BBC's take on ObamaCare as it hits home...
OK, so the so called "ObamaCare" is now affecting me as my wife is out a job at this time, and we have undertaken self-paid BC/BS.. So I am actually afforded a timing which is allowing me to see both sides (at least this year vs. 2014)..
BTW - I noted on USA today yesterday that the Healthcare.gov is open for business and the site is supposed to be swamped.
So currently what I have found on the policy this year as completely transitioned to totally family incurred premium (with reference to current top available policy in AL). Here is the long and short as compared to the previous group plan through her EX company she worked for.
CURRENT PLAN (on our own)
Premium ='s about
500$$
Annual "DEDUCTIBLE"/"self insurance"/"participation" (these terms may have variance TECHNICALLY)-
OUT OF POCKET AS ANNUAL MIN FOR SERVICES NOT STANDARD, ROUTINE, OR ALLOWED OUTSIDE OF is
750$ and with $2250 (or three people involved family cap) pertaining.
Other Co-Pays ARE $MORE$ from previous
group plan..-:
Outpatient (one day) up to $250 per visit and 100% after, or $500/day for lower tier hospitals. ( this is up from group $100)
Inpatient is NOW $250 per day for first (5) days and 100% after.
with attention to in-patient. (this is UP from group $250/one time)
** the notable difference in these trips to the hospital is the service charges WITHIN, such as (Importantly - Surgery, anesthesia, and maternity falling prey to the 80/20% CO-PAY. And on top of this $750 annual deductible, and on top of the 250/day inpatient. So in short its really SHIT in comparison to my GROUP Plan earlier this year where I forked out 100$ for a hernia surgery in total. Under my current one I would have paid 250$ outpatient DED, ate the first 750$ of service incurred, and then would be subject to 20% of the remaining $4,500 (or whatever they all charged). This would amount to about $1,500.00 MY PART - I speculate pending analysis of any other hidden "stick it in my ass" hidden coverage caveats..
*** But if your looking for a policy to cover your family for IN CASE SHIT HAPPENS and with SOLID fair prescription coverage for dirt, its ok. Just understand you are "self-insuring" yourself and family to the tune of an ESTIMATED 1-10K (and higher for serious shit) depending. But better than left of the street corner with a script for some tabs and a pat on the shoulder. For the most part the plan is not bad for a $500 monthly premium and noting that only some of the more "unusual" conditions fall to an 80/20 situation.. You must also consider that the company she worked for only charged her about $350/month for her portion of the previous group coverage.
IT SHOULD BE NOTED that just because you work for a company with a "group plan" does not mean they are not going to make you eat a SHITPILE of the monthly gross premium POTENTIALLY as high as $1600-$2000/month( depending on how many "goodies" they have opted for in their "plan". Ever interviewed for a job advertising "benefits" only to have them tell you it will cost you $200.00/week out of your check if you want the Group plan?!? There ya go.
It should also be noted that the self paid plans like the one I currently have NOT ONLY do not include far out stuff like SLEEP related (sleep apnea), etc.. BUT YOU CAN NOT EVEN OPT TO PAY MORE FOR THE COVERAGE...
Positively a lot of routine doc trips are covered with no exotic co-pays or 80/20 stipulation. The per visit trip copay is up slightly higher now 35$ - reg doc/50$ - specialist; instead of flat 25$ per office visit. Prescription coverage is also afforded at slightly higher copays for "Brand" drugs, but the same old 10 bucks for generic. Notably they also flat out determine that some brands (such as Welbutrin) are just not covered period.
