Phase III - Deja Vu All Over Again

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IlliniDave
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Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

cL, so I did some cursory research on balance billing. From what I could find, it is something I've encountered before, typically involving hospital charges where you go to a network hospital, get treated primarily by a network doctor, but there's some radiologist or something on duty who's not in-network so you get hit with a $1,500 bill on a procedure that was supposed to be covered with a $100 copay because the provider,s fees were $1,500 larger than the negotiated rate. Seems to be less prevalent than 15-20 years ago when provider networks were beginning to become the norm. But the insurance did cover the out-of-network service, just only up to the network rate.

What I was seeing in looking at summaries of ACA plans offered for 2020 was they'd summarize coverage sort of like this (I'm just making up the numbers):

In-Network: $6K, 80%, $13K (I think meaning meaning $6K deductible, insurance pays 80% thereafter until $13K out-of-pocket max is reached, then 100%)
Out-of-Network: No coverage.

The out-of-network line is balance billing, I suppose, but in the extreme since it seems to imply the insurance does not cover the service even up to the network rate, assuming I'm reading it right.

I got the electronic version of my retirement package and by contrast the plans there, if summarized similarly, but again notionally, would read something like:

In-Network: $6K, 80%, $13K
Out-of-Network: $9K, 60%, $15K.

So you're subject to a little more cost with out-of-network, and also potentially exposed to more balance billing (as a function of relevant state law I suppose), but not left completely hanging.

I'll have to dig some more because it just makes no sense to me that the ACA plans would just completely abandon you in the out-of-network scenario. Maybe the place I found the information was presenting it wrong. Or I suppose maybe letting legislators design then tinker with medical insurance plans just produced the results a cynical observer might expect. Worst case I can wait around until 2021 enrollment season and act like I'm an ACA buyer if I can't verify sooner.

The retirement package didn't seem to totally reflect the "rate sheet" for 2020 I found. On the rate sheet it appeared I'd have 3 options, one for about $850/no, one for about $1,200/mo, one for about $1,500/mo. Those numbers are with dental added. The package showed/summarized only the first two as options. Albeit spendy, the first is a network-based HSA-eligible plan that's pretty good, the second one is a non-network plan that's also pretty good. Both would cap my OOP around $20K, premiums included. I favor the first for several reasons, but don't know if it's available in my destination state/county. The latter, being non-network based I believe is an "anywhere" plan, but still need to confirm. The retirement package appears to be based on my current residence.

For a good while I've been stress-testing using medical expenses (incl premiums) pegged at about $24K every year (based on some prior ACA Bronze max OOP data) and that's tolerable, although I don't like the shape of the curve. Still seems like I could stumble onto a mine with balance billing (although I ran across something that implied Illinois is one of the states with some amount protection in that regard).

If it weren't serious this is a somewhat amusing vignette: dude who tends to over-complicate things meets crazily over-complicated system.

As an aside, I truly feel for people who might be forced into early retirement one way or the other without having aggressively stored up some resources. Medicaid is a safety net, but anecdotally in at least a few states it seems they really force you to turn your pockets completely out before you're eligible.

classical_Liberal
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Re: Phase III - Deja Vu All Over Again

Post by classical_Liberal »

@idave
You're mostly right.

1)Yes you can be balanced billed for in-network services like radiology. It's pretty common. $1500 is a lot to me for a technicality, if I was supposed to be covered by a co-pay, but to each their own I guess.

2)In emergency situations an ACA plan must pay out to out-of-network services. However, they only have to pay out whatever the services would have cost in-network. The convoluted nature of healthcare billing means that this can be a very tidy sum. In many cases double costs out-of-network. So, now we are potentially in the 10's of thousands for a severe incident out-of-network.

3) if you get sick and need to see a specialist out-of-network you have zero coverage. It''s not an emergency so they don't even have to pay in-network costs. So imagine if the surgeon that can do your procedure isn't in your network? Again potentially 10's of thousands or more.

Personally, I will never pay anything close to 24K annual for health insurance for a single person. This is 150% of my total spending. Even if I was at a 1% WR with the cost, the thought of paying that kind of money for insurance sickens me (pun), I'd never do it. Especially since you don't have coverage in the above situations anyway. At that price level some combination of self insurance/healthshare/medical tourism is the only option, IMO. Unless, of course, I had a chronic illness that costs 100K a year to manage. Then again, that's why the insurance costs 24K.

