Doctors Telling Employees: Your ObamaCare Plans Not Valid

[scagnt83]

There are three things you guys are overlooking:

1) These low income people are subsidized, so their premium may not be "hundreds", there's a good chance it's dollars and cents.
2) Thanks to CSR, low income people have deductibles in the hundreds, not thousands, on Silver plans (the one most of them went for, according to the data we have from CMS).
3) Anyone can pay for anyone's plan, technically speaking.

I just had a client go on a silver plan at $37/mo with a $250 deductible, and I'm sure many of you have something similar on the books. Yes, there will be people who can't or don't pay this.

As a facility, they'll pay the $287 on behalf of the client to submit their multi-thousand-dollar claim. It's day 31 and you show up with a broken leg. They have to treat you, they have to treat it like you're insured, but they know they're getting "pended" at the carrier, and will have to chase you down on day 91 for payment out of pocket.

We already know, between the $30 asprins and $150 pillows, x-rays, setting bone, cast, crutches, etc. it's going to be a bill far bigger than any premium owed. It almost always makes sense for a facility to pay premium.

I expect it to be really common, but that's just my opinion.

If you cant afford a few hundred for premiums; then I doubt that after you have been hurt, missed out on work and lost income, you will suddenly be able to afford even a $200 subsidized deductible.

Sure the hospitals will cover some of the smaller deductibles just to get the claim. But none of that fixes the problem that existed in the first place.... only perpetuates it through a different scheme.

No matter what the deductible is, if someone is broke they will not be paying it.

And while hospitals might be able to cover deductibles to cash in on claims; your doctor down the street from you does not always have that luxury.
Their claims are not as high as a hospitals, so the RoR will not be as high for them and many deductibles will just go unpaid and wind up as a write off for the doctor and another hit on the low income persons credit report.

 

[healther]

I pay over $600 per month in premiums but I do not keep enough cash on hand to cover my family deductible. Not even close to enough to cover my family MOOP.

... and for the record, some of the plans I have written have $0 deductible.

 

[VolAgent]

If you cant afford a few hundred for premiums; then I doubt that after you have been hurt, missed out on work and lost income, you will suddenly be able to afford even a $200 subsidized deductible.

Sure the hospitals will cover some of the smaller deductibles just to get the claim. But none of that fixes the problem that existed in the first place.... only perpetuates it through a different scheme.

No matter what the deductible is, if someone is broke they will not be paying it.

And while hospitals might be able to cover deductibles to cash in on claims; your doctor down the street from you does not always have that luxury.
Their claims are not as high as a hospitals, so the RoR will not be as high for them and many deductibles will just go unpaid and wind up as a write off for the doctor and another hit on the low income persons credit report.

Actually, I think Ray is suggesting the hospital will pay the premium for the patient. Obviously they are going to eat the deductible as well. But I take it he is suggesting they will pay the premium so there is coverage in order to get the larger claim paid. Doctors and other providers would get to ride their coattails.

I really have to wonder if that would rise to the level of some type of insurance fraud. I can't think the carriers would be very happy if they found out.

 

[scagnt83]

.

... and for the record, some of the plans I have written have $0 deductible.

and I bet they dont pay more than $5 or $10 a month... might as well just be on Medicaid...

 

[Yagents]

I have a client on expensive MS meds (4k/mo), who has a $3500 OOP on RX on his Non GF Humana plan. The Rx manufacturer pays that OOP for the client, so they can collect the other $45k from the insurance carrier.

Also, it's all in the timing of when the carrier receives the claims. I find some doctors who know there was a recent large medical expense, delay sending in the claim, so they are paid in full by the carrier (assuming the large expense hits first and OOP is met)

 

[VolAgent]

I have a client on expensive MS meds (4k/mo), who has a $3500 OOP on RX on his Non GF Humana plan. The Rx manufacturer pays that OOP for the client, so they can collect the other $45k from the insurance carrier.

