4 ms·

I don't get how an insurance won't cover something. Isn't that the point of Obama forcing you to buy insurance these days?

waterphone 10y ago
Insurance still doesn't cover many things, and most of the low-cost plans have such high deductibles ($10,000 is common) they're practically useless for all but emergency room visits where $10,000 goes by in your first day.
ssmoot 10y ago
There's still annual maximums, in-network coverage, PMO, HMO, etc. The minimums can be pretty basic. It looks like the ACA doesn't really do anything to change the picture for a $474,000 medical bill. The guy got charged $39 each for over 200 glucose checks. That's the price of a new meter for every check.
- rincebrain 10y ago
  Actually, annual maximums on ("essential") benefits are illegal under the ACA[1] - the only "annual maximums" allowed are for {deductible, out of pocket}, at which point they are supposed to cover 100% of covered claims. I don't obviously see the specific anecdote you're discussing in the thread, so I can't tell if what transpired is because it (somehow) didn't blow either of those thresholds, or because it wasn't an "essential" benefit, or simply pre-dated those terms of the ACA becoming effective. [1] - http://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html http://www.hhs.gov/healthcare/about-the-law/benefit-limits/i...
  - ssmoot 10y ago
    Thanks for correcting me. I could've sworn I saw annual maximums when I looked on healthcare.gov but maybe I mistook the max out of pocket for a max annual. The example I used is the case presented in the video. I just googled for Bob Weinkauf. http://writingshares.com/cnn-anderson-cooper-medical-news-video-bob-weinkauf-gets-474000-hospital-bill/ http://writingshares.com/cnn-anderson-cooper-medical-news-vi... I was also curious when this happened. Looks likely to be under the ACA unless it took years to hit the news though. So I don't know. Maybe he went to the emergency room and it was out of network under his plan, leaving him to shoulder the costs. I didn't dig much after skimming for an approximate date.
efa 10y ago
Yes you are supposed to buy insurance (though many just take the penalty). Many Obamacare plans are pretty crappy with low max pay outs. It drives me crazy when people don't read the plans they are buying. My plan has a huge deductible (10k) but no max pay out. So basically I pay 100% for everything but if I ever need some serious hospital time I'd only be out 10k. (And it's very expensive).
- cableshaft 10y ago
  I was pretty sure the Obamacare plans had OOP Maximums (out of pocket maximums), i.e. after a certain amount, your insurance pays for 100% of your medical expenses for the year. It might have been kind of high, but I was pretty sure it had it. (I had to have Obamacare for a few months in between jobs).
- efaref 10y ago
  I'm really going to miss the NHS when the tories have finished dismantling it. :(
  - kiruwa 10y ago
    NHS and ACA really have absolutely nothing to do with each other. The NHS has serious problems related to accountability, the typical problem with huge multi-level government bureaucracies. Honestly, the NHS has similar problems to the American public education system, for mostly the same reasons. The ACA has the serious problem that it was explicitly sold as a way to contain costs both at an individual and aggregate level. That has pretty much been exposed as a lie. The ACA has been good for the narrow band of people who were included in the expanded medicaid coverage, but it's not too hard to imagine a separate (and much simpler) bill that accomplished that part of the bill, without the massive rework of healthcare for the middle class.
67726e 10y ago
Corporate welfare at its finest. The cheapest plan I can find is about $250 per month and has something like a $10K limit. It's a fucking joke. Two years ago I was able to get a reasonable plan that actually covered part of my doctor visit and prescriptions for less than $100/month. Mots of the insurance companies in my state have been run out of business leaving you with basically one giant provider and a no-name company that isn't accepted anywhere.
- honkhonkpants 10y ago
  The fact that the benefits are defined in terms of dollars is the problem. There's nothing preventing a hospital from charging you 10000 dollars for a bandage.

waterphone 10y ago

Insurance still doesn't cover many things, and most of the low-cost plans have such high deductibles ($10,000 is common) they're practically useless for all but emergency room visits where $10,000 goes by in your first day.

ssmoot 10y ago

There's still annual maximums, in-network coverage, PMO, HMO, etc. The minimums can be pretty basic. It looks like the ACA doesn't really do anything to change the picture for a $474,000 medical bill. The guy got charged $39 each for over 200 glucose checks. That's the price of a new meter for every check.

rincebrain 10y ago
Actually, annual maximums on ("essential") benefits are illegal under the ACA[1] - the only "annual maximums" allowed are for {deductible, out of pocket}, at which point they are supposed to cover 100% of covered claims. I don't obviously see the specific anecdote you're discussing in the thread, so I can't tell if what transpired is because it (somehow) didn't blow either of those thresholds, or because it wasn't an "essential" benefit, or simply pre-dated those terms of the ACA becoming effective. [1] - http://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html http://www.hhs.gov/healthcare/about-the-law/benefit-limits/i...
- ssmoot 10y ago
  Thanks for correcting me. I could've sworn I saw annual maximums when I looked on healthcare.gov but maybe I mistook the max out of pocket for a max annual. The example I used is the case presented in the video. I just googled for Bob Weinkauf. http://writingshares.com/cnn-anderson-cooper-medical-news-video-bob-weinkauf-gets-474000-hospital-bill/ http://writingshares.com/cnn-anderson-cooper-medical-news-vi... I was also curious when this happened. Looks likely to be under the ACA unless it took years to hit the news though. So I don't know. Maybe he went to the emergency room and it was out of network under his plan, leaving him to shoulder the costs. I didn't dig much after skimming for an approximate date.

efa 10y ago

Yes you are supposed to buy insurance (though many just take the penalty). Many Obamacare plans are pretty crappy with low max pay outs. It drives me crazy when people don't read the plans they are buying. My plan has a huge deductible (10k) but no max pay out. So basically I pay 100% for everything but if I ever need some serious hospital time I'd only be out 10k. (And it's very expensive).

cableshaft 10y ago
I was pretty sure the Obamacare plans had OOP Maximums (out of pocket maximums), i.e. after a certain amount, your insurance pays for 100% of your medical expenses for the year. It might have been kind of high, but I was pretty sure it had it. (I had to have Obamacare for a few months in between jobs).
efaref 10y ago
I'm really going to miss the NHS when the tories have finished dismantling it. :(
- kiruwa 10y ago
  NHS and ACA really have absolutely nothing to do with each other. The NHS has serious problems related to accountability, the typical problem with huge multi-level government bureaucracies. Honestly, the NHS has similar problems to the American public education system, for mostly the same reasons. The ACA has the serious problem that it was explicitly sold as a way to contain costs both at an individual and aggregate level. That has pretty much been exposed as a lie. The ACA has been good for the narrow band of people who were included in the expanded medicaid coverage, but it's not too hard to imagine a separate (and much simpler) bill that accomplished that part of the bill, without the massive rework of healthcare for the middle class.

67726e 10y ago

Corporate welfare at its finest. The cheapest plan I can find is about $250 per month and has something like a $10K limit. It's a fucking joke. Two years ago I was able to get a reasonable plan that actually covered part of my doctor visit and prescriptions for less than $100/month. Mots of the insurance companies in my state have been run out of business leaving you with basically one giant provider and a no-name company that isn't accepted anywhere.

honkhonkpants 10y ago
The fact that the benefits are defined in terms of dollars is the problem. There's nothing preventing a hospital from charging you 10000 dollars for a bandage.