If you don't have chronic disease look at healthcare bluebook and take a look at what things really cost without insurance. When dealing in numbers like 12K- 24K a year just for shitty coverage, they start to look pretty reasonable in a pinch compared to that recurring cost. Don't forget medical tourism too. Most medical expenditures are not emergencies.

IlliniDave
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Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

cL, thanks, yeah, the $1500 was just a made up number for a fictional procedure to illustrate the one type of balance billind I'd encountered. Maybe $500 is more reasonable. Appreciate the clarification.

A colleague shared a story of a man who racked up $1M in hospital costs for a protracted ICU stay as part of Covid-19 treatment recently while we were bemoaning the jump in retiree premiums. That's the kind of thing that keeps me from wanting to self-insure. I also got a look at all my mom's bills for as her executor cancer treatment and related drugs, for just the final year of 4+. Not much wound up being her responsibility because of Medicare and a decent supplement. MY aunt was recently diagnosed with pulmonary fibrosis. Without insurance the medication she just started is north of $100K/yr and she'll be on it the rest of her life.

The $24K in my planning is intended to represent all premiums + hitting the plan's max out-of-pocket limit every year. Unlikely to be that unlucky, but the premiums do represent 1/3 to 1/2 of that. Most years I pay premiums and about $50 in lab fees and nothing else. I'm less worried about ongoing costs (though they matter a lot) than hitting a big black swan. I respect your stance. It was mine ten years ago, but sometimes a guy changes perspective as the grim reaper works his way closer and people around start falling apart.

Despite all that I'll take your suggestion re the healthcare bluebook. Sounds like excellent info to have. Also I have yet to look into the coop-type arangements, religious or secular. Haven't made any decisions yet.

Thanks again for the clarifications on ACA, truly appreciate it.

RockyMtnLiving
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Re: Phase III - Deja Vu All Over Again

Post by RockyMtnLiving »

classical_Liberal wrote:
Wed Jun 24, 2020 1:16 pm
@idave
Personally, I will never pay anything close to 24K annual for health insurance for a single person. This is 150% of my total spending. Even if I was at a 1% WR with the cost, the thought of paying that kind of money for insurance sickens me (pun), I'd never do it. Especially since you don't have coverage in the above situations anyway. At that price level some combination of self insurance/healthshare/medical tourism is the only option, IMO. Unless, of course, I had a chronic illness that costs 100K a year to manage. Then again, that's why the insurance costs 24K.
1. "Self insurance" = uninsured

2. "Healthshare" = purport to be religious even if you aren't, and even then this isn't insurance

3. "Medical tourism" = somehow get to Costa Rica and figure out how, as an American, I can get a CR physician to do my cancer surgery

All this stuff sounds good on paper, until one ages and diseases hit

My impression is that the folks offering reduced cost HC options are (fortunately) healthy

IlliniDave
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Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

RockyMnLiving, one quibble: self insurance means no insurance but the means to pay the bills. I'm a little uncomfortable with out-of-the-box solutions too, but for people that can make them work, awesome. There's a fair amount of medical tourism to the US, despite the cost, so one would have to probably weigh each potential event individually I think if you wanted to leave the country for care. I'm probably just too traditional and stodgy for my own good :lol:

Scott 2
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Re: Phase III - Deja Vu All Over Again

Post by Scott 2 »

Apologies if this has already been discussed, but have you looked into the cost sharing reductions available against the silver aca plans?

https://www.healthcare.gov/glossary/cos ... %20savings.

Also, with out of network balance billing, I wonder how effectively they can collect on the medical debt. If I owe $200k until I'm dead, so what?


I am following this aspect of your journey closely. Healthcare is by far the biggest risk to my early retirement. Retail price for my wife's chronic illness is $50k+ a year, due to an expensive medicine. On employer insurance, we might come out ahead by a few hundred bucks, after benefits and co-pay assistance provide by the pharmaceutical company.

Without that safety net? I have no idea. Maybe if I keep my income at 139% of the poverty limit, it remains almost free? Or maybe I am screwed. It's really hard to be certain.

