denied coverage saying that surgery is not warranted. We have had two appeals which were both denied and we are waiting on the third and final appeal right now. They have told us that coverage had not begun yet when we had the doctor's visit even though they needed an okay from the insurance company to do an MRI (which they approved).

When Sarah Palin warned about government death panels deciding who would live and who would die she was not very far off the mark.

Contact FOX News.  Seriously.

Good idea and I may do that. They tell us if the third appeal is denied our only other option is to have a lawyer file a complaint or suit who we have already contacted.

 

[redgreen5]

Now after 3 different doctors have said that surgery is the ONLY option the insurance company has denied coverage saying that surgery is not warranted. We have had two appeals which were both denied and we are waiting on the third and final appeal right now. They have told us that coverage had not begun yet when we had the doctor's visit even though they needed an okay from the insurance company to do an MRI (which they approved).

When Sarah Palin warned about government death panels deciding who would live and who would die she was not very far off the mark.

Wait.

Under private enterprise, you couldn't even get coverage for your wife.  Right? 
How was that not a "death panel"?

Now you have coverage, and are waiting through an appeals process. But now you have some coverage, and some amount of hope (however small).
How is that not a better situation than previously, when your wife had no coverage at all?

I don't understand the mindset that thinks the so-called "free market" doesn't have death panels. 
They do.
They're just staffed by insurance company employees.
But the results are the same.

 

[Bro Blue]

I thought that he said in the op that it was a government run deal.

 

[redgreen5]

I thought that he said in the op that it was a government run deal.

I was still editing my post. I have a bad habit of editing a lot after the first post.  :-\

 

[BALAAM]

Now after 3 different doctors have said that surgery is the ONLY option the insurance company has denied coverage saying that surgery is not warranted. We have had two appeals which were both denied and we are waiting on the third and final appeal right now. They have told us that coverage had not begun yet when we had the doctor's visit even though they needed an okay from the insurance company to do an MRI (which they approved).

When Sarah Palin warned about government death panels deciding who would live and who would die she was not very far off the mark.

Wait.

Under private enterprise, you couldn't even get coverage for your wife.  Right? 
How was that not a "death panel"?

Now you have coverage, and are waiting through an appeals process. But now you have some coverage, and some amount of hope (however small).
How is that not a better situation than previously, when your wife had no coverage at all?

I don't understand the mindset that thinks the so-called "free market" doesn't have death panels. 
They do.
They're just staffed by insurance company employees.
But the results are the same.

Good question. I will have to think about this one.

 

[Eliz553]

Wait.

Under private enterprise, you couldn't even get coverage for your wife.  Right? 
How was that not a "death panel"?

Now you have coverage, and are waiting through an appeals process. But now you have some coverage, and some amount of hope (however small).
How is that not a better situation than previously, when your wife had no coverage at all?

I don't understand the mindset that thinks the so-called "free market" doesn't have death panels. 
They do.
They're just staffed by insurance company employees.
But the results are the same.

Bingo.

 

[christundivided]

Now you have coverage, and are waiting through an appeals process. But now you have some coverage, and some amount of hope (however small).
How is that not a better situation than previously, when your wife had no coverage at all?

How about the fact.... they have to pay the premium money and are getting nothing for it. In fact, they are probably paying a higher premium based in the pre-existing condition option.

How is this not worse than having nothing at all?

At least they would be paying premiums on something that doesn't do them ANY good.

You're such a ditz

 

[redgreen5]

How about the fact.... they have to pay the premium money and are getting nothing for it.

Now you're just mad because you are losing the other argument about oil prices.

They *are* getting something for it.  They got an MRI, and they have a chance for having the procedures paid for through the appeals process. Does it suck? Yes, of course.

But with the private market insurance company, they got zero. No hope, no chance.  They were free to pay for it all out of their own pocket, providing that:

a. they could find a hospital willing to to do the procedures; and
b. the hospital was willing to accept private pay instead of insurance (many will not do so)

In fact, they are probably paying a higher premium based in the pre-existing condition option.

LOL you have no idea what they are paying, or whether it is more, or less.  How could you possibly know?  How could any of us know? The original poster hasn't divulged that private information (nor does he need to do so).

