A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

Post by lsc » Mon, Mar 26, 2018, 6:01 AM UTC

gizmo686 wrote: post #147

lsc wrote: post #110

Earlier quoted context omitted.

So there's a lower bound on how much you can make and still get the subsidized plan? that seems broken in a very American sort of way. I think a lot of the bureaucratic issues might be the nature of insurance companies? My (pre-aca) experience was that any lapse in coverage and they don't let you back on. All this 'life event' stuff, I think, was part of how group plans worked back in the day, the rules about when yo…

There is a lower bound on income to qualify for ACA subsidies because the ACA also expanded medicaid to cover people below that threshold. Unfortunately, the portion of the ACA requiring states to expand medicaid was ruled unconstitutional. As a result, 19 states have choosen not to expand medicaid, leaving a portion of the population to poor to qualify for ACA subsidies, but too rich to qualify for medicaid. I shoul…

Post by intended » Mon, Mar 26, 2018, 6:20 AM UTC

whatshisface wrote: post #128

tptacek wrote: post #123

Earlier quoted context omitted.

You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense. Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of…

If enough people didn't have access to insurance, then there would be pressure on hospitals to find ways to reduce prices (so that their volume could go up). As it stands the medical industry is allowed to hold the poor for ransom ("accept our increased costs or they won't get treated") against the US's deep but finite pockets. Before, we had the (very poor) demand elasticity of people paying everything they had and…

Post by intended » Mon, Mar 26, 2018, 6:22 AM UTC

AFNobody wrote: post #148

komali2 wrote: post #130

Earlier quoted context omitted.

>pressure on hospitals to reduce prices Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company. The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you wan…

I'm not sure its fair to argue that universal healthcare is a human right despite the fact it makes economic sense. Humanity survived just fine without real healthcare and healthcare is not essential to a fair balance of power b/t the government and its citizenry. Universal healthcare needs to be argued on the economics of the issue because that is the only practical way to make it sustainable. The "feel good" stuff…

Post by JamesBarney » Mon, Mar 26, 2018, 6:30 AM UTC

tschwimmer wrote: post #135

curun1r wrote: post #102

Earlier quoted context omitted.

My own personal "why I hate the ACA"... In 2016, I decided to take off from work and travel outside the US. I did what I thought was the responsible thing and purchased a travel insurance plan. In total, I was gone for a year...I had an amazing trip. When I got home, I wanted to sign up for insurance again. But since it wasn't a life event, I wasn't eligible to enroll until the open enrollment period. And when that t…

If your income was zero, couldn't you have gone on Medicaid?

Post by bsder » Mon, Mar 26, 2018, 7:15 AM UTC

mobilefriendly wrote: post #27

tptacek wrote: post #14

If you're a tech entrepreneur, it's the first story in here that should alarm you the most. It's about denying coverage altogether, not about denying individual claims. Outside of the "guaranteed issue" ACA market, there is virtually no due process for coverage denial. You can be denied on a whim, with little recourse. The list of conditions for which insurance outside the ACA will be denied is long and opaque. The s…

ACA is horrendous, unless you're receiving a government subsidy. I'm self-employed and we have one option of insurance provider, and the cheapest plan for my family last year was $18,000 a year with a huge deductible. That's after tax, out of pocket, for a healthy family with no pre-existing. Like all self-employed people I know (who aren't getting government subsidy), I moved my family to Christian Medishare, which…