[bearishgurl]

[quote=scaredyclassic]From the regular internist docs point of view, chasing down $ from insurance companies is more of a bureaucratic nightmare than I think even the most cynical among u can imagine[/quote]scaredy, I can imagine it because I have heard this from my providers, also. It’s especially hard for them now to know who to use for ancillary services such as lab and x-ray for each and every one of their patients. They’ve got to have competent people on staff who keep up with all these carrier nuances on where to send a particular patient (OR, in the absence of the patient, their “specimen”) to the “right” lab and the “right” radiology group. If they don’t (especially in the case of a patient specimen), the patient will get a “surprise” out-of-network bill that could be up to 10x the normal PPO reimbursement rate. If the patient has to report in person (in the case of a blood drawing or x-ray referral, for example) to the ancillary service, they can be stopped at the counter and told that that office no longer accepts their plan and then call their doctor and ask for a referral to a lab/radiology group which does accept their plan (a hassle but at least the patient won’t be gouged after the fact). But if their specimen is sent to a lab that their provider has always used (and the patient’s carrier has always covered in the past) and their carrier ends up rejecting the claim because they recently narrowed their network, (common these days) the huge OON bill is on the patient.

This actually happened to me last fall because one of my longtime doctors had shut down their practice a couple of days after my visit and was short-staffed in the days and weeks following (closing down the billing/books) and my “specimen” got shuttled to the lab it always went to before. However, my marketplace plan carrier had narrowed its network even further in 2015 and rejected the claim, leaving me with a $173 bill in which they paid $19 (and my pre-ACA carrier paid $34) for the same service in several past visits to the same provider (0 copay for me). On a small scale like this, I was able to negotiate a balance billing with the lab, which, if paid by a certain date, would not go on my credit report. It still cost me $125, which is nearly 4x the amount it should have cost. On a larger scale, this provider mistake could have been for lab work for a hugely expensive endoscopic ultrasound specimen which was sent “stat” to a lab while the patient was still anesthetized. What kind of OON bill would the patient be left with in this (common) scenario? The patient has no control over these provider back office mistakes and they sour the patient to ever using the provider again, because it cost them so much out-of-pocket unnecessarily, all due to their provider’s staff not paying attention to detail for each and every patient.

see: http://kff.org/private-insurance/issue-brief/surprise-medical-bills/

It didn’t used to be like this when the 6-8 major carriers’ PPOs were functioning side by side in SD. They ALL paid for ALL the major Radiology groups and labs in town. I do believe it is harder to run a medical office efficiently now due to the fickle carriers who lower their networks mid-year and eliminate providers without deleting them from their online provider lists and without sending member medical offices any notice that they have done so.

My marketplace PPO carrier reimbursements have also gone to sh!t in the past 12-18 months. My internist rec’d just $58.93 (0 copay) for my “intermediate established pt appt” (of 20-25 mins) last year but in years past, he rec’d $168 (0 copay) for the same type of appt, acc to my EOB’s. A sole practitioner, he has 2-3 FT front office personnel and 2 FT back office personnel in a leased office in a mid-rise bldg situated in a very convenient (and expensive) Hillcrest (SD) location.

How is an established and even renowned local provider with multiple hospital privileges going to survive on these tiny reimbursements? They would have to see 2-3 patients at once all day every day and run from room to room, while their support staff (and magazines) keep their patients (in dressing gowns) occupied while they wait for the doc to come back in from another patient’s room. It’s just crazy. I can completely understand why so few providers are willing to see Medi-Cal patients but the marketplace PPO reimbursements are now getting so low that I’m wondering what the actual current HMO and Medi-Cal reimbursements are for the same service :=0

And we’re not even taking into account how much (required) malpractice insurance costs these providers (varies wildly by specialty). The presence of the ACA has really screwed the providers in favor of paying the multi-layered bureaucracy to constantly mind everyone’s personal financial business who signed up for a plan (or Medi-Cal) on the federal and state exchanges.

Back to the STEM issue, I’m not sure if it’s worth incurring the crushing student debt to become an MD today. If one can go thru what it takes to become an MD without any student loans, then maybe it is worth it. But don’t expect to make what your predecessors (in your specialty) may have made in the past. A new MD has to love what they are doing and feel they are making a difference in their niche in society because I feel going forward that the “psychic rewards” (whatever they may be) are going to outnumber the monetary rewards of practicing medicine.