That is the reason that you carefully worded your response with the word "probably".  You wanted to cast aspersions on the plan, but didn't want to do the footwork to find out the cost and compare.

If you haven't actually checked it out, then why are you commenting on it? Why should anyone care about your guesses?

How is this not worse than having nothing at all?

At least they would be paying premiums on something that doesn't do them ANY good.

You're not paying attention, as usual.
Under free market health insurance, there was no coverage whatsoever.
None. Zero. Zip. Nada.

Under the high-risk pool, they have some amount of path forward, although not as hopeful as they would like.
Now I ask you: 
would you rather have *some* hope?  Or none at all?

Besides, if they don't feel like they are getting their money's worth in the high risk pool, they are free to leave it at any time and save all their money. The high risk pool is not mandatory, nor do they need to pursue their health care concerns through it. They can take their chances in the free market and pay the entire cost themselves. 

Apparently you think they'd be better off that way. I wonder if they would agree?

You're such a ditz

And you're one of those people who can't untangle your rightwing politics from reality.  It cripples you from understanding how politics and economics actually operate.

 

[christundivided]

First let me say you're obviously an expert at bloviating. If you can't win the discussion based on merit.... you'll post 5000 words to "muddy" the discussion.

They *are* getting something for it.  They got an MRI, and they have a chance for having the procedures paid for through the appeals process. Does it suck? Yes, of course.

Maddog.... you really are silly. Who wants an MRI without a solution? Juts like a liberal....

LOL you have no idea what they are paying, or whether it is more, or less.  How could you possibly know?  How could any of us know? The original poster hasn't divulged that private information (nor does he need to do so).

So extended liability in covering preexisting conditions hasn't driven up health care premium prices? Are you that stupid?

You're not paying attention, as usual.
Under free market health insurance, there was no coverage whatsoever.
None. Zero. Zip. Nada.

Most preexisting condition are covered after the first year of coverage. The way things are going.... its going to be a year before they get to the solution.

How is the system better? Its NOT.

Besides, if they don't feel like they are getting their money's worth in the high risk pool, they are free to leave it at any time and save all their money. The high risk pool is not mandatory, nor do they need to pursue their health care concerns through it. They can take their chances in the free market and pay the entire cost themselves. 

IDIOT.... There is no such thing. Obamacare has/will increase liability and produce increased premiums across the board. You can't extend liability to 20 million plus people and not PAY for it.

General liability has increased and this will have to be offset with premium increases.

Do you even know how insurance works?

 

[redgreen5]

[quote author=christundivided ]
First let me say you're obviously an expert at bloviating. If you can't win the discussion based on merit.... you'll post 5000 words to "muddy" the discussion. [/quote]

No, you're just one of those folks who loves to shoot their mouth off.
But when confronted with someone who actually knows what they're talking about, you fall apart like rotting styrofoam.

They *are* getting something for it.  They got an MRI, and they have a chance for having the procedures paid for through the appeals process. Does it suck? Yes, of course.

Maddog.... you really are silly. Who wants an MRI without a solution? Juts like a liberal....

1. An MRI is a step towards a solution.  Life doesn't always give you nice tidy solutions all wrapped up like a birthday present, in one easy step.  Sometimes it takes a series of tests, procedures, etc. to narrow down the issue, rule out other possible sources, etc.  Medicine operates largely by doing tests for known issues, and ruling each one out. Eventually you zero in on the remaining item and that is the disease/condition that is at fault. Did you not know that?

2. I am not Maddog whoever he/she is.  As I told you: wander over to the Bible Versions Discussion Board.  You'll see my posts over there for the last three years.

LOL you have no idea what they are paying, or whether it is more, or less.  How could you possibly know?  How could any of us know? The original poster hasn't divulged that private information (nor does he need to do so).

So extended liability in covering preexisting conditions hasn't driven up health care premium prices? Are you that stupid?

That is not what you claimed.
You claimed that this SPECIFIC family was "probably paying more" under the high risk pool.  You do not know that. 

You're not paying attention, as usual.
Under free market health insurance, there was no coverage whatsoever.
None. Zero. Zip. Nada.

Most preexisting condition are covered after the first year of coverage.

