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Who Will Be The Next President?

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3 hours ago, Chaparral Rider said:

don't look down on those who made it happen.

I look down on no one my friend. My parents raised me the same way I raised my kids, treat the janitor the same way you treat the head honcho. Congrats on your accomplishments.

 

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I can see where one would say they don't know anyone that makes less than $50k.  If I look around at my inner circle, I can say the same thing.  There are a couple of family members that make less but its the choices they make.  The caveat is that I am approaching 50 years old, have multiple advanced degrees in a technical and business field and have worked hard, taken risks and made sacrifices (I remember sitting in the engineering library on a Friday night while all my friends were out partying).  My family was taught to work hard and we do.  My wife's family was also brought up that way, but she does have a sibling or two that have made some not so bright choices in the past.  My circle of friends are similar to me, have worked hard, made the same sacrifices and are reaping the same rewards.

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If you are making over $ 500,000 a year. You may direct everyone that you are officially taking the " Sargent Schulze Amendment ".

" I know nothing. "     " I see nothing. " 

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I picked up my prescription the other day. Fist renewed prescription for 2017. Geez...sticker shock.  I stopped at my health provider to have explained to me again why it jumped so much. Simply put, huge increase in copay which I forget applied to drugs too. So we got to talking......

The agent mentioned about the total cost for a single plan. A monthly premium could be 1000.00. Add in large co-pays and high deductibles, people are shelling out huge sums of money. Or cutting services to reduce the cost. Ouch.

It amazes me that the media are so focused on Obama Care and how wonderful it is......But yet, no longer a discussion on how expensive it is to the same people.  The provider agreed with me. Maybe there is a discussion but I have pretty much turned off the TV news programs. Watching "The End of the Earth" with people getting underground bunkers able to survive a direct hit is less stressful than CNN political news hour 26hours per day.

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On 3/10/2017 at 11:18 AM, SST said:

I picked up my prescription the other day. Fist renewed prescription for 2017. Geez...sticker shock.  I stopped at my health provider to have explained to me again why it jumped so much. Simply put, huge increase in copay which I forget applied to drugs too. So we got to talking......

The agent mentioned about the total cost for a single plan. A monthly premium could be 1000.00. Add in large co-pays and high deductibles, people are shelling out huge sums of money. Or cutting services to reduce the cost. Ouch.

It amazes me that the media are so focused on Obama Care and how wonderful it is......But yet, no longer a discussion on how expensive it is to the same people.  The provider agreed with me. Maybe there is a discussion but I have pretty much turned off the TV news programs. Watching "The End of the Earth" with people getting underground bunkers able to survive a direct hit is less stressful than CNN political news hour 26hours per day.

I have probably stated this before at least once but when my wife was going through her cancer treatments two years ago I had two women in the hospital billing office tell me they have yet to see an Obama Care plan pay more than one claim. This was the large hospital in Dothan Ala and the claims were made on the National Exchange policies. We discussed cost and coverage a lot since my wife's treatment was on my dime, no insurance available for her. By the way had we been able to purchase a National Exchange plan it would NOT have paid a penny for her treatments as we live in Ga and had treatments in Ala (the closest cancer center) and the "National Exchange" policies will not cover across state lines.

We have first hand experience with "Government in Healthcare" and believe me we cannot take much more government help with our healthcare.

Joe

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Nonsense and ignorance ... there is no national exchange that manages health care relation and claims between consumers and federal government under Obamacare. There is a federal marketplace, basically a federal website that shows all available health coverage options provided by individual insurance companies and facilitates a signup with a particular insurance company, and is available to consumers from the states that opted not to provide state marketplace or state portal. Many states offer own portals that serves information and signup option for consumers from that particular state.

That is it, these marketplaces provide health care policy information and facilitate contract signup between individual consumer and individual insurance company. All else is up to that particular insurance company.

Health care insurance policies and the terms are not created or defined by the federal or state bureaucrats, they are defined by the individual insurance companies' underwriters. It is each and every insurance company decision to define, within federal and state laws, each individual policy type, its terms including geographical coverage, and the costs.

Some insurance companies offer cross state options ... we had looked at some such insurance policies when we were evaluating our residency options and potential health care coverage in NJ, NY, and FL. On the other hand, some insurance companies do not even cover all counties in the state they are present ... it is their P&L decision, not a federal or state government's doings.

