Karma,

[Vox]

What has happened though is that aggregate deductibles have taken a more prominent roll, meaning in a family situation BOTH individual deductibles must be met before the insurance company begins paying.

which means you are actually paying out of pocket for your medical care and paying premiums to insurance company for NOTHING.

 

[Vox]

I was in physical therapy yesterday, and I couldn't help overhearing this woman talking to someone in the next room. She was upset, she was crying. I listened closer (call me an ass, but it is human nature)..and I heard her say that she would have to stop coming to therapy in January. That she is losing her insurance and cannot afford to come anymore because the only insurance she can now afford will never pay for anything.
She was speaking of course of the outrageous $10,000 deductible and 40% copay.
She can't afford to go to the doctor next year.
And that....is Obamacare.
And take that liberals and shove it up your ass...you caused this. Because you wanted something for nothing...and instead got nothing for something.

She was upset, she was crying. I listened closer (call me an ass, but it is human nature)..and I heard her say that she would have to stop coming to therapy in January.

In fairness this swings both ways, good and bad.

She was speaking of course of the outrageous $10,000 deductible and 40% copay.

The federal mandate is that no single individual can owe more than $6350, $12,700 for a family. (I agree with you, this helps nobody)

not true, because the out of the network costs could be up to 25K for the INDIVIDUAL.
and in-the-network in many cases is extremely narrow set of providers.

 

[Antares]

What has happened though is that aggregate deductibles have taken a more prominent roll, meaning in a family situation BOTH individual deductibles must be met before the insurance company begins paying.

which means you are actually paying out of pocket for your medical care and paying premiums to insurance company for NOTHING.

Essentially yes.

 

[Antares]

The Departments interpret the PPACA to require that all non-grandfathered group health plans must comply with the new annual limit on OOP expenses beginning with their 2014 plan year. The level of the new OOP maximums will be the same OOP dollar maximums that apply to HSA-qualifying high-deductible health plans in 2014. Those amounts are $6,250/single and $12,500/family in 2013 but will be indexed later this year to identify the 2014 amounts

Twenty New PPACA FAQs Clarify the Out-of-Pocket Maximum Mandate and Numerous Preventive Services Issues - Towers Watson

6350 for 2014.

 

[Antares]

That's because the federal government is giving some health plans extra time to comply with the rules.

Under the law, the maximum amount a consumer with single coverage will pay out-of-pocket in 2014 will generally be $6,350 while a family could pay up to $12,700. Those totals include copayments and deductibles, but not premiums, and they apply only to plans that are not grandfathered under the law


Federal Rule Allows Higher Out-Of-Pocket Spending For One Year - Kaiser Health News

 

[Antares]

The only exception.

Here's the catch. Although all non-grandfathered plans will have to cap the amount that consumers pay out-of-pocket for major medical expenses, if health plans use more than one company to administer their benefits—as many do for major medical and pharmacy benefits, for example—consumers may face separate caps next year, or no cap on their pharmacy spending at all.

Federal Rule Allows Higher Out-Of-Pocket Spending For One Year - Kaiser Health News

 

[hunarcy]

Nothing about Obamacare and its failures if funny. Nothing. It's all very sad and depressing.

Everything about it is funny. Without Obamacare people might still believe that government is the answer.

Well, I might have supported a single payer system, but after seeing that government can't even set up a website that works in 3 years, and listening to a couple of friends of mine were talking about the VA and how it fluctuated from a good system to screwed up depending on which Administration has been in office, I don't trust the government with single payer either.

 

[Vox]

so how come Florida Blue has, for example this plan, how is it possible?



BlueSelect Predictable Cost 1456
Silver Pediatric Vision

$496.43

per month
Add To Cart

Plan Details
Plan Benefits What You Pay In-Network What You Pay Out-of-Network
Annual Deductible Individual: $5,000 / Family: $10,000 Individual: $12,000 / Family: $24,000
Coinsurance (%) 0% 50%
Annual Out-of-Pocket Maximum (includes deductible, copays and coinsurance) Individual: $6,250 / Family: $12,500 Individual: $12,500 / Family: $25,000

 

[Antares]

Out of Pocket Maximum (Individual) $6,250 $12,500 Out of Pocket Maximum (Family) $12,500 $25,000 - See more at: ]Florida Blue BlueSelect Predictable Cost 1456 FL

LOL, you are reaching

Do you know what out of network is?

From your plan....

Out of Pocket Maximum (Individual) $6,250

 

[Antares]

[MENTION=44192]Vox[/MENTION]

Ya got me, if you are in Italy you can get hosed.

 

[hunarcy]

Out of Pocket Maximum (Individual) $6,250 $12,500 Out of Pocket Maximum (Family) $12,500 $25,000 - See more at: ]Florida Blue BlueSelect Predictable Cost 1456 FL

LOL, you are reaching

Do you know what out of network is?

From your plan....

Out of Pocket Maximum (Individual) $6,250

Do you know what co-pays and deductibles are? You'll be coming up with $6,250 before the insurance company pays a nickel. Great job!

 

[Vox]

Out of Pocket Maximum (Individual) $6,250 $12,500 Out of Pocket Maximum (Family) $12,500 $25,000 - See more at: ]Florida Blue BlueSelect Predictable Cost 1456 FL

LOL, you are reaching

Do you know what out of network is?

From your plan....

Out of Pocket Maximum (Individual) $6,250

for IN THE NETWORK.

I am NOT talking about in the network needs.

it is CLEARLY on the plan website 12.500 for individual Maximum out-of the pocket for the year for out of the network.