SO NOW OBAMA CARE is kicking in 2014 officially it seems. The 2014 similar policy was summed up on the phone to me today as premium GOING UP to $800.00/mnth (from $500/mnth), and the ANNUAL Out of pocket DED/Co-PAY going UP from 750 to $2000.00!!(per person), with the positive caveat that the family max is reached with ONLY two people (totalling 4K, vs the current 3 people sum of 2250.00. So family aggregate still goes up by 750 to 4K total, BUT AT LEAST THEY DID NOT LEAVE AT (3) People maxing which would have made it 6K..., The new policy apparently removing some of the 80/20 action as current, and perhaps giving back coverage like SLEEP related. But of course when the fucking Annual DED is higher than the sleep even and CPAP equipment put together.. So look like we only get CPAP equipment in the future after someone in the family has conveniently been hit by a buss, and we are in "Happy DED is MET land" for that year..[

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SO WHAT DOES OBAMA CARE APPEAR TO BE DOING TO ME???
It appears it is jacking my monthly premium UP 300 Bucks per month. It LOOKS like my annual OUT OF POCKET just went from $750.00
UP $1250.00 to 2K..!! NOT GOOD. Thats a major FUCKHOLE as the actuaries have analyzed and realized where the $$ goes out and KNOW its in the "small service arena". PSYCHOLOGICALLY, it convinces folks NOT TO EVEN SEEK and extensive DOC Recommended Treatment, cause they think it wont be enough CO$T to merit, Or more importantly they cant take a 2K DED, plus 250 COPAY, Plus any remaining 80/20 in place HIT. I COULD Bump back down to a 500$ premium but have SHIT coverage probably on scripts, and a MASSIVE 10K Annual OUt_of_Pocket... So in short, ObamaCare has fucked me into paying another $3600.00/year in premiums. I dont know if the 250 per day inpatient ded (up to fifth day) will remain...
WHAT ABOUT THIS SHIT "EVERYONE MUST HAVE COVERAGE"..??
This is where the .GOV website comes into play. Apparently there are massive government SUBSIDIES in place for low income families which will "Assist" with these premiums. Perhaps even pay ALL of the monthly premium for MANY poor folks. I Dont know if that will assist them with out of pockets and Co-Pays. I DOUBT it, which in short will leave a GAP OF OPPORTUNITY$$, and these folks which the govt is paying for will not fully utilize the plans. They will be tempted to see the doc, get the script, BUT NOT TAKE THE RECOMMENDED SURGERY - Or at least STILL not pay for it in the end.
So what has changed..?
We are already a socialist medical society UNSPOKEN. Its called get down to clinic a few times before they call u out on past bills not paid, or Go directly to ER, or Go to ER after that clinic you have not paid refuses service and an ambulance winds up picken yur poor ass up again... So WHAT HAS Changed, and what will be the result.
The change is going to be where the $$ changes hands (of course). The PLAYERS are; M.E. The GOVT, BC/BS (ins providers), Health Providers (docs & Hospitals), Corporate America, Politics, and BIG PHARMA. The latter which is going to be the MOST RESISTANT, but will be pressed due to capitalist MARKET.
(1) My Annual Deductible NOW at 2K will SUBSIDIZE the premium, assistance for the poor at the .GOV site. PERIOD. Anyone NOT working for a company on a GROUP PLAN will eat this in this manner.
(2) Corporate America will tend to DECREASE their negotiated Group Coverage with BC/BS, as it will cost them more. Now even if my wife goes back to work, she will more likely eat MORE out of her check every month for OUT PART of the premium which the company does not pay, and the coverage will be shittier. Corporate America will ALSO BEAR much of the PREMIUM$$ Subsidized to low income folks. ONE WAY OR THE OTHER - I suck it in the end. Corporate American AINT Gonna eat it and WILL pass it as shittier coverage Group plans and high monthly pass on to employees - PERIOD!
(3) BC/BS will play the "actuarial game" and see how this pans out. They will WATCH AND SEE how docs and medical establishments LEARN to work within the new system, and become stricter and more vigilant at observing claims and attempting to DETECT OPPORTUNITY... They will also Strong Arm Big PHarma, or attempt to. The fun Money Making Dance is getting down to a less Giggy song it seems.
(4) Health Providers DO NOT LIKE OBAMA CARE. Your doc will probably wind up being allowed even LESS than he already is for a service charge provided. This infringes with/on Corporate America somewhat. Which translates to FUTURE POLITICS (President, congress, senate), YOUR VOTE. Odds are the Govt will be offering the medical establishment more incentive for UNPAID treatment of those sliding by as "Current unspoken socialist already in place". But it wont last and will be squeezed on hard. The time to recoup will be more extensive as well - Speculated.