By the same token, "national exchange" does not process or pay claims. It is an individual policy issuer, an insurance company, processing, approving or not, and paying or not the claims made agains their insurance policy. It is up to the individual consumer to find a suitable policy and level of coverage, and evaluate the insurance company to fit their needs and budget. This has nothing to do with the federal or state governments.

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 now I am ignorant to this so I'm going to ask. Aren't those same insurance companies regulated by federal and state government agencies as to what they can accomplish and what they can't? 

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Yes, in broad terms ...

The federal and state laws define the dos and don'ts framework, and general terms like pre existing condition, child coverage, and profilactics, but not the details like geographical presence, coverage cost, hospital/doctor network inclusion or exclusion, deductibles, out of pocket costs, health services covered fees, etc. These are defined by the insurance companies, and/or negotiated by insurance companies with health care providers and pharmacies.

In order to regulate all aspects of the health care coverage, we would have to move to a single payer model like in Canada ... I am not proposing doing it, I am just stating the fact.

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OK Richard. I am ignorant and completely full of nonsense. However, since you are the first person to call me ignorant I will take that at face value and consider the source. Since I have first hand knowledge purchased at a great cost and you are just repeating talking points I'll keep telling the TRUTH of what happened and continue to ignore the "Sales Pitch" we were ALL lied to about.

I guess I'm so ignorant I don't have any idea why I had to dish out the 125 large deer for cancer treatments.

All I know is that we were bounced from one person to another trying to purchase insurance. We were REFUSED at every turn.

I live on tax free income and O care is based on taxable income. They refused to sell me insurance because "I did not make enough money" so they forwarded our file to the state Medicaid (without our knowledge or approval) which REFUSED to help because we made TOO MUCH money as Medicaid looks at household income.

The National Exchange said they would sell us insurance for her after we received a rejection notice from Medicaid. While waiting the 6 months for the state medicaid rejection letter we ran up the 125,000 worth of treatments.

DON"T talk to me about how government interference in the medical processes work. I know first hand. 

By the way. Just why does the government need to be in healthcare anyway.

You can keep all your starry eyed pie in the sky democrat BS about O care. Keep up the talking points because that is all they are. Just BS. Talk to me AFTER you or yours goes through a major medical expense with your BO care. 

Joe

PS, this is twice I have been insulted on this site. Is this normal?

 

 

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On 3/8/2017 at 4:07 PM, phills fan said:

I look down on no one my friend. My parents raised me the same way I raised my kids, treat the janitor the same way you treat the head honcho. Congrats on your accomplishments.

 

"treat the janitor the same way"    Explains why you and I get along so well.   W

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7 hours ago, Guzzi said:

OK Richard. I am ignorant and completely full of nonsense ...

...

PS, this is twice I have been insulted on this site. Is this normal?

 

Now you made it clear that your comments were based on your experience while you were not qualified and refused by Obamacare and then by Medicaid. You replied to a quote that discussed coverage under Obamacare and that was a context for my comments. Not sure where you ended up after, private insurance?

I am still not sure what is the National Exchange you are referring to but I guess it ain't a typical experience under Obamacare. I will get back to you on this later.

PS. Stop counting ...
I do not count anymore, and do not care about insults and innuendoes anymore, I ignore them and it feels better ... ;)

EDIT >>> CONTINUATION

I cannot get a good description of "national exchange" where you ended up after not qualifying for Obamacare and for Medicaid. Your case, unfortunately, fell in between federal and state legislative cracks and you got short changed ... I am really sorry.

A few years back me and my wife were in a similar early retirement and income position as you and yours. Fortunately, we did not have major medical emergency and we had time to educate ourselves about Obamacare requirements to project and plan our income in advance. What also helped is that we have been maintaining the continuity of our health care coverage: from employer provided to COBRA, then to private insurance, and then to Obamacare when the next enrollment period started. We did not have to try to secure the coverage when minor emergencies happened ... we were covered all the time.

You could, and potentially you still can, change your income status and qualify for Obamacare legally going forward. If you are 59.5 or older, it takes a CPA or tax planner to project your income within the means of your retirement savings, and make the correct declarations.