RockyMtnLiving
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Re: Phase III - Deja Vu All Over Again

Post by RockyMtnLiving »

@IlliniDave:

You are a role model. I've been reading you for years here. I'm not qualified to park your car, let alone comment on financial issues.

I will say this. I'm post-55, and DW is post-60. In recent years we've unfortunately dealt with the U.S. health care system. If we were self-insuring, we'd be in a world of hurt. The problem with self-insurance is that it is impossible to know in advance if one has the means to pay the bills. Indeed, the whole purpose of insurance is to pool those risks that otherwise would be financially unsustainable for a single person or family unit.

I'm still w*rking only because of employer-provided HC. DW and I are desperately trying to get to age 65. We're fans of the ACA, and when I was self-employed, that sustained us. I'm aware of the ACA subsidies. Unfortunately, a medical center we need doesn't accept the ACA. So we're stuck. ACA subsidies won't help us. The ACA could be free for us, and we still wouldn't get the care that we need.

We aren't religious. And even if we were, that healthshare stuff just seems iffy to me. You pay in, I guess, then submit a bill and hope the powers that be reimburse us. I can get similar returns playing slots in Las Vegas.

And we're unwilling to take our medical charts, get on a plane to [Country X] (even if we could do so in the Pandemic world in which we live), and have major cancer surgery performed.

I think the United States is moving towards a single-payer/Medicare-for-All system, but it will likely come too late for DW and I.

classical_Liberal
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Re: Phase III - Deja Vu All Over Again

Post by classical_Liberal »

@RockyMtnliving
I'm sorry for your situation.
Deletion Edit: I'm going to leave it at that.

IlliniDave
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Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

RockyMtnLiving wrote:
Wed Jun 24, 2020 6:32 pm
RockyMtnLiving,

Thanks for the kind words. I'm flattered to be considered in some small way a role model, but I'm not superior to anyone and in most ways inferior to the vast majority--and that's before factoring in the blood guilt bestowed on me for being a male of European descent. Anything that involves me and you and my car will be me driving you around and enjoying a fine day. Deal?

I feel for you in your situation, truly. Many times talking to colleagues, neighbors, people I might casually encounter at a social event, they relate being in a similar bind--stuck in a job they'd just assume retire from except they feel (and often are) dependent on the medical insurance. Your dilemma is common and very real. The anecdotes I mentioned above were all people already on medicare, so aside from living with terminal conditions they at least weren't worried about how they were going to keep the bills paid. I look at them as reminders there's some nonzero chance I could wind up there with years to go before hitting medicare age. Maybe I deserve more blood guilt for being relatively healthy, I dunno, but I'll likely find a way through.

I look at self-insurance as sort of a Pascal's wager situation--cough up an appreciable amount every year knowing you might not need it versus hanging on to the money in the short term and risk getting hit with something big. Working with the tentative numbers I've come up with I'm looking at spending between $100K and $130K for insurance premiums to bridge the period from retirement Medicare. So my break even point would be around $140K-$200K in medical costs without insurance. That's an oversimplification, but it illustrates the trade-off. So based on my history $200K medical costs over 9 years is unlikely making it look attractive. But you are correct. Something might happen that blows past $200K far enough it becomes a life-altering financial setback, maybe even cleans me out (I'm not a 1%-er). To give people an idea of my genetic liabilities (not medical, mental) I relate this story.

My aunt, who's been my primary mentor/confidant in a lot of ways, was recently diagnosed with pulmonary fibrosis and given a 3-5 year life expectancy with a relatively new drug that for most people slows it down, but won't cure it. I mentioned above the drug costs north of $100K per year. She filed it with her supplemental prescription plan, and with the insurance it was going to be something in the low 30s of $K/year. After thinking about it for a while she'd decided she wasn't going to pay it, that the ~$150K would be better used by the beneficiaries of her estate (ironically, one of the largest will be a hospice center). I was horrified when she told me that. Fortunately the story ends relaltively less grim because the drug plan has a $7500/yr out-of-pocket max and she decided that was inexpensive enough to be worth paying. My cheapskate and forward-looking nature comes from a ladle full of the same gene pool.

