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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: X Post: Family Medical Insurance
Posted by BargainMama
Posted by SecretlyTTC14
Posted by jessnbrian
Posted by blue11
Posted by alli3131
Posted by CunningOne
We have Empire BCBS through ACA (obamacare) and I don't care what anyone says, it's not affordable. We have a low level plan (minimal coverage) and we still pay $1100 a month for family coverage. Yet, that was still cheaper than the $800/week plan DH's employer was offering.
Anyway, I didn't have any issues with doctors. We researched the plan before getting it and all our doctors are in it.
The trouble we are having is hospitals. None of the major 3 that we would consider using take it. The one we would use that takes it is a considerable distance should we need it for anything. And all our doctors happen to be affiliated with hospitals that don't take the insurance (Winthrop and St. Francis).
Should it be an emergency they will take any insurance.
Yes if you present in the emergency room you must be treated. They can tell by the type of empire plan that its the exchange.
They have to treat you, but the insurance doesn't have to pay.....
This exactly. I have no out-of-network coverage with my plan so even though any hospital has to treat me... I will get stuck with the bill for it. The closest hospital that is in-network is 25 miles away from my home.
I was told by two different hospitals and my insurance company, that they HAVE to take insurance payment in the event of an emergency. This was also noted recently in the news.
And I'm not sure of the other plans, but Fidelis notates Bronze, Silver and Gold right on the card. Many providers take the medicaid/medicare version of the insurances, but not the exchange version.
JUST because they have to accept the payment from the insurance doesn't mean that (a) your insurance will pay, or (b) that there won't be a balance due. TRUST me , this is what I do for a living, have been doing it for over 10 years.
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Posted 5/6/14 12:03 PM  |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
|
Re: X Post: Family Medical Insurance
Posted by SecretlyTTC14
Posted by BargainMama
Posted by SecretlyTTC14
Posted by jessnbrian
Posted by blue11
Posted by alli3131
Posted by CunningOne
We have Empire BCBS through ACA (obamacare) and I don't care what anyone says, it's not affordable. We have a low level plan (minimal coverage) and we still pay $1100 a month for family coverage. Yet, that was still cheaper than the $800/week plan DH's employer was offering.
Anyway, I didn't have any issues with doctors. We researched the plan before getting it and all our doctors are in it.
The trouble we are having is hospitals. None of the major 3 that we would consider using take it. The one we would use that takes it is a considerable distance should we need it for anything. And all our doctors happen to be affiliated with hospitals that don't take the insurance (Winthrop and St. Francis).
Should it be an emergency they will take any insurance.
Yes if you present in the emergency room you must be treated. They can tell by the type of empire plan that its the exchange.
They have to treat you, but the insurance doesn't have to pay.....
This exactly. I have no out-of-network coverage with my plan so even though any hospital has to treat me... I will get stuck with the bill for it. The closest hospital that is in-network is 25 miles away from my home.
I was told by two different hospitals and my insurance company, that they HAVE to take insurance payment in the event of an emergency. This was also noted recently in the news.
And I'm not sure of the other plans, but Fidelis notates Bronze, Silver and Gold right on the card. Many providers take the medicaid/medicare version of the insurances, but not the exchange version.
I was told the exact opposite by my dr, the hospital, and by BCBS. They said even if it's an emergency, I have no out-of-network coverage. Which worries me but, none of the plans through the health care exchange have the hospitals near my house listed as in-network so it's not like I even had a choice.
This is accurate. You might have been confused, in any emergency situation, and it had been late for a VERY long time, the hospital MUST see you, however your INSURANCE does NOT have to pay a penny if the hospital and doctor treating (multiple bills) are not in network. If you have questions, please feel free to FM me!
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| Posted 5/6/14 12:05 PM |
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BargainMama
LIF Adult
Member since 5/09 15657 total posts
Name:
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Re: X Post: Family Medical Insurance
Posted by jessnbrian
Posted by BargainMama
Posted by SecretlyTTC14
Posted by jessnbrian
Posted by blue11
Posted by alli3131
Posted by CunningOne
We have Empire BCBS through ACA (obamacare) and I don't care what anyone says, it's not affordable. We have a low level plan (minimal coverage) and we still pay $1100 a month for family coverage. Yet, that was still cheaper than the $800/week plan DH's employer was offering.