If I need treatment in Anderson Cancer center ( God forbid) - and that is why one needs insurance - for a major disaster, appendicitis can be treated in any community hospital ( provided you know which surgeon is worth what) - that IS going to be out of the network - which means I have to pay 12.500$ for the year, otherwise why would they even post that figures?

 

[Vox]

[MENTION=44192]Vox[/MENTION]

Ya got me, if you are in Italy you can get hosed.

Nope, If I need state of the art cancer treatment - that is what is going to cost me.

It was not there before.

My PPO plan covered the cancer treatments in the renowned centers all over the USA.

 

[Antares]

Out of Pocket Maximum (Individual) $6,250 $12,500 Out of Pocket Maximum (Family) $12,500 $25,000 - See more at: ]Florida Blue BlueSelect Predictable Cost 1456 FL

LOL, you are reaching

Do you know what out of network is?

From your plan....

Out of Pocket Maximum (Individual) $6,250

Do you know what co-pays and deductibles are? You'll be coming up with $6,250 before the insurance company pays a nickel. Great job!

Um yeah, I said that.

 

[Antares]

Out of Pocket Maximum (Individual) $6,250 $12,500 Out of Pocket Maximum (Family) $12,500 $25,000 - See more at: ]Florida Blue BlueSelect Predictable Cost 1456 FL

LOL, you are reaching

Do you know what out of network is?

From your plan....

Out of Pocket Maximum (Individual) $6,250

for IN THE NETWORK.

I am NOT talking about in the network needs.

it is CLEARLY on the plan website 12.500 for individual Maximum out-of the pocket for the year for out of the network.

If I need treatment in Anderson Cancer center ( God forbid) - and that is why one needs insurance - for a major disaster, appendicitis can be treated in any community hospital ( provided you know which surgeon is worth what) - that IS going to be out of the network - which means I have to pay 12.500$ for the year, otherwise why would they even post that figures?

Get back to me when you are able to comprehend what you read, you are simply parroting my points kid.

 

[Vox]

Out of Pocket Maximum (Individual) $6,250 $12,500 Out of Pocket Maximum (Family) $12,500 $25,000 - See more at: ]Florida Blue BlueSelect Predictable Cost 1456 FL

LOL, you are reaching

Do you know what out of network is?

From your plan....

Out of Pocket Maximum (Individual) $6,250

for IN THE NETWORK.

I am NOT talking about in the network needs.

it is CLEARLY on the plan website 12.500 for individual Maximum out-of the pocket for the year for out of the network.

If I need treatment in Anderson Cancer center ( God forbid) - and that is why one needs insurance - for a major disaster, appendicitis can be treated in any community hospital ( provided you know which surgeon is worth what) - that IS going to be out of the network - which means I have to pay 12.500$ for the year, otherwise why would they even post that figures?

Get back to me when you are able to comprehend what you read, you are simply parroting my points kid.

are you an idiot? or you are simply not able that you were WRONG

 

[Antares]

(pssst, Anderson take BCBS)

 

[Antares]

for IN THE NETWORK.

I am NOT talking about in the network needs.

it is CLEARLY on the plan website 12.500 for individual Maximum out-of the pocket for the year for out of the network.

If I need treatment in Anderson Cancer center ( God forbid) - and that is why one needs insurance - for a major disaster, appendicitis can be treated in any community hospital ( provided you know which surgeon is worth what) - that IS going to be out of the network - which means I have to pay 12.500$ for the year, otherwise why would they even post that figures?

Get back to me when you are able to comprehend what you read, you are simply parroting my points kid.

are you an idiot? or you are simply not able that you were WRONG

LOL, you are an idiot, show me where I said anything different.

6350/12700 ind/fam

the 25 number is out of network.....Anderson takes BCBS, you are a moron.

 

[Vox]

Out of Pocket Maximum (Individual) $6,250 $12,500 Out of Pocket Maximum (Family) $12,500 $25,000 - See more at: ]Florida Blue BlueSelect Predictable Cost 1456 FL

LOL, you are reaching

Do you know what out of network is?

From your plan....

Out of Pocket Maximum (Individual) $6,250

Do you know what co-pays and deductibles are? You'll be coming up with $6,250 before the insurance company pays a nickel. Great job!

he actually said that and the webpage also states that.

but there is a different MAXIMUM OUT OF POCKET depending on WHERE are you getting the treatments - in the network or out of the network.

And THAT is the basic problem here.

Becasue many plans on obamacare exchange are designed in such a way that they include very narrow set of providers.

But even if you have a wide set of providers - the big cancer centers all over the US are going to be out of the network, unless you are lucky to live exactly there.

Which means that if you really need life saving treatments - they are most obviously going to be out of the network.

Which is going to be out of your ability to pay.

With the figures as 12.500 for an individual.

or, if God forbid, you are driving with your family and happened to have a major accident - the costs of saving the lives of your family in the Level 1 trauma center are going to be 25K per year.

which is essentially bankruptcy for a standard family.

 

[Vox]

Get back to me when you are able to comprehend what you read, you are simply parroting my points kid.

are you an idiot? or you are simply not able that you were WRONG

LOL, you are an idiot, show me where I said anything different.

6350/12700 ind/fam

the 25 number is out of network.....Anderson takes BCBS, you are a moron.

FINALLY you, moron, got what I am talking about the last half an hour

you idiot it make take out of the BCBS plans, but not necessarily the ones from the exchanges.

that is the whole point of this crap - to lower the costs they limit the network of providers.

otherwise there won't be such a type of service - out of the network - altogether. or differences across the COUNTY lines and I am taking the STATE lines here.

stubborn idiot you are.