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This is extremely welcome and much needed change BUT please, everyone reading this, pay attention to the fact that IF you get healthcare through your employer (
by subhobroto 7y ago
This is extremely welcome and much needed change BUT please, everyone reading this, pay attention to the fact that IF you get healthcare through your employer (aka "Group" health plan), this regulation MIGHT NOT APPLY to you and your plan if your employer did not purchase the plan through the ACA marketplace!
Group health plans are, EXEMPT, from most state regulations. I know it does not make sense and sounds unbelievable but unfortunately your employer has more lobbying power than you do!
As a result you, the employed, could still be on the hook for hundreds of thousands of dollars in surprise medical bills with little recourse (because you are employed and don't qualify for financial relief) and can have your wages garnished, which WILL be exercised by the provider if you refuse to pay the bill.
The providers are OON precisely because they make more money that way and there's little reason for them to be in-network (they have nothing to gain by being in network!)
So if you go to the ER today in an ambulance - that's highly likely to be OON - and have your XRays and/or CT scans read by a radiologist that's also highly likely to be OON and attended to by specialists that are also highly likely to be OON, you ARE on the hook for everything unless you're lucky enough to have a CA state regulated health plan.
Most individual plans purchased through the ACA marketplace are required to be in compliance with the regulations of the state that the employee is resident of.
Group health plans are not.
If your employer did not purchase the plan through the ACA marketplace, even if the plan is ACA compliant, it might not be required to comply with the regulations of the state that the employee is resident of as long as it's in compliance with current federal regulation of health benefits.
This can take a lot of employees by surprise, specially employees of multistate employers where the employer chooses the cheapest plan in compliance with current federal regulations without necessarily looking into state level details.
I put in some details here: https://www.quora.com/In-the-US-the-majority-of-people-under-65-years-old-have-health-insurance-through-their-employers-What-is-the-logic-behind-tying-health-insurance-to-an-employer/answer/Subhobroto-Sinha-1 https://www.quora.com/In-the-US-the-majority-of-people-under...
I really hope each of you take measures to decouple health insurance from employment.
How do we, in this day and age, still think, an employer has the right to solely dictate the standard of care we receive?
Please, if you think it's logical to so severely and tightly couple health insurance with your employer, let's have a discussion.
- jcrben 7y agoYes, self-insured employer plans are exempt from state law under ERISA. It sucks but the big multi-state corporate lobby doesn't want to have to deal with the patchwork of state laws. I believe the DOL could fix this via regulation, but doubt they will. S 1895 Lower Healthcare Costs Act would fix this nationally https://www.natlawreview.com/article/beyond-surprise-billing-lower-health-care-costs-act-2019 https://www.natlawreview.com/article/beyond-surprise-billing...
- subhobroto 7y agoLoved the link, thank you. I personally believe, the main way to untangle this mess is to make it indifferent for employers to provide primary care plans and repeal Executive Order 9250 that allows employers to claim exemptions. They are free to provide any secondary and supplementary plans It's past the time employers and health insurance are tightly coupled. It's holding back progress.
- jcrben 7y agoEveryone who knows anything about healthcare policy has been on board with decoupling for decades, but the big corporate self-insured plans lobby plus the union lobby plus the loosely-informed general public is too strong. ACA exchanges set up the infrastructure to decouple in a market-oriented way. But single-payer would also fix it.