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]
This figure has to be at least 5% higher today.[/quote]

Because of your made up facts? You have absolutely no evidence of that. Nobody has been forced into Medicaid plans unless they wanted subsidies. If you have newer data, please share it. Your observations that you see lots of Mexicans crossing the border isn’t really evidence.[/quote]The vast majority of people who sign up for coverage on the exchanges DO take a subsidy. Why would anyone go thru all those layers of BS just to have a healthplan if they weren’t going to get a subsidy?

As has been mentioned here, there are always the carrier websites themselves as well as online health insurance agents such a ehealthinsurance.com, where one can buy insurance during the fall open enrollments periods without entering their income details and having to constantly “prove” their income to keep their coverage. Why give the gubment all that access to your personal business if you can’t qualify for a subsidy?

SK, why don’t you leave “border crossing” and your other racist comments out of this discussion? The “border crossing” situation will either get fixed …. or it won’t, but we won’t know until after “We, the People” have spoken. They’re going to be speaking loud and clear in your border state (AZ) as well, so stay tuned.

[bearishgurl]

[quote=ucodegen][quote=bearishgurl]
Had you even bothered to read any of the links I carefully referenced for your information in the following thread OR the CA agent-facilitator-in-the-trenches blogs they came from, you would have known this.

http://piggington.com/ot_predictions_2016_presidential_election?page=3
[/quote]

I would suggest not using the ‘page number’ links, they don’t always end up at the same location. If you ‘hover’ over the title to your post, you will notice a link popping up. That would be better to copy-paste (has comment number in it).

Your ref to links did not show your post in my ‘view’ of the thread. Did you mean this one?
http://piggington.com/ot_predictions_2016_presidential_election#comment-264482

Or maybe this one?

http://piggington.com/ot_predictions_2016_presidential_election#comment-264580
[/quote]Well, uco, there were two posts by me with relevant ACA links (as it applies to CA) on that thread but the one I brought to SK’s attention was on page 4 or 17, depending on how the reader has his/her Pigg site set up. Hope that helps.

When I did “hover” over the title to my post on that thread and click it, it gave me the link of page 1 only (or the latest page, as you posted here).

[bearishgurl]

[quote=flu][quote=harvey][quote=flu]I really don’t understand why you have an axe to grind with HLS. [/quote]

You’re the one turning it into drama.

I’m just poking fun at his ethics, and his fanboy’s inability to see past their rationalizations.

A simple rule of thumb to apply when asking if behavior is ethical: Ask yourself, if everybody did the same thing, what would happen?

What if every mortgage broker in SD were on this site peddling their services and disparaging anybody who questioned their gimmicks?

This site better is better than many others because it is not just a cheap marketing venue.[/quote]

What ethics issue? First it’s not your website. Second, if HLS was a problem he would have been banned a long time ago. I don’t get it. Find one thread that he started that solicited business. If he ever said “if you ever want to talk about mortgages, feel free to contact me”, it was because someone asked. What’s wrong with that? Certainly better than listening to the start of a floating advice here about how an option ARM these days is better than a fixed rate mortgage (not that it’s from you)

How’s that different than any of the former realtors that were here? Most things are by reference, and referrals. Just like any other service business on other blogs.

Apparently, you’re seeing something that most of us aren’t. I guess the world is flat.[/quote]flu, you’ve (arrogantly) managed to again twist my words to suit yourself. The purpose of my posts re: Option ARMS on this thread was to “educate” the ignorant (not that that was you, lol) in the difference between a Prime/Alt A Option Arm offered from ~1982 to ~2002 and the Subprime exotic no-income, no-asset (NINA) adjustable mortgage with regular interest rate resets, frequently I/O and with usurious up-front points and other usurious terms attached to it that we are all familiar with from the fog-a-mirror-get-a-loan, era. This type of (subprime) “Option ARM” (frequently not following any specific index closely) was primarily offered between 2004 thru 2007.

There IS a distinction between the two, vastly different, “Option ARMs,” (if one is intelligent enough to compare).

I fully realize that you may be too young to be familiar with the former, but it DID exist. And that is but just one choice (of many today) which has been taken away from prospective prime mortgage borrowers.

