Pregnant & Uninsured?

[cadylou]

Even an *** will find a bridge they're not dumb enough to jump off.

If you ask me, a pregnancy SEP is that line in the sand they're not dumb enough to cross. For many people, pregnancy is the most expensive medical expense they have; letting people go on just for the pregnancy period is too ripe for abuse.

Pregnancy shouldn't be a SEP - this is the only decision they've made to date that I agree with. But, I'm sure they didn't make it because it was the right one - only because they were being pressured by the carriers who don't want to pay for maternity.

 

[GreenSky]

Pregnancy and other planned claims shouldn't even be covered by insurance. I thought insurance was for unforeseen occurrences.

That is until we passed Obamacrap with bipartisan support (both democrat and "indpendents.")

Rick

 

[cadylou]

Pregnancy and other planned claims shouldn't even be covered by insurance. I thought insurance was for unforeseen occurrences.

That is until we passed Obamacrap with bipartisan support (both democrat and "indpendents.")

Rick

I'd go a step further & say that insurance really shouldn't even be for preventive care - it's really to insure against catastrophic risk (at least it used to be). You don't expect your car insurance to include your tune-ups, or your homeowners to include regular maintenance . . . . .it's all ridiculous.

 

[GreenSky]

I'd go a step further & say that insurance really shouldn't even be for preventive care - it's really to insure against catastrophic risk (at least it used to be). You don't expect your car insurance to include your tune-ups, or your homeowners to include regular maintenance . . . . .it's all ridiculous.

Agreed. Though we haven't met I must have taught you well.

Rick

 

[sman]

Agreed. Though we haven't met I must have taught you well.

Rick

Only because Luke taught you so well.

 

[Norwayguy]

I'd go a step further & say that insurance really shouldn't even be for preventive care - it's really to insure against catastrophic risk (at least it used to be). You don't expect your car insurance to include your tune-ups, or your homeowners to include regular maintenance . . . . .it's all ridiculous.

Careful next we will have obamauto policies that cover oil change and tire replacement and be subsidized.

 

[VolAgent]

I'd go a step further & say that insurance really shouldn't even be for preventive care - it's really to insure against catastrophic risk (at least it used to be). You don't expect your car insurance to include your tune-ups, or your homeowners to include regular maintenance . . . . .it's all ridiculous.

You always hear that analogy. There is one problem with it.

Auto policies don't cover mechanical breakdown. Paying for an oil change does nothing for the company, they don't have to pay for the blown engine.

Health insurance does cover "health breakdown". Don't take care of yourself now, and the insurance company will be paying that big bill for the heart attack, stroke, preventable cancer, etc. It can potentially benefit them to pay for some preventative care along the way if it can help stave off bigger claims.

 

[cadylou]

You always hear that analogy. There is one problem with it. Auto policies don't cover mechanical breakdown. Paying for an oil change does nothing for the company, they don't have to pay for the blown engine. Health insurance does cover "health breakdown". Don't take care of yourself now, and the insurance company will be paying that big bill for the heart attack, stroke, preventable cancer, etc. It can potentially benefit them to pay for some preventative care along the way if it can help stave off bigger claims.

So if I refuse to maintain my car and it has a catastrophic failure it is somehow different? Your comment makes no sense to me. Everything should be paid for by insurance? Insane. . . .

 

[yorkriver1]

So if I refuse to maintain my car and it has a catastrophic failure it is somehow different? Your comment makes no sense to me. Everything should be paid for by insurance? Insane. . . .

The JenCare model of one stop patient care in Medicare Advantage, where money is spent up front, especially on the sickest, like congestive heart failure and diabetes, has been proven to save money in the long run by keeping people out of the hospital.

Are we arguing against the original intent of HMO's, which certainly have been a mixed bag of effectiveness? The newer accountable care organization model is to stop rewarding providers for excessive procedures and to pay higher reimbursements based on keeping patients out of the hospital, that is, keeping them out by avoiding them crashing and burning with "emergencies" that could be prevented.

Intel has a division developing home monitoring that would predict which seniors are likely be more prone to falling, among other concepts. Get them in for office or home based interventions early, prevent catastrophic claims. http://aginginplace.com/mini-2/technology-for-aging-in-place/3/

I geek out on these newer ideas to reduce healthcare costs and improve health, like my HMO giving out FitBits, because we really are at the point of unsustainable healthcare cost escalation. So, from the standpoint of personal responsibility to keep one's own healthcare costs down, yes, why should we pay for someone's unwillingness to take care of themselves. OK, now we have high deductibles, hint. I also have a surprising number of fairly ill MA clients who are using their free gym memberships with gratitude.

Wow, this seems a bit "rant-y", maybe it's day 14 on this: www.whole30.com, just kidding, or check this out: http://terrywahls.com/minding-your-mitochondria-dr-terry-wahls-at-tedxiowacity/ I am actually glad to clean up the eating a bit. Things really are changing in a good direction structurally in healthcare; insurance is another discussion. I give an elevator speech about it to my clients who are all doom and gloom.

But some of you may be joking, right?

 

[somarco]

The newer accountable care organization model is to stop rewarding providers for excessive procedures and to pay higher reimbursements based on keeping patients out of the hospital,

If you are referring to the new SGR replacement consider there are unintended consequences there. Such as limited access to health care.