Except that in this case, there was no "first year of coverage".  The free market wouldn't give them a policy for his wife.  So the "first year of coverage" never started.
As I said:  you are not paying attention.

How is the system better? Its NOT.

The system is better because *some* coverage is better than NO coverage.

Besides, if they don't feel like they are getting their money's worth in the high risk pool, they are free to leave it at any time and save all their money. The high risk pool is not mandatory, nor do they need to pursue their health care concerns through it. They can take their chances in the free market and pay the entire cost themselves.

IDIOT.... There is no such thing. Obamacare has/will increase liability and produce increased premiums across the board. You can't extend liability to 20 million plus people and not PAY for it.

Hey idiot - "Obamacare" is not what is blocking them from seeking a free-market solution. What is blocking them from going with private insurance is the fact that NO INSURER WILL OFFER THEM A POLICY IN THE FIRST PLACE.

General liability has increased and this will have to be offset with premium increases.

Or, unplanned high-cost items like emergency room visits will be drastically reduced because people will be covered under normal insurance and not forced to rely on the emergency room as their primary care facility.  As a result, those costs -- which the hospital currently has to eat, and which get assessed against the overall insurance pool -- will go down.

Duh.

Do you even know how insurance works?

Far better than you do, apparently.

 

[christundivided]

No, you're just one of those folks who loves to shoot their mouth off.
But when confronted with someone who actually knows what they're talking about, you fall apart like rotting styrofoam.

I post less than 200 words and you double my output? Thanks for proving my point.

1. An MRI is a step towards a solution.  Life doesn't always give you nice tidy solutions all wrapped up like a birthday present, in one easy step.  Sometimes it takes a series of tests, procedures, etc. to narrow down the issue, rule out other possible sources, etc.  Medicine operates largely by doing tests for known issues, and ruling each one out. Eventually you zero in on the remaining item and that is the disease/condition that is at fault. Did you not know that?

2. I am not Maddog whoever he/she is.  As I told you: wander over to the Bible Versions Discussion Board.  You'll see my posts over there for the last three years.

1. LOL... an MRI is worthless without the solution. Nothing you say is going to change that.

2. I posted thousands of responses in the forum before your "triumphant" return. Let's make a deal.....I'll stop calling you maddog if you stop acting like one?

That is not what you claimed.
You claimed that this SPECIFIC family was "probably paying more" under the high risk pool.  You do not know that. 

The words... HIGH RISK... may provide a clue.  :-\

Except that in this case, there was no "first year of coverage".  The free market wouldn't give them a policy for his wife.  So the "first year of coverage" never started.
As I said:  you are not paying attention.

It wouldn't? That's not how I read it. Read it again. You're assuming too much.

Hey idiot - "Obamacare" is not what is blocking them from seeking a free-market solution. What is blocking them from going with private insurance is the fact that NO INSURER WILL OFFER THEM A POLICY IN THE FIRST PLACE.

Doubt it. Just can't find one that covers preexisting conditions.

I didn't say it was fair. I believe all polices should cover preexisting conditions within reason. Someone that has had insurance and lost due to no fault of their own... should be covered. On the other hand.... if you live your entire life without insurance and then get sick.... You shouldn't. Charity can help those in such case.

Or, unplanned high-cost items like emergency room visits will be drastically reduced because people will be covered under normal insurance and not forced to rely on the emergency room as their primary care facility.  As a result, those costs -- which the hospital currently has to eat, and which get assessed against the overall insurance pool -- will go down.

Duh.

The hospital makes it up in charging those who pay. They don't "eat" anything. I can tell you don't work in healthcare.

All OBAMACARE has done is SHIFT the cost. Those who can afford to pay will stay PAY for those who can't. MORON.

 

[redgreen5]

I post less than 200 words and you double my output? Thanks for proving my point.

Shoveling BS is easy.
Cleaning it all up takes more work.

1. An MRI is a step towards a solution.  Life doesn't always give you nice tidy solutions all wrapped up like a birthday present, in one easy step.  Sometimes it takes a series of tests, procedures, etc. to narrow down the issue, rule out other possible sources, etc.  Medicine operates largely by doing tests for known issues, and ruling each one out. Eventually you zero in on the remaining item and that is the disease/condition that is at fault. Did you not know that?