If I hit my 65th birthday knowing I spent $100K plus for 8-9 annual "wellness checks", I'll feel pretty stupid. But if I watch everything I've worked for my whole live evaporate because I was too cheap to buy insurance I could afford to buy, I'll feel worse than stupid. It would feel almost devastating.

Sorry, RockyMtnLiving, I was getting way down the rabbit trail there.

I mentioned I'm uncomfortable with the healthshare stuff, could work for some folks but in your case with preexisting conditions and not being of the right tribe ...

I've heard of some high profile people that have sought cancer treatment in Germany (Edward Van Halen comes to mind), but I doubt he did that because it was cheaper than what he could get in California.

What I would like to see in the US is universal catastrophic coverage funded by taxpayers with a private insurance market/employer coverage/Medicaid on top. Insurance policies would be much less expensive because the underwriters wouldn't have the huge downside to worry about. I'm not smart ehough to know if that would possibly work. I'm more than a little leery of a top-to-bottom single payer system because it would just be ACA on steroids.

That's a shame that the facility you need won't take ACA and give you some more flexibility. I do kind of like that providers can 'opt out' to preserve some choices for care that aren't dictated by numbskull government bureaucrats or insurance company accountants. But there's a real human cost to that too.

Best wishes for you wife's speedy recovery!
Last edited by IlliniDave on Fri Jun 26, 2020 2:53 pm, edited 2 times in total.

IlliniDave
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Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

Scott 2 wrote:
Wed Jun 24, 2020 5:12 pm
Apologies if this has already been discussed, but have you looked into the cost sharing reductions available against the silver aca plans?

https://www.healthcare.gov/glossary/cos ... %20savings.

Also, with out of network balance billing, I wonder how effectively they can collect on the medical debt. If I owe $200k until I'm dead, so what?
Scott, so far I've just looked at ACA Bronze, I'll follow up on the silver plans over the next two weekends.

Credit cards and student loans follow a person across state lines pretty readily, but for a lot of debts you can run away from them, at least for a while. But that stuff can catch up to you in other ways if you can't live a cash only existence. I've even heard of banks refusing to open accounts for people with trashed credit.

Bottom line with me is if I have a debt, I'm going to pay it if I can. They don't just vanish, they wind up getting passed on to others through increased cost of goods and services. Doesn't seem right that my medical bills ultimately get paid by people who on average are less able to pay them than I am. I'm far too old fashioned and respectful of others' property to be that woke. :)

Scott 2
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Re: Phase III - Deja Vu All Over Again

Post by Scott 2 »

Before my wife developed her chronic condition, I would have agreed with you on the debt. I hate owing money so much, I even pay my property taxes early.


My experience with medical bills, is they cannot be considered individually. They are one move in a shell game, playing out between many giant, bureaucratic parties. The first number you see is only tangentially related to the costs you personally incurred. Providers have zero expectation that is the cash amount coming out of a patient's pocket. It is the starting point of a negotiation, where players try to push as many operating costs onto the other parties as possible.

My wife's medicine is a good example. Depending on the source - retail is between $5000-$8000 a month, about double the European price. But there is a biosimilar (blocked by law in the us, due to a 16 year patent extension granted in 2012) estimated to sell for 15-30% less. The drug company will happily pay $10k+ a year in copay assistance, to capture the back end of that monthly payment from the (secret but lower) negotiated rate they have with the insurer. US revenue for the one drug is 5 billion dollars. What should you expect to pay as an uninsured party? For the right paperwork - $0. You get on the drug company's assistance program, where they generously offer free medicine, probably to avoid kicking off a legislation storm over their cash cow. Why pays for that medicine? Must be buried somewhere as a cost of doing business.

I was talking to a pharmaceutical executive about this pattern - his point was a lot of the money is to cover R&D, FDA rules, etc. Not just on the good drug, but the failed ones as well. It is minimally related to the cost of production. Every player feels screwed by the others in the game.


