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A short conversation with a bank

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Re: A short conversation with a bank

#241

Post by salawat »

monktastic1 wrote: post #150
Tijdreiziger wrote: post #144

Earlier quoted context omitted.

Excuse me -- your yearly deductible is $10,000? Here I thought €385 was a lot...

No, the deductible is much lower. This is the maximum I can spend out of pocket in a year. But most ACA ("Obamacare") plans have no maximum for our of network providers.

Actuallly... If it is an ACA plan, there has to be a MOOP.

https://obamacarefacts.com/health-insurance/out-of-pocket-ma...

Now keep in mind, as mentioned earlier, if you go to an out-of-network provider, and get billed for the balance of what that provider charges and your insurance won't cover, that is now between you and the provider because the insurance claim is technically complete.

This is why in some cases you may want to redline the financial responsibility statement and specify you will pay up to a set amount over what your insurer disburses. Technically, the provider can come back and grumble, but if you absolutely cannot afford to get nailed with a notorious "surprise" medical bill, that's a much more "good faith" way to approach the transaction.

It sucks... I know.

Re: A short conversation with a bank

#242

Post by salawat »

OrlandoHakim wrote: post #206
pinko wrote: post #129

Earlier quoted context omitted.

This is almost true: you will, in fact, be forever on the hook for any medical expenses charged which exceed the "reasonable" limits your insurer has set for each given service, even after you've exceeded your MOOP. So if your physical therapist charges $150/hour and your insurer reimburses $120/hour, you'll still owe $60 OOP for two hours of therapy even if you've exceeded your MOOP. Ask me how I know.

This happened to me and I found the practice extremely deceptive. In California it is nearly impossible to find therapy or similar services that don’t charge much more than the per service maximums allowed by Anthem Blue Cross (and likely others). This is primarily about out-of-network care, but good luck finding a competent therapist in-network in the Bay Area. For example, the max paid for a therapy visit might be…

Huh. Ya know what? I'm going to go look through some paperwork to see if I can find regular omissions of that sort, because now that you mention it, that seems a rather glaring omission if true.

Re: A short conversation with a bank

#243

Post by monktastic1 »

salawat wrote: post #134
monktastic1 wrote: post #90

Earlier quoted context omitted.

https://imgur.com/a/t7M2RGv When I called, I was told that it's there to show that the OOP max for in-network and out-of-network providers isn't summed to get my total OOP max; instead it's just equal to my OON OOP max. (Of course, this plan makes it hard to go bankrupt, unlike all ACA plans. That was a bit of literary liberty.)

Ah... So they're differentiating MOOP levels they'll honor based on the provider in question. I'm guessing they probably have some funneling arrangement that recoups the extra spend they'd incur from the potentially more frequent MOOP attainment in network. Cute, but it really kinda sidesteps the concept of "Max out of pocket". I sense an MBA at work.

Replying here because I couldn't respond to your other comment. All the ACA plans I've looked at pay nothing for OON, so in effect there's no maximum I may pay, right? I'm curious about this redlining solution. How do you decide how much you'll pay them?

Re: A short conversation with a bank

#244

Post by alasdair_ »

thereticent wrote: post #238
alasdair_ wrote: post #237

Earlier quoted context omitted.

Seriously. My son is the same. He started kindergarten completely comfortable with negative numbers (we just always drew the number line with both positive and negative parts) and basic algebra and only was allowed to test to enter the gifted program in third grade. They are finally doing algebra again now that he is in fourth grade (they do math grades 3 and 4 in third grade and 5 and 6th grade math in 4th grade) bu…

That's a strikingly similar situation to ours. Our 4th grader has autism and needed special education services, but of course those didn't exist. At the same time, our typically developing kid was starting kindergarten virtually. At one point the teacher booted him from the class meeting because he was drawing a picture instead of writing words. She told us to ensure that he only joins class ready to learn. All I can…

Damn straight.

As a final anecdote: our kids had a full-time gym teacher. They were supposed to have “gym” lessons three times a week.

For the entirety of covid, their “lesson” was a single powerpoint slide with the words “go play” on it.

That was the entirety of the work that needed to be done by the gym teacher for a year - post that one slide to google classroom at the appropriate times.

Re: A short conversation with a bank

#245

Post by p1esk »

monktastic1 wrote: post #22

A short conversation with Blue Shield of California last month: BS: Have a question? Ask us via this very useful secure messaging form! Me: Great! Can you explain the difference between these two arcane out-of-pocket limits that you display that are un-Googleable and nowhere in your documentation that I can never find anyway? BS: Sure! We will wait two days and then send you an email suggestively titled "a response t…

A short conversation with Medicare:

Never happened. They never pick up the phone, and they don't have any other way to contact them after you applied for benefits. I tried for weeks to resolve an issue with an application for my father, a dozen of calls, every time being on hold for hours. Sometimes the automated system says "leave your number and someone will call you back tomorrow at a certain time". That's a lie, no one has ever called back.

Re: A short conversation with a bank

#246

Post by iaw »

p1esk wrote: post #245
monktastic1 wrote: post #22

A short conversation with Blue Shield of California last month: BS: Have a question? Ask us via this very useful secure messaging form! Me: Great! Can you explain the difference between these two arcane out-of-pocket limits that you display that are un-Googleable and nowhere in your documentation that I can never find anyway? BS: Sure! We will wait two days and then send you an email suggestively titled "a response t…

A short conversation with Medicare: Never happened. They never pick up the phone, and they don't have any other way to contact them after you applied for benefits. I tried for weeks to resolve an issue with an application for my father, a dozen of calls, every time being on hold for hours. Sometimes the automated system says "leave your number and someone will call you back tomorrow at a certain time". That's a lie,…

I feel like more an more having a lawyer on retainer is the only answer to this type of crap.

Re: A short conversation with a bank

#247

Post by hadlock »

tvanantwerp wrote: post #35
ethbr0 wrote: post #30

Earlier quoted context omitted.

Generally, anything not-for-profit and older than 40 years is a technological shit-show. There's neither the individual or management will to successfully migrate or upgrade at the pace required. Consequently, everything is held together with duct tape and person-hours.

I worked for a 80+ year old non-profit. Their tech was definitely a shit show before I turned it around. I won't be surprised if it ends up degrades into a shit show again in a decade or so.

Almost immediately after you left, they promptly lost the admin password, Phyllis in accounting said, "why don't we just go back to copy machines and filing cabinets, we know how those work" and they unplugged all your computers.

Re: A short conversation with a bank

#248

Post by throwoutway »

> some idiot, interjecting in this imaginary conversation: sir, may I interest you in our pamphlet, superbowl ad with a QR code which later precipitated a fight with one of the best ad agencies in the world when the crypto CEO claimed to come up with the idea all by themselves

True story

Re: A short conversation with a bank

#249

Post by throwoutway »

p1esk wrote: post #245
monktastic1 wrote: post #22

A short conversation with Blue Shield of California last month: BS: Have a question? Ask us via this very useful secure messaging form! Me: Great! Can you explain the difference between these two arcane out-of-pocket limits that you display that are un-Googleable and nowhere in your documentation that I can never find anyway? BS: Sure! We will wait two days and then send you an email suggestively titled "a response t…

A short conversation with Medicare: Never happened. They never pick up the phone, and they don't have any other way to contact them after you applied for benefits. I tried for weeks to resolve an issue with an application for my father, a dozen of calls, every time being on hold for hours. Sometimes the automated system says "leave your number and someone will call you back tomorrow at a certain time". That's a lie,…

If this is what we have to look forward to when Congress eventually makes a nationwide health insurance, I’m not going to be happy
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