OBummercare

[desertrat]

Yep. I spelled it correctly. I would suggest anyone who hasn't had recent blood work to get it done soon and this is why.

Went in to pay my health insurance bill and talked to a very nice but very bored customer service rep.

Got on the subject of insurance premiums as I was interested in maybe upping my deductible to lower the premium cost.

She looked up my policy, glanced around to see if anyone was listening, and then in sotto voce, said not to change my policy.

You see, she explained, the old policy I have is grandfathered in (I pay individual insurance,) meaning OBummercare has to accept its covered amounts.

Apparently, if I chose to pick a new policy, under Obummercare, blood tests will NOT be covered. Yes, if you go to a hospital, blood tests will be covered, but only for the specific diagnosis. Not for anything else.

So, say you go for your yearly blood tests with your primary. He/she can only ordered certain blood work that pertains to your yearly physical, such as the usual CBC.

For example, no Vitamin D tests will be covered. It is not considered a necessary blood test. She also stated hormones, thyroid, and any vitamins tests are not covered!!!

I routinely get blood work every 6 six weeks (to the tune of over $4,000 each time...insurance pays $359 to the lab and they accept it as full payment!). These blood tests have really helped me to quickly fine tune what I need and how well I have improved or not.

If I chose the new policy, I will be expected to pay the full $4,000 for the blood work tests! They will not cover it. And get this....the premiums from the old policy to the new are only 10 dollars less in savings.

The customer service rep (Blue Cross/Blue Shield) said to hold to my existing policy for as long as I can. Everything starts to take effect this September. She suggested to wait until 2015. That is because the year 2014 is going to see such upheaval that she doesn't know how things are going to pan out. She told me she expects a lot of very unhappy people.

So, a warning to all of you out there. Call your healthcare insurance provider. Ask them what is covered in your policy and what won't be under OBummercare. Any tests, surgeries, etc. should be carefully looked at if you need them in the near future. Don't ask your employer. They don't know a thing! Your insurance company does. And they are not happy at all about the coming changes.

Mandy

[jgivens]

Well, of course, your insurance company knows exactly what is going to happen, because they and the pharmaceuticals were going to lose money on the whole Obamacare plan. They worked so hard to lobby against it and get it watered down that yes, indeed, 2014 is going to be a rough year--for US not, them. It is only when enough of our legislators lose healthcare (which isn't going to happen anytime soon!) that we may have a prayer of a REAL health care plan for everybody in place.

[wmonique2]

Mandy,

Lucky you that you have insurance, period. Some of us don't have it and can't buy it at any cost. Have you thought about that alternative? I pay everything from my own pocket. Doctors visits, blood tests, EVERYTHING. Thousands of dollars, cash. No discounts. Gyno $395, Gastro $125 visits. Then tests, tests, tests.

Mesalamine $900, Entecort $1200 (I buy them in India or Canada). Insulin $120, Needles for my pump $300, testing supplies...You want to hear more or you had enough?

I can't wait for 2014 so I can have some sort of coverage.

So I guess it depends where you're at in life...Some of us are luckier than others.

Monique

[JeanIrene]

Monique, I'm curious. Don't know anything about what will happen in 2014. I have Medicare right now. So will you buy insurance from your state exchange at that time? And will it be from a private insurer or will that be Medicaid administered by the Feds? And do you have any idea as to cost? I don't know anyone that really knows what will happen in 2014.

Jean

[wmonique2]

I believe that I'll have to buy from an exchange. No medicare or medicaid. Not administered by the feds either. Private insurance. They'll be forced to give me insurance whether they like it or not. Just like for car insurance. If you've had too many accidents and can't buy insurance, then insurance selected by a certain process will have to give you insurance.

Don't know about cost yet. If a person can't pay, there'll be subsidies available.

Monique

[Lesley]

Monique, that's it exactly. So many people are going to get SOME coverage when they never had any before. SO many kids! No more

BTW - as a Medicare recipient I have already seen some benefits. I had to have all my check ups done. I used to have a copay, but not this year.

Also, do you work? If you are disabled by this disease (or any other) you get early medicare after 2 years. No more preexisting conditions.

[Deb]

I'm not sure how lucky I am to have my insurance. We were forced to go to a risk policy after DH had high cholesterol and I was a year into recovering from a torn ACL in my knee. Our premiums cost us over $14,000 per year. We each have a high deductible of $3,000 which results in us paying virtually all of our medical costs. Just with our annual visits we approach $20,000 each year and that's with no major medical issues. Granted, we have coverage in case of something catastrophic but it seems my costs are only going up and will continue to rise with these policies. I hope there is still some semblance of Medicare when we get there and we can get something affordable so we can hopefully retire some day. Deb

[desertrat]

Monique,

I was speaking to people who have existing policies, to be careful with their tests in the near future. There is so much confusion as to what the premiums/care/coverage will be available to the American public.
Have you talked to anyone with regards to getting covered?
Do you know what coverage will be available to you?
It is imperative that you get the help you need, what with those insane payments you have to make!

On a side note, I know several people in the medical field. My ex BIL was a major CIGNA bigwig before he retired last year. My niece is head of pulmonary at a major hospital in Phoenix, my cousin a Level 1 trauma nurse, my friend an ER doctor, and another friend who is head of finances at Baylor.

All are very concerned with the coming care. Many doctors are going to quit their practices rather than be under the new care system. Or they will go cash only.
I could tell horror tales, but won't.

I just think everyone who is going to be affected by the new care system had better know what it is all about, with regards to their own personal care.

Mandy

[Gloria]

We've been on Medicare for 1 year. I was surprised when Medicare didn't pay for DH's A1c test, explaining that it's not covered (he's a diabetic). Luckily, the negotiated price wasn't very high and I willingly paid the charge. DH's private insurance always paid for the A1c test.

The future for seniors on Medicare doesn't look good. Medicare is the first place they are looking to save money. I agree that some changes need to be made. However, there is a lot of fraud in Medicare and they should investigate that first. I saw the fraud firsthand when my mother was alive. She had short-term memory loss, but a psychiatrist was visiting her (and many other elderly residents in the nursing home) for 10 minutes a week and billing Medicare. My mother didn't receive any benefit from those visits, but the psychiatrist sure did. It was months before I got a statement from Medicare with the billing information. Once I realized what was happening, I called the doctor's office and told him not to visit her anymore. Unfortunately, Medicare had a time limit on reporting problems and the statements arrived way past the deadline.

Gloria