Chronic Pain Support Group
Physicians and professionalsdefine pain as chronic if it lasts longer than three to six months and is persistent. It's distinct from acute pain that is a direct result of injury or trauma. This support group is dedicated to those suffering from chronic pain. Discuss treatments that have worked for you, find advice for your specific experience, and find support. You're not...
For 2016 ObamaCare insurance providers have decided to basically remove the Houston area (Houston and surrounding counties) from any decent, or affordable, health insurance in the Individual Market Place (IMP). Last summer BCBS of Texas fired the first public warning shot saying that they were going to lose $400M in the Houston area with their IMP Plans. They added that they would have to make changes, but provided no details.
Well, now that the 2016 enrollment period has opened for the IMP Plans, we now have the answer. BCBS of TX, along with all other providers (about 5 or 6), have eliminated all PPO Plans and now only offer small, highly restricted, and expensive, HMO Plans.
I will use me as an example of what is happening. First, I am only in the IMP because my former employer saw ObamaCare as a get out of responsibility exit ramp, and terminated their long promised pre-65 retirement health insurance plan (that was similar to their regular employee plan). Since I was lucky enough to be able to retire early, I have counted on this long promised insurance. Well, they ended their Plan a year ago, so I had to find insurance in the IMP. For 2015, I found a good, but expensive ($836/month), Sliver PPO Plan from BCBS of TX. With this Plan I was able to keep all my doctors and it has worked fine.
For 2016, the apple cart has been turned upside down. As mentioned all insurance companies dropped their PPO Plans, and now only offer HMO Plans, all with NO OUT of NETWORK coverage, zip, nada. That sounds bad, but it is even worse than it may first appear (see hospitals).
After reviewing what little was available, I had to make a decision on which doctors I no longer wanted. No Plan offered all my doctors, and after reviewing all the networks, I either had to throw my PCP under the bus and keep some of my specialists, or keep my PCP and lose all my specialists. I decided to dump my PCP and hope that I can find a new HMO PCP that will refer me back to my specialists that I have been seeing for years. What a deal!
In addition to removing the great majority of doctors from all the networks, they also eliminated a huge number of hospitals, and other medical facilities of all types, and I am now limited to two walk-in pharmacies (CVS & Walmart/Sams).
It gets worse: As many of you probably know, Houston is home to the world famous Texas Medical Center (TMC). The TMC is the world largest medical center with 21 hospitals (including the most famous; The MD Anderson Cancer Center), and has over 100,000 employees. The TMC is as large as the downtown business centers in many large cities. It is unbelievable just to drive through.
I will let you guess which hospitals have been removed from all Plans. You're right, the entire TMC has been eliminated, along with their satellite hospitals in the suburbs. Therefore, even though I live about 25 miles from the TMC, I will not have the coverage to be able to set foot in any of them (remember, no out of network coverage). So, it is very likely that many of you folks that live all over the world will have a better chance to access these hospitals than I will in 2016.
That is my story, but do not forget that this covers anyone applying for insurance through the IMP or directly with the insurance companies. My Gold Humana HMO Plan (there are no Platinum Plans offered by anyone) will cost me $1,039 per month with a $2,500 deductible. Even if a person has a subsidized plan, the final costs for any of the Plans will still be too high for most.
My wife is a member of a Facebook support group for her major medical problem called CIDP. One of the members in Tennessee, I believe, said that her insurance was going through the roof and was so expensive that she did not know what she was going to do. She added the Obama is the anti-Christ for what he has done to the majority of the country. I would add Harry Reid and Nancy Pelosi.
One more thing about me; I turn 65 in September, so I get to start the whole process all over again with Medicare this coming summer. Will I keep my new PCP, or change back to the one I have had for 10 years???? All my doctors take Medicare, except one; at least for now.
Well, now that the 2016 enrollment period has opened for the IMP Plans, we now have the answer. BCBS of TX, along with all other providers (about 5 or 6), have eliminated all PPO Plans and now only offer small, highly restricted, and expensive, HMO Plans.