Anyway, I didn't have any issues with doctors. We researched the plan before getting it and all our doctors are in it.
The trouble we are having is hospitals. None of the major 3 that we would consider using take it. The one we would use that takes it is a considerable distance should we need it for anything. And all our doctors happen to be affiliated with hospitals that don't take the insurance (Winthrop and St. Francis).
Should it be an emergency they will take any insurance.
Yes if you present in the emergency room you must be treated. They can tell by the type of empire plan that its the exchange.
They have to treat you, but the insurance doesn't have to pay.....
This exactly. I have no out-of-network coverage with my plan so even though any hospital has to treat me... I will get stuck with the bill for it. The closest hospital that is in-network is 25 miles away from my home.
I was told by two different hospitals and my insurance company, that they HAVE to take insurance payment in the event of an emergency. This was also noted recently in the news.
And I'm not sure of the other plans, but Fidelis notates Bronze, Silver and Gold right on the card. Many providers take the medicaid/medicare version of the insurances, but not the exchange version.
JUST because they have to accept the payment from the insurance doesn't mean that (a) your insurance will pay, or (b) that there won't be a balance due. TRUST me , this is what I do for a living, have been doing it for over 10 years.
Well, my son broke his ankle a while back, we went to Stony Brook, they were "out of network" (unknown to me) and it was still covered, 100% in full. So I dunno.
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| Posted 5/6/14 12:18 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: X Post: Family Medical Insurance
Posted by BargainMama
Posted by jessnbrian
Posted by BargainMama
Posted by SecretlyTTC14
Posted by jessnbrian
Posted by blue11
Posted by alli3131
Posted by CunningOne
We have Empire BCBS through ACA (obamacare) and I don't care what anyone says, it's not affordable. We have a low level plan (minimal coverage) and we still pay $1100 a month for family coverage. Yet, that was still cheaper than the $800/week plan DH's employer was offering.
Anyway, I didn't have any issues with doctors. We researched the plan before getting it and all our doctors are in it.
The trouble we are having is hospitals. None of the major 3 that we would consider using take it. The one we would use that takes it is a considerable distance should we need it for anything. And all our doctors happen to be affiliated with hospitals that don't take the insurance (Winthrop and St. Francis).
Should it be an emergency they will take any insurance.
Yes if you present in the emergency room you must be treated. They can tell by the type of empire plan that its the exchange.
They have to treat you, but the insurance doesn't have to pay.....
This exactly. I have no out-of-network coverage with my plan so even though any hospital has to treat me... I will get stuck with the bill for it. The closest hospital that is in-network is 25 miles away from my home.
I was told by two different hospitals and my insurance company, that they HAVE to take insurance payment in the event of an emergency. This was also noted recently in the news.
And I'm not sure of the other plans, but Fidelis notates Bronze, Silver and Gold right on the card. Many providers take the medicaid/medicare version of the insurances, but not the exchange version.
JUST because they have to accept the payment from the insurance doesn't mean that (a) your insurance will pay, or (b) that there won't be a balance due. TRUST me , this is what I do for a living, have been doing it for over 10 years.
Well, my son broke his ankle a while back, we went to Stony Brook, they were "out of network" (unknown to me) and it was still covered, 100% in full. So I dunno.
It depends on your OON benefit schedule... Also, I would call to verify that they don't have bills coming to you.. Hospital billing is extremely behind (compared with a doctors office) you might get bills 1-2 years later. But, if your OON benefits are that they cover hospitals OON 100%, then it doesn't matter. Stony Brook might also be "waiving" the coinsurance, which they can do, but it's not ALWAYS done.
Message edited 5/6/2014 12:30:59 PM.
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| Posted 5/6/14 12:30 PM |
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BargainMama
LIF Adult
Member since 5/09 15657 total posts
Name:
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X Post: Family Medical Insurance
3 Years ago no bill. I'm going with what I was told by both parties. Emergency visit covered in full by insurance, regardless if they are participating or not ;) This policy has no OON benefits either.
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| Posted 5/6/14 1:19 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
|
Re: X Post: Family Medical Insurance
Posted by BargainMama
3 Years ago no bill. I'm going with what I was told by both parties. Emergency visit covered in full by insurance, regardless if they are participating or not ;) This policy has no OON benefits either.