I never stated here that Option ARMs were “better” than fixed-rate mortgages. It depends on the borrower and their personal situation.

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]You don’t have to be insulting, SK. I didn’t see you post any links here to your “anecdotal `evidence.'”[/quote]

Health Insurance Coverage of Children 0-18

It wasn’t anecdotal. If it was anecdotal, I’d be you. I’m not. As of the latest year available, 41% of children 0-18 were on Medicaid and other public insurance. More than 50% are covered by private insurance.

You’re right. I don’t have to be insulting. And you don’t have to be a bigoted racist. So it goes.[/quote]Um, SK, your link was from 2014. Not sure if it was referencing the beginning or the end of 2014 but that was the year (1/1/14) when the ACA was first “put into practice.” Let’s see here ….

Your link says: 47% Employer-provided; 5% Non Group (exchange plan?); 39% Medicaid; 2% Other Public (if Tricare, that figure seems low to me); and 6% uninsured. That totals 99% of all children … close enough. You apparently haven’t been paying attention! Children have been dropped from parents’ “exchange-purchased marketplace plans” in droves by the state and federal exchanges and state Medicaid agencies and involuntarily placed into Medicaid/Medi-cal after the Medicaid family income threshold went up last spring (2015)! A large percentage of them were dropped with no notice whatsoever to the parents, who had been paying their premiums in the “family premium” they were paying to their marketplace carrier every month.

Had you even bothered to read any of the links I carefully referenced for your information in the following thread OR the CA agent-facilitator-in-the-trenches blogs they came from, you would have known this.

http://piggington.com/ot_predictions_2016_presidential_election?page=3

If you want more links (than these 10 you obviously didn’t read) re: the CA Medi-Cal forced-placement debacle, I’ve got more I can now provide you).

I won’t even acknowledge your other nasty, arrogant comments as you have absolutely no idea of my race and/or nationality nor that of my family or friends. You’re being insulting and clearly making stuff up, here.

41% of children on Medicaid PLUS 2% gubment-insured children PLUS a presumed 6% uninsured children in the US is 49% of ALL children and THAT is a HUGE percent of our country’s children in which US health providers got sub-par (or zero) reimbursements for in 2014 (or part of 2014).

This figure has to be at least 5% higher today.

[bearishgurl]

[quote=FlyerInHi]There is a national apartment boom now.[/quote]That sounds like a “less-than-optimal lifestyle” for a millenial to begin raising a family in who has 2+ kids who are already walking.

Whatever floats their boat.

[bearishgurl]

You don’t have to be insulting, SK. I didn’t see you post any links here to your “anecdotal `evidence.'”

[bearishgurl]

[quote=SK in CV][quote=SK in CV][quote=bearishgurl]”We, the People” are now burdened with a healthcare industry which is a burgeoning behemoth of layers upon layers of additional bureaucracy with LESS providers to choose from than before the ACA! [/quote]

I’m pretty sure you mean “fewer” not less. Any evidence to support this claim? Or is it more of your spewed out of your ass bullshit?[/quote]

Nevermind. I found the answer myself. It’s more made up bullshit. The US has been adding over 12,000 net additional doctors each year in recent years.[/quote]Please tell some of them to move to SD. I’m going to have to search for a replacement doctor by mid-August. The ones who were referred to me by my doctor who closed their office don’t accept my plan … and I have a marketplace “PPO.” The only other marketplace PPO in Region 19 (SD) is UHP, who just came in on 1/1/16 and has already announced they will be leaving by the end of 2016 because offering plans to “we the people” in CA is not “financially feasible” for them.

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]”We, the People” are now burdened with a healthcare industry which is a burgeoning behemoth of layers upon layers of additional bureaucracy with LESS providers to choose from than before the ACA! [/quote]

I’m pretty sure you mean “fewer” not less. Any evidence to support this claim? Or is it more of your spewed out of your ass bullshit?[/quote]Yes, “fewer” is what I meant. For starters, I personally have lost three (out of eight) of my longtime providers since fall of ’14. They had ALL practiced in SD for a minimum of 40 years, owned their own medical buildings and just got fed up with the low reimbursements which weren’t enough to keep their staffs employed. All three of their goodbye/referral letters to their patients indicated that their difficult decision had been made due to the effects of the ACA.