I've concluded the patient has no choice but to play as well, exercising the (broken) rules as hard as they can. The US medical system will wipe out someone who has the misfortune of getting sick and agrees to all charges thrown their way. That is part of what would keep me away from a health share. When things go sideways, I want the weight of a blue cross blue shield or humana in my corner.

classical_Liberal
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Re: Phase III - Deja Vu All Over Again

Post by classical_Liberal »

@Scott 2
Just remember, humana and blue cross have their interests to look after in any negotiation. Health shares also negotiate on your behalf. However, in that case both your interests and the health share interests directly overlap. They pay whatever doesn't get negotiated away. Whereas the large insurers have to think about the arrangement in consideration of their total costs within their network. ie balance billing is meaningless to them, it's your responsibility not the networks. The healthshare has to look at your individual transaction with a provider or facility and try to get the best deal for each situation.

On the dissenting side. I do think there is some risk of healthshares not ponying up. However, my healthcare experience with patients using them seems to show this doesn't happen. Although it's achedotal and not meta-data. IMO the risk of an unexpected high balance billing incident in an ACA plan is much more likely.
Scott 2 wrote:
Fri Jun 26, 2020 4:00 pm
My experience with medical bills, is they cannot be considered individually.
Excellent observation.
Scott 2 wrote:
Fri Jun 26, 2020 4:00 pm
I've concluded the patient has no choice but to play as well, exercising the (broken) rules as hard as they can. The US medical system will wipe out someone who has the misfortune of getting sick and agrees to all charges thrown their way.
In this vein, I want to remind people that ACA plans are REQUIRED to cover preexisting conditions. This is why they are so expensive. A healthy person, who then becomes unhealthy with a chronic illness has the right to get an ACA plan during enrollment each year. A flexible person can easily meet the criteria of a Qualifying Life Event even outside those windows. So, if we think of health insurance as insurance, and not some other magical thing. This is the equivalent of being able to buy homeowners insurance after your house has already caught fire! Something to think about. Although this does no good for people in situations in which expensive chronic medical care is already needed, it does help everyone else.

So, I think of my Healthshare as an emergency gap policy, to ensure I have some coverage in an unexpected event. However, if I ever get really sick (house starts on fire), you can bet I'm gonna get an ACA policy (homeowners insurance) if I want treatment in the US. Is this cheating? You be the judge, but it's completely legal. (Edit: and it's not like this is some backdoor, or technicality. The system was specifically designed to be this way). It also insures I don't help pay into and support a broken payor system I want changed, unless it's life or death with no other options. So ethically there is plenty to think about.
Last edited by classical_Liberal on Fri Jun 26, 2020 5:03 pm, edited 1 time in total.

classical_Liberal
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Re: Phase III - Deja Vu All Over Again

Post by classical_Liberal »

IlliniDave wrote:
Fri Jun 26, 2020 11:01 am
What I would like to see in the US is universal catastrophic coverage funded by taxpayers with a private insurance market/employer coverage/Medicaid on top. Insurance policies would be much less expensive because the underwriters wouldn't have the huge downside to worry about.
This would be a great start. Some form of federal reinsurance. FYI in some cases medicaid is already doing this. People on hemodialysis automatically qualify for it, because it's so expensive in an ongoing basis insurers would bankrupt covering it.

nomadscientist
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Re: Phase III - Deja Vu All Over Again

Post by nomadscientist »

The biggest problem with US healthcare is reconciling two competing expectations:

1. market funding

2. extremely high level of provision (world highest, perhaps by a large margin)

In other words Americans want "affordable healthcare" but do not want to wait 2 months for an MRI like in the UK. Does waiting 2 months for MRI significantly reduce your life expectancy? No. But in reality far fewer Americans are willing to accept the wait than in the abstract want "affordable healthcare."

The biggest risk with reforming US healthcare is that you keep the over-provision and associated costs but simply create a new and wasteful DMV-like bureaucracy managing it*. After living in the US, I find this to be the actually most likely outcome. Even if provision control were attempted (questionable) it would be buried in lawfare establishing all sorts of "rights" to provision, many of which already exist. And so, I begin to understand at last why the Republican Party exists.


*Admittedly it's not totally clear whether DMV sclerosis making one determination of one final price would actually be worse than the multiple highly efficient agencies chasing each others' tails negotiating fake prices.

