Pregnant & Uninsured?

[VolAgent]

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. . . .

To the insurance companies it is a huge difference. The auto company isn't required to pay for repairs due to lack of maintenance. The health insurance company is definitely going to be paying for more expensive treatment due to lack of preventive care.

Methodist Hospital upgrades health care in 38109

They spent more in preventive care, but they kept the people out of the ER which ultimately saved the hospital money in charity cases.

You are looking at this from a "moral" standpoint. Perhaps insurance companies shouldn't pay for the small stuff. But from a business standpoint, it can save them money in the long run.

 

[yorkriver1]

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

I have seen more "ACO's" mentioned in IFP and group. Definitely could be limited networks. Works for some.

In general, both in SNP and "regular" MAPD's, there is the trend to do lots of up front monitoring of patients, especially "high risk" for hospitalization.

I haven't reviewed SGR yet. Yay, weekend pleasure reading. You are always a good source of info, thanks.

VolAgent: yes, spending money up front to save bigger later. Keep oil changed regularly, avoid engine overhaul or replacement, since we are paying for that in health insurance. Now "big data" is being used to show what works to reduce costs without compromising health.

 

[somarco]

Never mind. Forgot I was in the hc reform section. SGR applies to Medicare

 

[AllenChicago]

June 18, 2015

The state of New York now allows pregnancy as a "life event" that triggers a Special Enrollment Period (SEP) opportunity.

Ref: NY first state allowing pregnancy as Obamacare 'life event' - NY Daily News

I wonder if this will be the final straw that causes some health insurers to leave the New York market?

 

[yorkriver1]

Would that be more likely in states that have the Medicaid expansion? In our state, which didn't pass the expansion, the state offers coverage under Medicaid for pregnant women.

 

[RayNY]

This pregnancy law is broader than you'd think. I'd agree it'll cause insurers to leave NY, but single payer in 2017 will take care of that...

To quote the bill:

"The state health insurance exchange shall allow for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Upon such enrollment, any qualified health plan in the state health insurance exchange shall ensure that coverage is effective on the date of application."

TL;DR: You can apply any time during pregnancy from conception through birth and have coverage effective the same day.

 

[AllenChicago]

This pregnancy law is broader than you'd think.


TL;DR: You can apply any time during pregnancy from conception through birth and have coverage effective the same day.

Wow..that's a disappointment. Coverage should be retroactive to the day of sex, and also cover the baby's daddy. New York is starting to slack...

 

[RayNY]

Don't be silly Allen, they would owe months of premium!

This way, while you're crowning, you can sign up, get delivery covered, and drop after delivery. Of course, with a subsidy, if eligible.

I should also note, because of the way it's written, it's not a "one time use". It can be used "at any time after the commencement of pregnancy". The others are all tied to a specific event with a 60 day window, while this is tied to a status with no window.

 

[somarco]

it's not a "one time use".

Don't give Octomom any more ideas

 

[unic.consulting]

Don't be silly Allen, they would owe months of premium!

This way, while you're crowning, you can sign up, get delivery covered, and drop after delivery. Of course, with a subsidy, if eligible.

I should also note, because of the way it's written, it's not a "one time use". It can be used "at any time after the commencement of pregnancy". The others are all tied to a specific event with a 60 day window, while this is tied to a status with no window.

Nice. So they can get prenatal care at the cheapest rate possible. Then if something happens and they need some emergency procedures, they can switch to a plan that covers that better? And I thought Massachusetts was screwed up.