I will use me as an example of what is happening. First, I am only in the IMP because my former employer saw ObamaCare as a get out of responsibility exit ramp, and terminated their long promised pre-65 retirement health insurance plan (that was similar to their regular employee plan). Since I was lucky enough to be able to retire early, I have counted on this long promised insurance. Well, they ended their Plan a year ago, so I had to find insurance in the IMP. For 2015, I found a good, but expensive ($836/month), Sliver PPO Plan from BCBS of TX. With this Plan I was able to keep all my doctors and it has worked fine.
For 2016, the apple cart has been turned upside down. As mentioned all insurance companies dropped their PPO Plans, and now only offer HMO Plans, all with NO OUT of NETWORK coverage, zip, nada. That sounds bad, but it is even worse than it may first appear (see hospitals).
After reviewing what little was available, I had to make a decision on which doctors I no longer wanted. No Plan offered all my doctors, and after reviewing all the networks, I either had to throw my PCP under the bus and keep some of my specialists, or keep my PCP and lose all my specialists. I decided to dump my PCP and hope that I can find a new HMO PCP that will refer me back to my specialists that I have been seeing for years. What a deal!
In addition to removing the great majority of doctors from all the networks, they also eliminated a huge number of hospitals, and other medical facilities of all types, and I am now limited to two walk-in pharmacies (CVS & Walmart/Sams).
It gets worse: As many of you probably know, Houston is home to the world famous Texas Medical Center (TMC). The TMC is the world largest medical center with 21 hospitals (including the most famous; The MD Anderson Cancer Center), and has over 100,000 employees. The TMC is as large as the downtown business centers in many large cities. It is unbelievable just to drive through.
I will let you guess which hospitals have been removed from all Plans. You're right, the entire TMC has been eliminated, along with their satellite hospitals in the suburbs. Therefore, even though I live about 25 miles from the TMC, I will not have the coverage to be able to set foot in any of them (remember, no out of network coverage). So, it is very likely that many of you folks that live all over the world will have a better chance to access these hospitals than I will in 2016.
That is my story, but do not forget that this covers anyone applying for insurance through the IMP or directly with the insurance companies. My Gold Humana HMO Plan (there are no Platinum Plans offered by anyone) will cost me $1,039 per month with a $2,500 deductible. Even if a person has a subsidized plan, the final costs for any of the Plans will still be too high for most.
My wife is a member of a Facebook support group for her major medical problem called CIDP. One of the members in Tennessee, I believe, said that her insurance was going through the roof and was so expensive that she did not know what she was going to do. She added the Obama is the anti-Christ for what he has done to the majority of the country. I would add Harry Reid and Nancy Pelosi.
One more thing about me; I turn 65 in September, so I get to start the whole process all over again with Medicare this coming summer. Will I keep my new PCP, or change back to the one I have had for 10 years???? All my doctors take Medicare, except one; at least for now.
Some States have not advertised the places where you can go for sign-up help anyone who needs it, https://localhelp.healthcare.gov you just enter your zip code and check.
Hope you can make it through until your Medicare kicks in!
Louisiana just elected a new governor a little over a week ago. One of the things he ran on was expanding Medicaid. The day after he was elected, he said he wasn't positive if Louisiana could do it because he wasn't sure if Louisiana had the 10% needed to put up.
Not many private providers in Louisiana will accept Medicaid and I don't see that changing. When you look at the list of providers from the managed care organizations it looks like the majority of drs take Medicaid Only, which is not correct. The reason is because the state Medicaid database doesn't distinguish between providers that accept Medicaid Only and Medicaid with Medicare Only. Many people on Louisiana Medicaid now can't find a provider that will give them decent care. It's going to be a nightmare if/when Medicaid is expanded here and a lot of upset people when they realize the quality of care, or lack of, that they will have.
I've already had two people call me and ask me what pain management drs will accept Medicaid. Louisiana Medicaid won't pay for the management of chronic pain, so no pain management drs will take it. But that hasn't stopped Medicaid PCP's from telling patients that they need pain management.
Thank you, but I do not have a need for any specific help, mainly concerned what I would do if I got seriously ill the next few months. I am more concerned with all the other people in the Houston area that are in big trouble. The Houston Chroncial newspaper just yesterday had a front page story on the thousands of people who are losing care in Houston's big hospitals. BCBS of TX alone has dropped 88,000 members. The article was centered around several specific individuals, and one couple, that were going to lose their cancer treatment since MD Anderson Cancer Center was very intentionally dropped from all Market Place Plans. Very sad for many people who will likely not survive this mess.
there's nothing to be done for a lot of people.