Also, it's all in the timing of when the carrier receives the claims. I find some doctors who know there was a recent large medical expense, delay sending in the claim, so they are paid in full by the carrier (assuming the large expense hits first and OOP is met)

I'm not lawyer, but I'm pretty sure there is a difference between eating a deductible and paying the actual premium.

As to the second, that is only smart.

 

[RayNY]

It's been discussed previously, as per CMS (who was the one who responded to the Hospital's question), they say they frown upon it and discourage the practice, but can't prevent it, track it, and it's not breaking any rules or laws. They will, however "monitor this practice and take appropriate action, if necessary". If you ask me-they'll never be able to track it down. Carrier's can't even tell us if a case is active, you really think they'll notice who owns the bank account they got paid from? Paid accounts are not the "squeaky wheel".

http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/third-party-qa-11-04-2013.pdf

Also, here's a Forbes article: Hidden Practice: Hospitals Pay Patient Insurance Premiums - Forbes on the same subject from a few days after, clearly indicating (like Yagents said) that it's something that already goes on in some cases, and is likely to persist.

 

[yorkriver1]

Just had a situation where the almost $900 subsidy/$215 lowest silver plan for a couple was still not enough.

Almost $40,000 of unpaid bills from a series of surgeries, still needing more. Couldn't pay for silver, opted for $5 bronze, to stop the madness of 5 figure surgery bills, $6,250 max OOP didn't look so bad.

If the hospital would pay the premium for the silver plan that would be great, but too late for this year.

At least they have a subsidy. Another referral, lowest bronze is $500, but they are in payback mode on bankruptcy, can't pay even that for another 18 months.

Oh, and one carrier has everyone up and running, clients showing, has been that way for some time, just didn't have time to go check. Have more plans with them will see how commission payment time compares...

BCBS, however, got inundated with last minute 2013 plans, and, you know, I remember when there was a rollout of a new MAPD, took almost a year to get commission.

They are saying that even when the system shows payment received, it could still take up to 2 weeks for policies to be matched up and validated. BCBS must have a non-automated way of applying payments to policies and changing the status from uploaded to active. Had one client with off exchange gold plan need to reschedule a scan as plan wouldn't verify coverage to the doc. Payment had been received almost a week earlier.

 

[xrac]

If you cant afford a few hundred for premiums; then I doubt that after you have been hurt, missed out on work and lost income, you will suddenly be able to afford even a $200 subsidized deductible. Sure the hospitals will cover some of the smaller deductibles just to get the claim. But none of that fixes the problem that existed in the first place.... only perpetuates it through a different scheme. No matter what the deductible is, if someone is broke they will not be paying it. And while hospitals might be able to cover deductibles to cash in on claims; your doctor down the street from you does not always have that luxury. Their claims are not as high as a hospitals, so the RoR will not be as high for them and many deductibles will just go unpaid and wind up as a write off for the doctor and another hit on the low income persons credit report.

Jesus said, "The poor you have with you always." No matter what we do some people just cannot or will not be fixed. Doesn't mean we do not do what we can but we need to be realists and realize a lot of these grand schemes will never work because they do not strike at the heart of the problem. The problem is human nature and what is inside of a person.

 

[russelltw]

If the hospitals pay for the premiums, it reminds me of a story about a hedge fund named Magnetar. They put ask financial institutions to create collateralized debt obligations (CDOs). These CDOs would be made of 1/3 of really bad risk loans. Magnestar would purchase the bad 1/3 and would get the rest of the good loans sold to financial institutions. At the same time they would buy credit default swaps to bet against the CDOs they just purchased. Knowing the CDOs would fail because 1/3 of it consisted of extremely toxic loans, they lost on the CDO; but made 10x their money on the swaps.
The hospitals are simply fleecing the government (by paying the client's premium) to get paid for the claim and they are being forced to do so to stay solvent...we live in a backwards world.