I bet that if you knew then you could have generated enough in taxable income. You only needed $12k of taxable income then (any combination of earnings, pensions, retirement distributions, and/or investment income like dividends, interest, and investment gains) to qualify for Obamacare. A bit more is needed every year but not much more, and you still would be in or below the 10% tax bracket with no real federal tax liability. Not sure about your state tax. These are just my comments based on my situation, you would need to get your CPA to evaluate your situation and calculate details of your case.

If you are interested in more details, send me a PM and I will provide you with more info and links to start the conversation with your CPA. It's too late to fix the past mistakes, but this might help you going forward. In any case, all the best to you and yours.

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10 hours ago, Richard W said:

f you are interested in more details, send me a PM and I will provide you with more info and links to start the conversation with your CPA. It's too late to fix the past mistakes, but this might help you going forward. In any case, all the best to you and yours.

You are completely correct in that the timing of our issue caused the damage. I am correct that all the damage caused us was due to government interference in our healthcare system. Every attempt we made to provide for our own coverage was denied by government actions or rules.

Complete timeline. In May of 2012 I was forced from employment due to medical issues. My last employer covered me until termination in Feb of 2013. I took and continued Cobra coverage for the recommended 18 months with the assurance that loss of Cobra coverage was a qualifying event and purchasing coverage outside of open enrollment would not be an issue.

Cobra coverage started March of 2013 and by law ended on July 2014.(First set of laws passed concerning my healthcare) On June 6th we started shopping at brokers and ins agencies for coverage. We were told repeatedly "No ACA Compliant Private plans available in GA" "our only option was to log onto Healthcare.gov."

Completed the Healthcare.gov application. June 28th notified we were not qualified for coverage based on our IRS taxable income and that our file has been forwarded to Ga Medicaid. (Second set of laws passed where government interfered with my ability to purchase coverage). This application was forwarded to Ga Medicaid without our knowledge or approval..

June 28th after receiving notice in mail we contacted advertised brokers for ACA compliant coverage. We are told sure we can sell you a policy. The plan was 695 deer a month with a 10,000 deer deductible. I said great sign us up. I was called back about an hour later from the broker and told I would need to supply a Ga Medicaid rejection letter before they could accept our application since we had already applied for Medicaid. (We DID NOT, it was done by rules of O care that said we were poor and treated us as such because we did not have any TAXABLE income).

On July 1, 2013 Cobra ends. On August 15, 2014 during a regular OB visit she is told "I've seen this a hundred times, you have cancer". Treatment starts the following week and by December 3, 2014 we have bills over 125,000 deer. 

On December 28, 2014 we receive the rejection letter from Ga Medicaid because we have too much household income (Third set of laws passed that interfere with our ability to get health coverage). So now we can purchase coverage, just now she has the preexisting condition so there goes the 695 a month gig.

On to better news. Here we are two years later and she is cancer free, everyone is paid and all is good in the world. Well worth taking retirement funds to pay for, but enough that I have a very low tolerance for people telling me I don't understand or did something wrong.

Look, to be blunt. The reason I am spreading our story is to let people know that when you have government interfering (or more accurately attempting to control to the point of micro management) in something as complex and important to a single individual as THEIR health then you WILL end up causing harm. 

I am not interested in hearing about how many people were helped by this POS law. I worked closely with the billing departments in three different hospitals, four different doctors practices and negotiated cash payment prices for her medications at our local pharmacy. One single story I heard over and over was how the billing people had to explain to people who presented their Healthcare.gov policy card (regardless of provider, the plans details were dictated by ACA) why they owed 20 or 30 thousand deer after their hospital stay when they thought they had insurance to cover their problem.

It is cheap and easy to repeat the BS you hear in the news when it does not touch YOU. When it does trust me you will see it differently. When I had good insurance coverage I did not think much about it. When I first took Cobra I did not worry, I was just going to stroke a check for whatever it took for the Cobra and whatever private coverage cost after the Cobra ran out. What I found to my surprise was different laws passed at different times by different sets of politicians PREVENTED me from purchasing coverage for my own wife.

