Premium Health Care Plan Not So Premium For Some

Posted in the Columbus Forum

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Dublin, OH

#1 Mar 21, 2014
SEATTLE -- Alex Szablya just wants the best health care she can get for her children. So she got a gold plan, the highest level possible with the Washington Health Benefit Exchange. She picked a plan with Lifewise, an affiliate of Premera Blue Cross.

In early March, her 16-year old daughter had a medical emergency. Alex drove her to the nearest hospital, which was Seattle Children's. Alex says doctors there felt her daughter's situation was so dire she needed to be admitted to the hospital immediately. She was there for nine days.

Then came news that her stay, which involved specialized mental health care for adolescents, was going to cost $36,000 and her insurance would only pay for half because Seattle Children's was considered on out-of-network facility.

She thought by going for the highest premium PPO gold level coverage offered the state exchange, a majority of the bill would have been covered.

http://www.komonews.com/news/local/Premium-He...
Pope Che Reagan Christ I

Lodi, OH

#2 Mar 22, 2014
Wait what wrote:
SEATTLE -- Alex Szablya just wants the best health care she can get for her children. So she got a gold plan, the highest level possible with the Washington Health Benefit Exchange. She picked a plan with Lifewise, an affiliate of Premera Blue Cross.
In early March, her 16-year old daughter had a medical emergency. Alex drove her to the nearest hospital, which was Seattle Children's. Alex says doctors there felt her daughter's situation was so dire she needed to be admitted to the hospital immediately. She was there for nine days.
Then came news that her stay, which involved specialized mental health care for adolescents, was going to cost $36,000 and her insurance would only pay for half because Seattle Children's was considered on out-of-network facility.
She thought by going for the highest premium PPO gold level coverage offered the state exchange, a majority of the bill would have been covered.
http://www.komonews.com/news/local/Premium-He...
That is an insurance industry problem that has been around since we decided to let insurance companies control our healthcare delivery. That anecdote isn't unique to the ACA system.
Big Johnson

Columbus, OH

#3 Mar 22, 2014
Wait what wrote:
SEATTLE -- Alex Szablya just wants the best health care she can get for her children. So she got a gold plan, the highest level possible with the Washington Health Benefit Exchange. She picked a plan with Lifewise, an affiliate of Premera Blue Cross.
In early March, her 16-year old daughter had a medical emergency. Alex drove her to the nearest hospital, which was Seattle Children's. Alex says doctors there felt her daughter's situation was so dire she needed to be admitted to the hospital immediately. She was there for nine days.
Then came news that her stay, which involved specialized mental health care for adolescents, was going to cost $36,000 and her insurance would only pay for half because Seattle Children's was considered on out-of-network facility.
She thought by going for the highest premium PPO gold level coverage offered the state exchange, a majority of the bill would have been covered.
http://www.komonews.com/news/local/Premium-He...
It takes only a couple of minutes online to see if a doctor or medical facility is in my insurance network, and only a couple of minutes more to check it out on Angie's List.

Haste makes waste!
Pope Che Reagan Christ I

Lodi, OH

#4 Mar 22, 2014
Big Johnson wrote:
<quoted text>
It takes only a couple of minutes online to see if a doctor or medical facility is in my insurance network, and only a couple of minutes more to check it out on Angie's List.
Haste makes waste!
It's Obama's fault!

“Bee Hive Jive”

Since: Apr 10

Location hidden

#5 Mar 22, 2014
Big Johnson wrote:
<quoted text>
It takes only a couple of minutes online to see if a doctor or medical facility is in my insurance network, and only a couple of minutes more to check it out on Angie's List.
Haste makes waste!
You are a stitch! You're also right!
=~}

Since: Sep 10

Location hidden

#6 Mar 22, 2014
As it turns out, the limitations of doctors and medical providers were not listed at the time of enrollment and once they chose a plan they couldn't get out of it. In other words, they weren't able to check as you suggested.

What an odd group - so uninformed and yet so willing to laugh at the expense of others.

Since: Sep 10

Location hidden

#7 Mar 22, 2014
***Not listed for some due to such things as IT issues and listings are still being pulled for inaccuracies. The government is making it extremely hard to change your plan whether it's IT issues, getting through to a call center, what have you.
Reality Speaks

Columbus, OH

#8 Mar 22, 2014
Pope Che Reagan Christ I wrote:
<quoted text>
That is an insurance industry problem that has been around since we decided to let insurance companies control our healthcare delivery. That anecdote isn't unique to the ACA system.
cash always works....try that.

Obamacare is not the answer, but compounding the problem.