I am just looking at my options for 2016, determined not to waste money like I did with United Healthcare for 2015 ( at least they have admitted they are only in it for massive profits! how surprising... )
But frankly I don't know how a lot of people even get to sign up if they don't have Internet/ computers...
No wonder US medicine is bottom of the developed world.
The basic info is there- monthly premium cost, copay amount for each service used, maximum yearly out of pocket then more detailed links to what is excluded or limited in the policy, drugs and pharmacies available, doctors and hospitals you can use.
I believe from 2016 the law says the insurance companies must keep these lists up to date which will be very useful to the consumer.
It's taken me @ 15 hours so far to read @ 12 of the 50 policies on offer in my zip code, so far none offer real insurance in terms of covering me for accidents and emergencies properly- there are limitations and prohibitive expenses on everything I read so far.
I chose to keep my Internet connection to complete the process since it's so time-consuming and important.
There is a library next door but I could not sit in there comfortably for hours at a time.application on the telephone or at a help vente
One reason I'm not doing my application via kindle!
To actually USE the health insurance-
* make sure all premium payments are up to date; I always pay my bills when they come in but I was surprised twice this year to find my checks were cashed but not 'applied to account' which is the only reason the insurance co can cancel your insurance...and drs won't take the insurance if it is delinquent...even if it's not really. They rely on insurance co info.
Two premium payments are required up front to start the account on healthcare.gov
I used a credit card I don't use much and kept an eye for spurious charges after.
* Most accounts require pcp gp dr referral for specialists. I had to nudge mine as she was convinced it was like it used to be, they will send for a backdated referral if needed.
Nope.
If you do not follow the procedure exactly the insurance co can refuse the claim.
I even got a letter from United Healthcare saying self-referral was ok and the one time I did they refused the claim!
All this has been forwarded to state dept but they seem to do what they like...even though people know that United Healthcare CEO was prevaricating if not lying when he blamed 500 000 sign-ups for a $4.25 million profit shortfall ( on $130 billion profit ) then refused to provide ANY actual numbers to back up his claim....very little said in mainstream media except 'largest insurer pulls out of Obamacare'.
* double check the specialist is in network. If it's a procedure requiring hospital check that the specialist's hospital's are in-network. Try to get 'proof' in writing from insurance co. Print it out if it's one of those time-limited email servers.
I will be recording calls to health insurance company in future.
* There are situations where hospitals employ drs and specialists who don't take insurance and in an emergency you have no say or choice to be in-network. The PPACA law is supposed to cover this but the insurance co or doctor will still try to bill the uncovered amount. Don't pay- complain, then submit to state dept of insurance, then ( thanks to whoever told me this ) federal complaint. Complain sooner rather than later is what I will do in future, then I won't get so stressed as to be worn down into just paying.
* it's annoying but keep everything the insurance co or dr sends. Get copies of all test results in case insurance suddenly changes and so you don't have to start tests over.
* I tell my drs right away- I have poor insurance, can someone check this is covered, how much will it cost etc. If the insurance won't pay the bill will be two or three times as much in my experience for trying to put it through insurance rather than pay cash up front.
* a lot of services supposedly 'included' or 'compulsary' with the policies that doesn't mean they are free, check small print. My friend for example was recommended colonoscopy which is supposedly 'covered' in her plan, basically that meant it was 'available' but she paid full price until she met the maximum out-of-pocket on the policy ( $7000 ) That was nearly $700.
* when the bills come in later they are often undecipherable. Expect that and don't be afraid to call providers and ask for an explanation- they might be wrong.
As far as blaming Obama for the state of American Healthcare, Tikka, you must understand that the problem with insurance companies and the cost of healthcare started way before Obama. This problem is multilayered and what wet are dealing with today is a direct result of mismanaged healthcare system. No other president has ever done anything about it and this is the explosive manifestation of something that was coming for decades. People have been abusing the insurance model and getting tremendous profits off of it.