I feel the need to let this be known. NO one in Washington DC can pass a law that benefits everyone. So in my opinion they should just get out of it. We did not experience ANY issues getting ANY treatment she needed in a timely manner even though we told everyone up front we had no health ins. To put it simply, she was not denied healthcare, she was denied healthcare insurance coverage. Two different things.

Money was not and is still not the issue. We paid our bills, it was my wife and my bills. The issue was why were we put in this position in the first place, just to get some votes?

Hope this helps someone to see just a bit more clearly that vote buying laws only help the ones in DC. NOT you and I.

Joe

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Again, I am sorry it happened to you and yours. In the ideal world this should never happened. The laws were not flawless, then some 26 states decided not to expand Medicaid to breach the coverage gap. Sound like your state was one of them. Then there is consumer awareness. Being exactly in the same situation minus urgency we have managed to maintain our health care coverage.

As you, we were eligible for special Obamacare enrollment when our COBRA coverage expired. We had researched the eligibility requirements and have started the Obamacare enrollment, but then during the enrollment process we read all the info/links provided there to assist in enrollment and felt we might not have enough income to qualify and had backed off. We went with private insurance for the remainder of the year to buy time to plan our situation and make ourselves qualified for Obamacare coverage. The  Medicaid was an option then but we had evaluated our state status and suspected that the outcome will be not good, exactly like yours. We did not have any discussions with federal Obamacare or state Medicare clerks, we suspected they are just as confused as we are. Instead, we just read all available info and FAQs on their sites, looked for expert interpretations of the law, and talked to a number of CPAs as some were clueless about ACA. Our healthcare insurance was our priority and we took time to understand the landscape and get ourselves ready. It took a lot of time and effort but the last thing we wanted is to be ignorant of the facts to be left without healthcare coverage.

I am hearing what you say about the government involvement, but I have to tell you that the private insurance was much worse in terms and coverage or much more expensive. This is where we are heading if ACA is repealed instead of being fixed and improved. The state Medicaid is going to get worse as well. Hopefully, the one aspect of ACA that benefited you and many others, no preexisting conditions, will remain in place.

The confusion, gaps, eligibility denials are and will be the reality no matter which/whose laws are in place. The only thing we, the consumers, can do is to be informed and aware of the guidelines, and work out our situations to make ourselves compliant and qualified.

My take from this story, and advice to others would be ... don't be ignorant of reality, some things you cannot change or cannot change quickly enough, so get informed and start planning early for what you have to work with.

The next step for us is SS pensions signup, and even more important, Medicare signup. There is a relatively small window to sign up for Medicare, and there is a significant penalty for missing it ... the higher premiums paid till end of life. One can say it's the government messing with us again. Yeah ... but I say to myself, get ready, put the date on your calendar, and before the time comes educate yourself about Medicare coverage layers and options for each layer. Some actions one takes or doesn't take have lasting consequences.

 

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Guzzi, thank you for your very personal story about the total health care debacle.  Our mid size company spent time, money and energy on trying to figure out the health care system called Obamacare.  That health system law was poorly researched by congress and the White House. The law was poorly written by congress and the White House. The rollout of the law was poorly done by congress and the White House. The sustainability of the law was poorly supported by the congress and the White House.  So a big governmental screw up.  Then comes the new congress and White House and they did the exact same thing only it was never voted because it was just as crummy as the predecessor.  The one constant theme in all this is our elected officials are not willing to put in any time to really work on the problems and solutions, why because they have great no cost coverage. 

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In my opinion, I really don't believe that the dems in power had any intention of making the AHCA work.  Once the plan fails, and it will, we will be forced to a single payer system just like Canada, GB, and most of Europe, all run by our Federal beaucracy whose goat it is to control our lives.

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One thing I found was that if you talk to the billing offices of these doctors and hospitals you can work out significant charge reductions for cash payments. 

Just a couple of examples off the top of my head. Lab work for her last procedure was billed at 480 and we (the hospital and I) agreed on a check for 28 paid on date of service. Her cancer doctor set us a cash pay price for an office visit at 48 deer when it was billed at 148 to ins. Each was HAPPY to not mess with ins claims, a check at time of service was just fine with them.

Maybe as suggested I was stupid and failed to make adequate efforts but whether my state took or did not take medicaid expansion (which was only political pressure/punishment to get this crap passed) I had no input. How quickly the state bureaucrats process a rejection to a claim I never made is somewhat  beyond my limited ability to predict .