**If you have the stomach for it maybe the best way to handle health costs in the USA is to only consume emergency services and then simply reject the bills. It'll wreck your credit score but if you are wealthy who cares? Can/would they ever truly attempt to enforce a physical collection?

ertyu
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Re: Phase III - Deja Vu All Over Again

Post by ertyu »

nomadscientist wrote:
Fri Jun 26, 2020 4:35 pm
lawfare establishing all sorts of "rights" to provision, many of which already exist. And so, I begin to understand at last why the Republican Party exists.
Well, the lawfare is their idea in the first place, isn't it. God forbid we have a freeloader or two - so in the name of work ethic calvinist cruelty, we must sacrifice the efficiency of the system -- which actually costs less to run if it's a bit "inefficient."

This is fine, though: even though our ridiculous demands that no "freeloaders" ever sneak in have made the system mindbogglingly inefficient, that's not an issue. We just use it to argue that the government is clearly not any good -- and thus shouldn't provide (so many) merit goods -- and thus the very rich clearly don't need to pay so much taxes.

The republican party exists so that the rich have someone to bribe into getting them out of paying taxes. There, US politics explained ...

classical_Liberal
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Re: Phase III - Deja Vu All Over Again

Post by classical_Liberal »

@nomadsceintist and @ertyu

I don't necessarily disagree with either of your points. This situation is... interesting. However, I may have taken this a bit too far, when my ultimate goal was only to provide some good options wrt ERE and healthcare for relatively healthy people. We probably shouldn't muck up @idaves journal with a US medical system debate.

nomadscientist
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Re: Phase III - Deja Vu All Over Again

Post by nomadscientist »

@ertyu

The system is full of freeloaders. There are a lot of rights to provision that must be paid for by people who have health insurance, which is why the bills became fake. If people could only be billed for actual cost of services rendered every hospital with an ER would go bankrupt. I'm guessing plenty of judgement proof people consume non-emergency services and skip out on the bills too.

This system really has no redeeming feature. It is an example of path-dependence in politics only, no underlying design principle.

IlliniDave
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Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

Wow, quite a lot has happened since I last checked in yesterday afternoon, too much for me to engage everything! I'll just add a couple things/comments.

Yes, there's an aspect of what I call the engineer's dilemma (cheap, fast, good: pick any two) to the medical care problem. I don't know that it has to be the way it's manifested in some nations that have opted for a completely public healthcare system--I suspect MRI availability isn't driving the bottom line of many national healthcare systems for example. In a single payer system there's just not a lot of motivation to maximize the "customer's" experience. I'd heard about provinces in Canada that have a system where commercial medical services are available outside the national health system, where someone who can and is willing to pay for an MRI themselves can get one in a more timely manner. Sort of like a surcharge for priority. Other nations (Italy, for example, if what's been relayed to me is accurate) have concierge services that those who can and want to pay for can cut through some of the delay.

Some will hate me for saying this, but I think our current president has floated some pretty good ideas regarding healthcare reform in the US. Specifically in mind are price transparency and streamlining of the tangled web of regulatory hurdles (which are high test fertilizer for bureaucracies).

I suspect the rates negotiated by medical insurance administrators generally reflect the actual cost of service plus some reasonable fee which are balanced by a promise of prompt payment. That gets the insurance (and the insured patients) out of having to chip in to cover the costs of repeated billings/collection and defaults. Good idea but it needs to be universalized else those costs are just passed on, in larger shares, to uninsured/out-of-network patients. Anyone who has a network based plan can easily see what fraction of the billed amount is likely going to that "overhead". That's one of the reasons I tend to think a universal catastrophic system could help.

ertyu, both political parties in the US, at least since the Clinton era, are all-in on the influence peddling racket. One of the best examples of blatant influence-peddling is currently running for president. Another lost in 2016. The only "freeloaders" conservatives I know harbor some resentment for are those who avail themselves while in the country in violation of immigration law, but that's part of a bigger issue. The average flyover country everyday conservative you'll find is actually quite charitable, although admittedly they exist on a continuum. The bigger difference in left vs right seems to be whose money they are charitable with (megawealthy aside).

Along with ACA, I think most employer-provided options are required to cover pre-existing conditions as well, at least if they want the tax incentives that go along with them.