Who decided insurance companies control our healthcare.......Obama did

Cash used to.
Pope Che Reagan Christ I

Lodi, OH

#9 Mar 22, 2014
Nickled Dimed wrote:
***Not listed for some due to such things as IT issues and listings are still being pulled for inaccuracies. The government is making it extremely hard to change your plan whether it's IT issues, getting through to a call center, what have you.
Here is how to change your plan. Stop paying for the one you have and start paying for a new one.
Wait what

Dublin, OH

#10 Mar 22, 2014
Pope Che Reagan Christ I wrote:
<quoted text>
Here is how to change your plan. Stop paying for the one you have and start paying for a new one.
You can only change plans during open enrollment unless you've had a divorce, marriage, baby, adoption, etc., etc., etc.

"Lawyer", huh? A lawyer who didn't know THAT?
Wait what

Dublin, OH

#11 Mar 22, 2014
Reality Speaks wrote:
<quoted text>
cash always works....try that.
Obamacare is not the answer, but compounding the problem.
Who decided insurance companies control our healthcare.......Obama did
Cash used to.
Actually, you're on to something there. Doctors are becoming more willing to work on a cash-pay basis with a discount than deal with the bureaucracy.

Going back farther, though, research the sixties/Kennedy/HMOs/Californi a. That was the root of it all. Prior to then, you had insurance for the big stuff and paid the doctor in full for the little stuff.
Pope Che Reagan Christ I

Lodi, OH

#12 Mar 22, 2014
Wait what wrote:
<quoted text>
You can only change plans during open enrollment unless you've had a divorce, marriage, baby, adoption, etc., etc., etc.
"Lawyer", huh? A lawyer who didn't know THAT?
Open enrollment is still open. You didn't know THAT?
Wait what

Dublin, OH

#13 Mar 22, 2014
Pope Che Reagan Christ I wrote:
<quoted text>
Open enrollment is still open. You didn't know THAT?
Nope, because mine is over as is most of the country's. Only those who Obama wants as voters seem to get extension after extension after extension - in today's news, people can even go past March 31st now.
Pope Che Reagan Christ I

Lodi, OH

#14 Mar 22, 2014
Wait what wrote:
<quoted text>
Nope, because mine is over as is most of the country's. Only those who Obama wants as voters seem to get extension after extension after extension - in today's news, people can even go past March 31st now.
You aren't a "people"?
Wait what

Dublin, OH

#15 Mar 22, 2014
Pope Che Reagan Christ I wrote:
<quoted text>
That is an insurance industry problem that has been around since we decided to let insurance companies control our healthcare delivery. That anecdote isn't unique to the ACA system.
Wrong. Seattle Children's is suing over the issue, as a matter of fact.

Narrower choices - lower costs, Obama, March 2014. In other words - you can't have affordable, accessible care for all.
Wait what

Dublin, OH

#16 Mar 22, 2014
Pope Che Reagan Christ I wrote:
<quoted text>
Open enrollment is still open. You didn't know THAT?
Since you're the lawyer, will you please explain how you can get out of a plan which has already starting paying out based on the contract signed?

http://www.wahbexchange.org/about-us/timeline...
Wait what

Dublin, OH

#17 Mar 22, 2014
Pope Che Reagan Christ I wrote:
<quoted text>
That is an insurance industry problem that has been around since we decided to let insurance companies control our healthcare delivery. That anecdote isn't unique to the ACA system.
Wrong again, "lawyer".

“This is not an isolated incident,” said The Seattle Children’s Hospital’s Dr. Sandy Melzer.“The exclusion of a major provider like Seattle Children’s from a major insurance network in this market is unprecedented.”

http://www.mediaite.com/tv/seattle-childrens-...
Wait what

Dublin, OH

#18 Mar 22, 2014
Pope Che Reagan Christ I wrote:
<quoted text>
You aren't a "people"?
When you have to play these kinds of games, you've lost the battle. G'night, Spawn.
Pope Che Reagan Christ I

Lodi, OH

#19 Mar 22, 2014
Wait what wrote:
<quoted text>
Wrong again, "lawyer".
“This is not an isolated incident,” said The Seattle Children’s Hospital’s Dr. Sandy Melzer.“The exclusion of a major provider like Seattle Children’s from a major insurance network in this market is unprecedented.”
http://www.mediaite.com/tv/seattle-childrens-...
Breitbart BS.
Pope Che Reagan Christ I

Lodi, OH

#20 Mar 22, 2014
Wait what wrote:
<quoted text>
When you have to play these kinds of games, you've lost the battle. G'night, Spawn.
What games? Out of one side of your mouth you say that open enrollment is closed. Out of the other side, you say it is open beyond March 31. You are the one playing games.

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