(5) BC as an involved party can only cover their ass and PROFIT via the STANDARD METHODs, and now minimizing payables on claims more effectively. DID YOU KNOW YOU DOC COULD GET HIS PRACTICE IN TROUBLE IF HE RUNS AROUND LIKE A RENEGADE ADVISING/RECOMMENDING/DIRECTING Service to YOU which is OUTSIDE the "unwritten" BC Protocol. Keep in mind there are other Ins carriers out there. BC just seeming to be the one with their hands the deepest in with all parties, and also seemingly MOST govt involved. But yes, if you and your doc think a test may prove something that could help you, you had better meet certain criteria - Or that PRACTICE may just get a NASTY LETTER from BC stating "Play right, or we Ain't gonna acknowledge YOUR PRACTICE as a Legitimate Vendor". Then your docs office can even process your claims. UT-OOOH...

:drooling: So the RULES ARE CHANGING. And TIGHTENING ULTIMATELY is the way medical establishment sees it.
(5) A Major Player in all this is of course - BIG PHARMA. They can sit back and take the democratic CAPITALIST Approach as - "We'll charge what the fuck we want for our shizzle. After all, we have research expense. I wont even delve into where the MARKETING EXPENSE is Justified to the extent it is currently. As far as I see it, BOTH Big Pharma as well as the Sam Adams Brewery should take a KICK IN THE ASS for the money they spend on ads. Sam Adams sacrafices its product integrity by not utilizing the QUALITY of INGREDIENTS and WORK EFFORT in change. Their BEER is NOT what you should get for the MONEY, market considered. What does this say about big Pharma's future. Sam has come down on Price$, but the beer is still run of the mill to false advertising IMHO. What will pharma do? I honestly dont know if Big Pharma gets their full ticket price at the pharmacy?!?!?! Does BC pay the entire balance of a 384$ bottle of brand wellbutrin after a 25$ co-pay per say. I would imagine this is negotiated from drug to drug. Im betting it is negotiated across the board, and thats where that "health insurance card" we all get in the mail to save money on scipts comes in. Perhaps thats the way to get the price BC has negotiated. DO PHARMACIES REALLY STICK IT IN UNINSURED ASS TO THE FULL TUNE??? And whenever they can??


Most likely its CORPORATE PHARMACY POLICY INTERNAL and varies from CVS, to WALGREENS, to the Corner Compounder.
Will the small mom and pop compounding Pharmacy re-populate the map from all this?? And out of the kindness of their hearts as Concern for the common folk getting a fair price??
THE TRUTH is we are ALREADY SOCIALIST as UNSAID/UNWRITTEN. The money is just not going where they want it to precisely. The issue is the devils out there PROFIT TAKING where
THEY PUSHED IT TOO FAR.
THIS IS ALL OF YOU/ THE ABOVE. So its a SHAKEUP/Shakedown is all..
But will street corner vendors pop up selling CPAPS at the 7Eleven? Used or black market poor shit? Are "wellness docs" going to take off as "Fair Charging" independent service providers now finding LOOPHOLES in potential patient related LIAbILITY pertaining to IN$urance/Malpractice. Will the market stand this "Leveling of the playing field". Do they really want docs to take less $alary after all their hard work in school, and more importantly dealing with the SHIT and STRESS the have to undergo watching folks Die, CRY, and Disfigure themselves against their advise to push away from the table.? Fuck, you don't want to even know what that TAX BRACKET is doing to their ASSHOLES anyway. THEY ARE ALREADY PAYING FOR THE Quasi-Socialist Market currently in place via their fucking TAX PAYMENTS..!!!!!! I could see where docs would want to live in Texas or FL with no State income tax to boot.
Welcome to the BEGINNING of the END of the Second Roman Times...
RANT OUT...