Scott, yes it's a mess and in general I would encourage everyone to navigate the system to their best advantage as well as they are able. I really believe streamlining and simplification would help things a lot, but what do I know.

So it's my fault for getting it started by throwing in opinions while discussing my search for medical insurance for my bridge years, but cL is right, the best place for re-architecting or airing grievances about healthcare systems really isn't here. I'm sure there are discussion topics already started for that. I always enjoy following tangents in discussions so I don't want to discourage anyone from chiming in with whatever comes to mind, but this isn't one we can solve here.

IlliniDave
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Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

I'm really spamming the ol' journal lately.

Yesterday I tipped the scales below 180 for the first time since 1999 I believe. I've often set a goal to get to the 170-175 range (@ 6'0"-6'1") but usually fall a little short. This time I bet I'll make it. The message that overweight men are disproportionately likely to succumb to c19 came through loud and clear. Still having issues with my BP. I don't think they are real, especially at this weight. Seems like "whitecoat syndrome". I went yesterday for samples for annual labs and the last thing I did was take too measurements. Taking the highest number of both individually I got 115/74. Once I get in there the nurse took it and it was 140/78. She's on the attractive side, but I don't think that's it (not even sure if BP works that way, ha). I've spot checked my home device against on at a nearby pharmacy and they seem to track reasonably well, usually within +/- 3 on either number. Several months back I was in a dentist chair about to get one of my teeth ground down to a nub for a crown and they measured me at 120/80. At the doctors office they never hurt me, yet through the roof it goes. Frustrating that she (the doctor) will be working with a number I'm not convinced is accurate.

I also got my official paper retirement package in the mail. No real differences with what I gleaned from the electronic.

One thing I did learn was I can keep my current coverage under COBRA for 18 months. For some reason I thought it was 6 months. So I can go 1.5 years at ~$460/mo (plus inflation) before going into the retiree pool where the same plan is a little over $800/mo currently. Every little bit helps, and it means I've got up to an extra year to completely sort things out.

Rather than whining about a future based on how I imagined things might go, I took some initiative logged onto my current provider's website and found there are a fair number of in-network providers in my destination county in N Illinois. Some are even taking new patients. So tentatively, that's a big worry off the plate. I should be able to use the COBRA continuation of my current coverage during the transition then have the option of getting into the retiree pool of the same plan. And with it I'm somewhat less worried about out-of-network. Obviously it will cover me well during times when I'm back in Alabama visiting my daughter. It also appears most of the providers up in NE Minnesota are in-network too, including the hospitals. Haven't checked Ohio yet, where for now my other daughter lives, mostly because It's unclear where she'll be living a year or two from now. My home town is close to the WI border, and since several Wisconsin-based practices are in-network in Illinois, I'm guessing there are options there. Not a huge thing because for the most part I am just driving through en route to Minnesota or otherwise visiting, so can't imagine much besides emergency care there outside the connection between the UW research hospital and the N. Illinois hospitals and groups they are affiliated with.

If I'd have done that first ... :) I guess panic first, think second is a survival strategy that is advantageous in some scenarios.

All that could change rapidly without notice, of course, and that doesn't count new options that might appear in N. Illinois as the merger progresses and benefits are brought into alignment as much as they can. But for now I can put that on the back burner and think more about how to adjust to the 60% higher-then-what-I'd-been-planning-with premiums.

IlliniDave
Posts: 2959
Joined: Wed Apr 02, 2014 7:46 pm

Re: Phase III - Deja Vu All Over Again

Post by IlliniDave »

Some other miscellaneous items.

Illinois has "comprehensive" balance billing protections (although in general it appears to apply mainly to facility-based providers). Minnesota has partial. Interestingly, there the protection appears not to apply to emergency hospital treatment, but does for non-emergency, which seems backwards in terms of utility to patients. Curious as to why, but not curious enough to take it up as a research project.

Info from:

https://www.commonwealthfund.org/public ... rotections

My browser did not display the page well but there's a map and a table in pdf for download.

I made a new best estimate of retirement spending range based on updated information from the retirement package information. As a snapshot, I'm back in what I consider the green zone. I could probably stress myself into an early grave worrying about all the vulnerabilities associated with the costs of medical care. I would prefer not to do that.

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