Two of them are still freelancing as “expert wits” in court but closed down their medical practices. One closed down his practice and fully retired.

Granted, two of these providers were specialists whom I didn’t see that often.

For a data point, I am just ONE person and, after getting these letters, I personally compared their reimbursements from the EOB’s of my marketplace plan against their reimbursements from the EOB’s of my pre-ACA carrier (Aetna), and the differences were stark. I posted that info awhile back on this forum.

[bearishgurl]

[quote=FlyerInHi]BG, don’t bitch about millennials. They were enabled by their parents. So there is responsibility all around.

I kinda like their happy go lucky attitudes.

The facts are we need to find a solution to keep consumers spending, and buying houses. Our economy depends on it.

Otherwise, the future is Japan where economic stagnation is eroding standard of living. Young people don’t really care, so they don’t work, produce and consume as much as their parents.

BTW, that’s why we need immigrants. Legalizing the immigrants already here would be awesome for the economy.[/quote]Actually, FIH, young people consume more than their parents did when they were their age as well as now. That is … they consume far more in consumer goods. If young people “don’t really care” and “don’t work as much (as their parents did/do),” as you say, then they shouldn’t be bitching as to why they can’t qualify to buy a home …. whether indebted with students loan(s) … or not.

[bearishgurl]

[quote=spdrun]At least this isn’t being offered to the average millennial Twitter-twit so not too many millennials will get uppity. A good millennial is one that’s happily renting away.

If people aren’t buying houses: BUILD FEWER HOUSES. Rednecks in the ticky-tacky box-building industry aren’t owed a job, last I checked.[/quote]Exactly, spdrun. Thank you.

[bearishgurl]

[quote=SK in CV]No. I didn’t forget to mention it. It isn’t the least bit pertinent to anything I was discussing.[/quote]Well it kind of is because medical workers (namely front-line health providers such as physicians, PA’s and NP’s) now have lower reimbursements from a portion of their longtime patients’ carriers because they were forced onto the state exchanges beginning 1/1/14.

[bearishgurl]

[quote=FlyerInHi]I don’t know… Vegas was ground zero for the housing crisis. It is said that there are still 30,000 houses in limbo.. but there are still building away and prices are increasing. prices have easily doubled since the bottom.

Resale prices are flat, but new homes sales are up, and tickytack houses are being built everywhere. if I remember, 7000 new construction were sold last year. Normal should be about 15,000 and peak was 35,000, iirc.[/quote]So, in the light of the fact that new “ticky-tack” homes currently on the market are suppressing buyer interest in resales (the kind of homes YOU buy there), are you still in favor of rampant gross over-building, FIH?

After all, if this continues further and further out into the moon-cratered landscape which is Clark County, NV, the urban properties which you already purchased for a song and spent your own hard-earned money and labor rehabbing may not end up to be worth more (or much more) than you paid for them :=0

Aren’t there any growth controls at all in Clark County or LV and suburbs?

[bearishgurl]

Yeah, scaredy, I LOVE small towns! Your spouse’s job offer is a LOT of $$ to work in a small town!

There are several towns of 800 to 2000 population which I would have LOVED to retire to but the nearest hospital is 23-35 miles away (on icy roads 9+ months per year). The nearest trauma center is 90-100 miles away (road closed to/from it intermittently due to weather, avalanche) and the nearest (major) trauma center with a helicopter landing strip is 350+ miles away.

Even the town with the hospital (16K pop) can’t keep providers there for any length of time. Providers do tend to stay a little longer in the town with the trauma center (20-23K pop, incl surrounding areas).

Believe it or not, those (under 2K pop) towns are mostly inhabited by the over-55 set and all they have is ONE working dentist, ONE (retired) doctor and a (paid and volunteer) search and rescue team to share between them.

I’ve posted here before that if one decides to retire to a bucolic place like these small towns, they have to accept that they have decided to live out the rest of their lives in “God’s country,” and if something should happen to them where competent medical personnel couldn’t get to them in time, well … they died living the life they wanted to lead. I think that’s the mindset of the permanent retirees in those towns.

[bearishgurl]

Why do Peds get paid so much? Most kids in the US are on Medicaid/Medi-Cal (even if their parents have private insurance).

Is it because so many Peds have retired??

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