Please Help Me Understand Your Suffering

drummerboy said:

I asked you kind of a specific question, which you overlooked. Here it is again.


are you saying that pre-ACA your insurance situation was better - and that the ACA caused you to go from good to bad?


My point is that if you went from good to bad because of the ACA, then you can claim you suffered from it. But if that didn't happen, then the claim of suffering can't be that strong.

I have not claimed that I am suffering from it. I had a job for 16 years with great benefits which I lost last year. This year I am unemployed and have a silver plan, which isn't as good, but isn't terrible, but for 6 months last year I had nothing. So I can answer that yes my insurance situation was better before the ACA than after, but it's not BECAUSE of the ACA, it's because the US health insurance system is a ******* dead elephant spread across I-78 by a road-roller and the ACA is a band aid holding some of its ankle together.

kthnry said:

I'm confused about deductibles. In 2015, I was covered by a BC/BS plan through healthcare.gov (the ACA). I had a busy year medically -- expensive meds, quarterly checks with my PCP, four skin cancer procedures, and two unrelated visits to minor emergency. I spent about $2,000 out of pocket, nowhere near my deductible ($6,000). All I paid was the copay -- $30 for GP, $50 for minor emergency, $60 for specialist, about $300 each for the procedures (which cost thousands each), and some minor amounts for meds and labs.

I hear people saying that you have to pay for everything out-of-pocket until the deductible is met before you get any coverage for anything, but that wasn't my experience.

@kthnry Not all services are subject to the deductible. For example, preventive services are not subject to a deductible. Last year my plan included a lot of services not subject to deductible: two sick visits, blood lab services, and prescription meds. The $300 you paid for your procedures was probably the contracted price -- when you have an insurance plan and have to pay the "cost" until deductible kicks in, the "cost" is not the price that the doctor bills the insurance company -- it's the negotiated/contracted price.

shoshannah said:

@kthnry Not all services are subject to the deductible. For example, preventive services are not subject to a deductible. Last year my plan included a lot of services not subject to deductible: two sick visits, blood lab services, and prescription meds. The $300 you paid for your procedures was probably the contracted price -- when you have an insurance plan and have to pay the "cost" until deductible kicks in, the "cost" is not the price that the doctor bills the insurance company -- it's the negotiated/contracted price.

Thanks for clarifying. I got a lot of value out of my policy that year. I worry that people are not seeking treatment because they think they'll have to pay the whole deductible first, when in fact you can get a lot of work done without touching the deductible.

gotcha.

ridski said:

drummerboy said:

I asked you kind of a specific question, which you overlooked. Here it is again.


are you saying that pre-ACA your insurance situation was better - and that the ACA caused you to go from good to bad?


My point is that if you went from good to bad because of the ACA, then you can claim you suffered from it. But if that didn't happen, then the claim of suffering can't be that strong.

I have not claimed that I am suffering from it. I had a job for 16 years with great benefits which I lost last year. This year I am unemployed and have a silver plan, which isn't as good, but isn't terrible, but for 6 months last year I had nothing. So I can answer that yes my insurance situation was better before the ACA than after, but it's not BECAUSE of the ACA, it's because the US health insurance system is a ******* dead elephant spread across I-78 by a road-roller and the ACA is a band aid holding some of its ankle together.

kthnry said:

shoshannah said:

@kthnry Not all services are subject to the deductible. For example, preventive services are not subject to a deductible. Last year my plan included a lot of services not subject to deductible: two sick visits, blood lab services, and prescription meds. The $300 you paid for your procedures was probably the contracted price -- when you have an insurance plan and have to pay the "cost" until deductible kicks in, the "cost" is not the price that the doctor bills the insurance company -- it's the negotiated/contracted price.

Thanks for clarifying. I got a lot of value out of my policy that year. I worry that people are not seeking treatment because they think they'll have to pay the whole deductible first, when in fact you can get a lot of work done without touching the deductible.

Exactly.

kthnry said:

shoshannah said:

@kthnry Not all services are subject to the deductible. For example, preventive services are not subject to a deductible. Last year my plan included a lot of services not subject to deductible: two sick visits, blood lab services, and prescription meds. The $300 you paid for your procedures was probably the contracted price -- when you have an insurance plan and have to pay the "cost" until deductible kicks in, the "cost" is not the price that the doctor bills the insurance company -- it's the negotiated/contracted price.

Thanks for clarifying. I got a lot of value out of my policy that year. I worry that people are not seeking treatment because they think they'll have to pay the whole deductible first, when in fact you can get a lot of work done without touching the deductible.

Exactly.

kthnry said:

shoshannah said:

@kthnry Not all services are subject to the deductible. For example, preventive services are not subject to a deductible. Last year my plan included a lot of services not subject to deductible: two sick visits, blood lab services, and prescription meds. The $300 you paid for your procedures was probably the contracted price -- when you have an insurance plan and have to pay the "cost" until deductible kicks in, the "cost" is not the price that the doctor bills the insurance company -- it's the negotiated/contracted price.

Thanks for clarifying. I got a lot of value out of my policy that year. I worry that people are not seeking treatment because they think they'll have to pay the whole deductible first, when in fact you can get a lot of work done without touching the deductible.

Exactly.

a moment's drift:

Here's why I will open almost any thread if I see ridski's name:

"I have not claimed that I am suffering from it. I had a job for 16 years
with great benefits which I lost last year. This year I am unemployed
and have a silver plan, which isn't as good, but isn't terrible, but for
6 months last year I had nothing. So I can answer that yes my insurance
situation was better before the ACA than after, but it's not BECAUSE of
the ACA, it's because the US health insurance system is a ******* dead
elephant spread across I-78 by a road-roller and the ACA is a band aid
holding some of its ankle together."

Clear thinking, clear exposition, plus true, out-loud LOL.

mjc said:

a moment's drift:


Here's why I will open almost any thread if I see ridski's name:

"I have not claimed that I am suffering from it. I had a job for 16 years
with great benefits which I lost last year. This year I am unemployed
and have a silver plan, which isn't as good, but isn't terrible, but for
6 months last year I had nothing. So I can answer that yes my insurance
situation was better before the ACA than after, but it's not BECAUSE of
the ACA, it's because the US health insurance system is a ******* dead
elephant spread across I-78 by a road-roller and the ACA is a band aid
holding some of its ankle together."

Clear thinking, clear exposition, plus true, out-loud LOL.

100% agreed.