What all of us here desire is socialized medicine where you are free to have all the care you need with little struggle. It I NOT going to happen in a capitalist society. There is no magic fix.
Many good changes have happened lately. This is a transition period and it is very very hard. It will eventually get better, but unfortunately we are sick now and want changes now.
If we get a president who is best friends with the 1%, I guarantee you that we will be screwed . If you think this is bad now, it is going to get even worse because The type of president I am talking about is NOT going to advocate for universal health care because it is not profitable.
its something I have written before, I worry that instead of fixing the gap for the 1-2% a republican govt will simply dismantle medicare and Medicaid...and make the gap wider yet again.
I do think that there is an opportunity here for americans to INSIST on coverage, and demand it from their politicians.
They won't get that from Trump etc though. The lack of compassion of some of these elderly men is spectacular.
Obama...I was very disappointed. Before he was elected he said stuff like 'the buck stops here' ( I thought he meant with him ) and 'we must make sure our own moral compass faces the right direction'....
When the healthcare.gov website unrolled it was appalling really for all the money spent. I expected Sibelius to resign immediately and truthfully I would have had way more respect for Obama if he'd stood down too or at least apologized, not strutted around as though this was amazing!
I don't even know what people mean by 'socialized medicine'...there are no poor doctors anywhere....all the drugs and technological innovations come from private enterprise in any country.
It's just other countries pay taxes so their citizens don't collapse financially when they get sick or have an accident, and any organization which tries to cream off immoral profiteering from those disadvantaged is questioned if not disallowed.
Universal healthcare IS profitable, it's just not AS PROFITABLE.
When CEOs like Stephen Hemsley can spout the kind of crap he did last week and people are shaken...with no recourse to the facts...that's what worries me.
I love America, we are such capable people, but we are being blindsided in this.
You were guaranteed to go anywhere you wanted for treatment. FREE. No copays. You paid for your own drugs but the medications were cheap. Equivalent of 2-3$ a pack for your basic meds.
If you wanted to see someone special you had a choice to see a private physician and pay out of pocket. The physician would make a deal with you depending what you could afford.
Pay utilities. Education and childcare were also free.
All you had to do was go to work and make money for food and clothing
Some of the major problems with out current healthcare system is the fact that we simply do not have enough hospitals or doctors to treat everyone. With all of the new people on healthcare who never had access to it before, there aren't enough doctors to cover all of the patients. I might be wrong, but this is what I have seen. Also, we provide healthcare to many non-citizens who do not contribute to the system. This is really breaking the system. Then you have the ridiculous amount of money that hospitals charge for their services. Who charges 500 dollars for an aspirin etc.
What needs to be done is the younger more healthy people need to be placed on catastrophic healthcare plans for low cost, and then pay cash for preventative healthcare. Then those of us who are really sick need to be placed in a different pool that can be subsidized by the government. I went from age 18 to 35 never needing a doctor or an emergency room visit. All I really needed before I got sick was a catastrophic policy. The biggest problem we have is people not even having catastrophic policies and then getting sick and bombarding the ER like I did (I am guilty of this) and then skipping out on the bill. I didn't skip out on the bill because my county had a program in place for people do not have health insurance. If not for that program, I would have been paying on a fifty thousand dollar hospital bill for the rest of my life Some college kids don't even have student loans that are as high as fifty thousand dollars. I am guilty of having the money to buy healthcare (I used to have it in 2005) for 200 a month on a great PPO plan. I chose not to have insurance and the tax payer/hospital had to bail me out when I had an emergency.
There are a lot of individuals out there who spend hundreds of dollars a month on cigarettes and alcohol, but they do not purchase and maintain health insurance. Like I said, I was guilty of this and so are a lot of others. That is another reason why the cost of healthcare has gone up over the years. I would also support a two tier system where low income people are on universal healthcare and people with government jobs and people with high incomes can be on a private healthcare network. They already have such a system in Great Britain. The only positive things that I've seen from the implementation of the PPACA is that Medicaid has been expanded in some states, and that insurance companies can no longer deny coverage to those of us who have pre-existing conditions. Beyond that it has been a mess. I hope I didn't step on any toes here! Hugs.
This is outrageous.