Anyway it was my 125 not anyone else's.

Joe

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57 minutes ago, Baum's aweigh said:

In my opinion, I really don't believe that the dems in power had any intention of making the AHCA work.  Once the plan fails, and it will, we will be forced to a single payer system just like Canada, GB, and most of Europe, all run by our Federal beaucracy whose goat it is to control our lives.

Chances are you are correct as the initial context around ACA early discussions was a single payer model. Would it work better? Maybe yes, maybe not, depending on who you ask. Personally, I doubt it being familiar with a single payer model implementation in two different countries. So, what is the option and how can we influence the right outcome? I am just freaking lost on this ...

51 minutes ago, Guzzi said:

One thing I found was that if you talk to the billing offices of these doctors and hospitals you can work out significant charge reductions for cash payments.

This is one of the paradoxes in the affairs between private insurance and private healthcare provider. The game they both play. One is trying to minimize payment, another is trying to maximize charges so they can negotiate a comfortable middle between them. The charges sent to the insurer are fake, it is an institutional fraud in my opinion justified by the need to provide care to uninsured or under insured Medicaid patients. These artificially inflated charges affect us all. We, the consumers, pay the price again in the form of unchecked increases of healthcare service costs if you self-pay, or running away insurance premiums if you are insured. This model does not make sense either ...

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11 minutes ago, Richard W said:

I really don't believe that the dems in power had any intention of making the AHCA work

At the peril of us all, neither party wants the other to have any success, we can all see that right?

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4 minutes ago, phills fan said:

At the peril of us all, neither party wants the other to have any success, we can all see that right?

Dennis for Emporium Maximus...   I'll vote for ya.  W

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29 minutes ago, phills fan said:

At the peril of us all, neither party wants the other to have any success, we can all see that right?

+12

Joe

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3 hours ago, Richard W said:

Chances are you are correct as the initial context around ACA early discussions was a single payer model. Would it work better? Maybe yes, maybe not, depending on who you ask. Personally, I doubt it being familiar with a single payer model implementation in two different countries. So, what is the option and how can we influence the right outcome? I am just freaking lost on this ...

This is one of the paradoxes in the affairs between private insurance and private healthcare provider. The game they both play. One is trying to minimize payment, another is trying to maximize charges so they can negotiate a comfortable middle between them. The charges sent to the insurer are fake, it is an institutional fraud in my opinion justified by the need to provide care to uninsured or under insured Medicaid patients. These artificially inflated charges affect us all. We, the consumers, pay the price again in the form of unchecked increases of healthcare service costs if you self-pay, or running away insurance premiums if you are insured. This model does not make sense either ...

Thing is the providers and insurers BOTH have costs associated with processing a claim. If a provider does not have to file they do not have to cover the cost of labor to file and close the claim. It costs the doctors less to just deposit a check. "IF" they are decent people they will pass the reduced cost of their service to you.

We have found this to be true across the board (so far). Offer cash at time of service and so far everyone has been more than willing to drop their fees at just a request.

See I'm not sure I can go full in with the The charges sent to the insurer are fake, it is an institutional fraud in my opinion justified by the need to provide care to uninsured or under insured Medicaid patients. These artificially inflated charges affect us all. We, the consumers, pay the price again in the form of unchecked increases of healthcare service costs if you self-pay, or running away insurance premiums if you are insured. This model does not make sense either ...

In our case providers were more than willing to offer and accept large cash discounts. This tells me either everyone was very nice to us from the goodness of their heart or there really is a large labor cost associated with the claims process.

However I do see the ease with which money can be "Juggled" to show the correct numbers on the bottom line. Thing is, NONE of it is the government's business. All government does is add costs.

I fully understand that we were what some would call "fortunate" to have the funds to self pay. I understand not everyone can. But I also understand that layer after layer of regulations and big buildings full of ins company workers all have an associated cost that is in the end paid in full by the individual. Either through premiums, co-pays, deductibles, taxes, etc.

We did not have coverage but we did have the best healthcare anyone could have gotten anywhere. Besides, rather have her than a new boat anyway. If you cannot spend your money on something important then what good is it.

Joe

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