I'll just warn anyone reading, please don't choose Humana, whatever you do. My staff complains the most about them...
$3550 deductible
$6750 max out of pocket
There is another plan that $107.25 month with $5000 deductible and $8150 max out of pocket.
Not an option in Oklahoma through the ACA Marketplace
No, I get that. Sounds like you're getting much better insurance than we can afford for our employees.
I'm out of it now, but when I retired at age 62 I bought a subsidized plan through ACA. It was a very good plan ... VERY good ... but I paid almost $900 a month for the wife and I. We did not get nearly as large a subsidy as you. At that time BCBS was the only option in the state of Oklahoma.
I used it back in 2015 and found out that my specialist doctor didn’t even take it. I had to be referred to a different doctor in his office who was willing to accept it.
Obama: “If you like your doctor you can keep your doctor.”
BS
Obama: “If you like your doctor you can keep your doctor.”
BS
Well I can say this much... I know some folks who have this insurance, aka the BCBS on the exchange, end up not getting much if anything in coverage. I don't know all the ins and outs, but...
It brings to mind a family I saw last year a number of times. Now this was a man, his wife and their young adult son. When we schedule people, we verify they have current insurance coverage for every visit, or they have to pay cash. These folks, I saw the man maybe... 3 or 4 times. Wife I saw at least that many and several times spent a LONG time with her - like going on an hour or more. Counseling for various stuff, etc. Son I think I saw 2 times, maybe 3.
Keep in mind, all these were verified insurance current and up to date before and at the time of visits. Wife I had come in to see our counselor multiple times, too.
Then they all dropped off the map. Haven't seen them in nearly a year.
A few months ago, I get notice from our business office manager and I realize why they're gone - they owe nearly $2,000 in bills to us (actually more like $2500, now that I think about it) among the three. Insurance (again, BCBS) never paid us a single penny for any of their care. Not one. So we had to try to collect from them, of course, they skipped and bailed. I know husband worked in Tulsa as a welder, that much came out. Son, I think worked locally part-time, maybe for WalMart or something. Wife didn't work.
But this was a working family, obviously lower end of the income scale from my interactions with them, living in an apartment, subsidized or not, I don't know. But they DID have BCBS, I am assuming it was "exchange coverage" aka "Obamaca/ACA". And BCBS never paid us a dime for all the care we provided. Patients never paid a copay, either, I'll add. Usually people just walk out the door instead of stopping on the way out to pay, or they give a reason they can't pay their copay today, etc. I think with our new system, they're asking them to pay the copay up front.
So that's an experience I have with this kind of stuff. My staff and I provided good, quality care, went above and beyond, I tried significantly to help these folks, all three, and we got stiffed for nothing.
And this is part of why I'm in the position I am (meaning struggling financially right now). People think it's a racket when their doc 'bills' $150 for a visit - you don't see what we actually COLLECT on that bill, and a lot of the time we collect NOTHING. Usually my collections run... oh, maybe around 50-60% of what we 'bill'? Some months a good bit less.
<edit> Oh, and when we turn people over to collection, we lose 50% of whatever they manage to collect, as well.
It brings to mind a family I saw last year a number of times. Now this was a man, his wife and their young adult son. When we schedule people, we verify they have current insurance coverage for every visit, or they have to pay cash. These folks, I saw the man maybe... 3 or 4 times. Wife I saw at least that many and several times spent a LONG time with her - like going on an hour or more. Counseling for various stuff, etc. Son I think I saw 2 times, maybe 3.
Keep in mind, all these were verified insurance current and up to date before and at the time of visits. Wife I had come in to see our counselor multiple times, too.
Then they all dropped off the map. Haven't seen them in nearly a year.
A few months ago, I get notice from our business office manager and I realize why they're gone - they owe nearly $2,000 in bills to us (actually more like $2500, now that I think about it) among the three. Insurance (again, BCBS) never paid us a single penny for any of their care. Not one. So we had to try to collect from them, of course, they skipped and bailed. I know husband worked in Tulsa as a welder, that much came out. Son, I think worked locally part-time, maybe for WalMart or something. Wife didn't work.
But this was a working family, obviously lower end of the income scale from my interactions with them, living in an apartment, subsidized or not, I don't know. But they DID have BCBS, I am assuming it was "exchange coverage" aka "Obamaca/ACA". And BCBS never paid us a dime for all the care we provided. Patients never paid a copay, either, I'll add. Usually people just walk out the door instead of stopping on the way out to pay, or they give a reason they can't pay their copay today, etc. I think with our new system, they're asking them to pay the copay up front.
So that's an experience I have with this kind of stuff. My staff and I provided good, quality care, went above and beyond, I tried significantly to help these folks, all three, and we got stiffed for nothing.
And this is part of why I'm in the position I am (meaning struggling financially right now). People think it's a racket when their doc 'bills' $150 for a visit - you don't see what we actually COLLECT on that bill, and a lot of the time we collect NOTHING. Usually my collections run... oh, maybe around 50-60% of what we 'bill'? Some months a good bit less.
<edit> Oh, and when we turn people over to collection, we lose 50% of whatever they manage to collect, as well.
I'll ad this: Some companies (UHC) will approve treatment, then deny claim. I got left with a damn near 10k bill in 2016. I appealed it, lost, appealed again...no opportunity to see these clowns in person, claims are reviewed by a "board". (I'd like to see how many appeals are granted)
Bill was paid, but I imagine you lower-income folks were overwhelmed when they realized they had 2500 to pay. No excuse to stiff you, but they probably expected insurance to cover most of it.
Not all BCBS is the same, when I call for prior auth you have to have all those codes to figure out what they get. It is stupid, 1 plan wanted X-Rays to confirm that they needed the MRI since the previous X-rays were 6 weeks old. Another plan would not approve an MRI without doing CT first. And another lady got her MRI just based on the doctor asking for it. And yet all 3 had BCBS, all 3 ended up with the same diagnosis. But, the price was different for all 3, as well as the number of office visits and tests performed.
But, at least BCBS doesn't come back 5 years after the fact wanting to know why you billed for something, then review all your patients and ask for a refund on bill from 5 years ago.
I have gotten authorization for tests for people, have the reference number, a fax saying it was approved, and then the diagnostic company coming to us because insurance will not pay, then we find we are not getting paid. And the reasons they give are great, such as we just got a denial because we didn't take vitals on a tele-health visit. We also lost one recently because we didn't chart that we didn't provide education on smoking cessation to a person who was in requesting to go on hospice because he wanted to stop fighting just after Christmas last year, he passed within a month. Some of the crap they pull is just stupid
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But, at least BCBS doesn't come back 5 years after the fact wanting to know why you billed for something, then review all your patients and ask for a refund on bill from 5 years ago.
I have gotten authorization for tests for people, have the reference number, a fax saying it was approved, and then the diagnostic company coming to us because insurance will not pay, then we find we are not getting paid. And the reasons they give are great, such as we just got a denial because we didn't take vitals on a tele-health visit. We also lost one recently because we didn't chart that we didn't provide education on smoking cessation to a person who was in requesting to go on hospice because he wanted to stop fighting just after Christmas last year, he passed within a month. Some of the crap they pull is just stupid
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