2. I am not Maddog whoever he/she is.  As I told you: wander over to the Bible Versions Discussion Board.  You'll see my posts over there for the last three years.

1. LOL... an MRI is worthless without the solution. Nothing you say is going to change that.

Unfortunately, things are not true just because you want them to be.  An MRI is not worthless, any more than a CATscan, blood test, or anything else is useless. They are all diagnostic, and may actually reveal the problem.

2. I posted thousands of responses in the forum before your "triumphant" return. Let's make a deal.....I'll stop calling you maddog if you stop acting like one?

1. I have no idea what 'triumphant return' means.
2. I don't care what you call me.
3. If you don't want me to respond, you could always stop making uninformed comments.  8)

That is not what you claimed.
You claimed that this SPECIFIC family was "probably paying more" under the high risk pool.  You do not know that. 

The words... HIGH RISK... may provide a clue.  :-\

However, the govt high-risk pool is also subsidized. $5 billion dollars was set aside and distributed to the states to set up their high-risk pools. You have no idea whether the final premium payment is more, or less, than it would otherwise be.  You also apparently didn't know how the high-risk pool actually worked.

Except that in this case, there was no "first year of coverage".  The free market wouldn't give them a policy for his wife.  So the "first year of coverage" never started.
As I said:  you are not paying attention.

It wouldn't? That's not how I read it. Read it again. You're assuming too much.

Nope. Here is the point-blank statement from the original post:

Due to the economic conditions we face we lost our group insurance policy and needed to find other insurance. I can get a policy with no trouble but it is impossible for me to get her insured because of a pre-existing condition

Would you like some help with that word "impossible"?  :

Hey idiot - "Obamacare" is not what is blocking them from seeking a free-market solution. What is blocking them from going with private insurance is the fact that NO INSURER WILL OFFER THEM A POLICY IN THE FIRST PLACE.

Doubt it. Just can't find one that covers preexisting conditions.

LOL nobody cares what you "doubt". I suspect that if this man loves his wife - as I'm sure he does - then he has been pretty diligent about looking for such a policy.

I didn't say it was fair. I believe all polices should cover preexisting conditions within reason. Someone that has had insurance and lost due to no fault of their own... should be covered. On the other hand.... if you live your entire life without insurance and then get sick.... You shouldn't. Charity can help those in such case.

How quaint.

Or, unplanned high-cost items like emergency room visits will be drastically reduced because people will be covered under normal insurance and not forced to rely on the emergency room as their primary care facility.  As a result, those costs -- which the hospital currently has to eat, and which get assessed against the overall insurance pool -- will go down.

Duh.

The hospital makes it up in charging those who pay. They don't "eat" anything. I can tell you don't work in healthcare.

Except you're wrong. My brother works full-time in EMR (electronic medical records) for a major hospital chain in the Southeast.  The hospitals *do* eat this cost. The hospitals cannot simply raise costs without negotiating with the insurance companies. They will try to pass it on to the insurance companies. Whatever portion they succeed in passing on, gets added to everyone's premiums.  But sometimes the insurance company refuses.  Whatever portion they do *not* succeed in getting passed on, the hospitals simply eat.  They will try to raise costs on uninsured patients, but that also doesn't work every time.

Hospitals really do have profit/loss statements, just like any other business.  Apparently you don't know that.

But your claim was that extending coverage costs more.  The discussion above demonstrates why your comment is simplistic and uninformed.  The cost of covering uninsured people goes down, because:

a. those uninsured people are still going to go to the hospital when they are sick;
b. hospitals cannot turn them away or deny care;
c. because they have no insurance, they'll delay going in because they cannot afford it;
d. because they delay, their condition becomes more expensive to treat in the latter stages, than it would have been in the early stages;
e. when they finally do come in for treatment, they head directly to the emergency room, which is the most expensive way to treat a patient and often gives bad results because an ER is designed to do trauma care and triage, not primary care

All OBAMACARE has done is SHIFT the cost. Those who can afford to pay will stay PAY for those who can't. MORON.

Wrong as usual. You should be getting used to that state of affairs by now.  8)