Then what likely happened was that Stony Brook waived the charges. They have the right to do that at any point (and I recommend that anyone who gets a bill from a hospital negotiate). When DH had no insurance in between jobs he was seen in the ER twice in one day, the bills would have been about $6K, he paid $200 total.
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| Posted 5/6/14 1:38 PM |
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MCD0524
LIF Adult
Member since 4/10 1199 total posts
Name:
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X Post: Family Medical Insurance
I am in the same position as you. What we decided was to keep our own plans (at what we pay now) and put our DS on Child Health Plus through the state. Depending on you income, your monthly premiums are pretty low and its low copays and no deductible. If you make under $110k combined I think its $60 a month. This was much better then making ourselves a family plan. FM me for more info, I did a ton of research and the ACA was not even an option as it cost the same after tons of research
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| Posted 5/6/14 2:17 PM |
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deekzee
LIF Zygote
Member since 8/10 26 total posts
Name:
Dee
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X Post: Family Medical Insurance
Thanks. I thought Child Health Plus was through ACA?
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| Posted 5/6/14 2:18 PM |
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MCD0524
LIF Adult
Member since 4/10 1199 total posts
Name:
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X Post: Family Medical Insurance
I don't think so, I only put my DS on it and he costs $60 a month. We kept our own plans. Most of my coworkers also put their children on it this year because it was the only affordable way. I think its a state managed plan but I have no complaints. I also work in early intervention and deal with insurance and any parent that has it, loves it. Call them and speak to them about it. If I didn't know about it we would be paying $1395 a month in a family plan! It's crazy
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| Posted 5/6/14 2:21 PM |
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deekzee
LIF Zygote
Member since 8/10 26 total posts
Name:
Dee
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X Post: Family Medical Insurance
Well when I called ACA they to me about their own plan call Child Health Plus so i think its a part of it. I'm glad that you are happy with it. I only researched Fidelis so far and the pediatrician I wanted doesn't take it. Then I found the list of 4 insurance companies they told me I could get there arent accepted by the dr. i want the baby to go to.
Message edited 5/6/2014 2:27:57 PM.
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| Posted 5/6/14 2:26 PM |
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jlm2008
LIF Adult
Member since 1/10 5092 total posts
Name:
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Re: X Post: Family Medical Insurance
Posted by jessnbrian
Posted by ali120206
Posted by jessnbrian
Posted by WannaBeAMom11
Your HR rep is a moron. As pp said you pick a company. No where does it say ACA. We just got our new rates and for now we are sticking with dh's company but will probably jump ship next year.
Every doctors office will KNOW if it's ACA or not, and many don't accept the ACA versions. It's unfortunate, but it's the truth.
To keep costs down, many of the ACA plans use what they call "narrow networks" which means that they don't have access to as many providers as the group plans.
BINGO, this is the truth, however, one of the major reasons why the network is so small is because these plans are reimbursing less than medicaid, so doctors can't afford to accept it.
All this. Not one of my Dr's accepts ACA. A family member just went through this trying to get new insurance and we share most of the same docs.
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| Posted 5/6/14 2:50 PM |
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SecretlyTTC14
LIF Adult
Member since 12/13 1770 total posts
Name:
B
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Re: X Post: Family Medical Insurance
Posted by BargainMama
3 Years ago no bill. I'm going with what I was told by both parties. Emergency visit covered in full by insurance, regardless if they are participating or not ;) This policy has no OON benefits either.
It def sounds like there was some reason they covered it. I know with DH's old plan, out-of-network was covered in some cases... depending on the situation and how it was billed.
Was this an ACA policy? I am just asking because I researched every plan when I was shopping and none of them had any sort of out-of-network benefits. We ended up going with the BCBS gold for a couple different reasons but it still bothers me that we have no OON coverage.
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| Posted 5/6/14 6:12 PM |
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SecretlyTTC14
LIF Adult
Member since 12/13 1770 total posts
Name:
B
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Re: X Post: Family Medical Insurance
Posted by jlm2008
Posted by jessnbrian
Posted by ali120206
Posted by jessnbrian
Posted by WannaBeAMom11
Your HR rep is a moron. As pp said you pick a company. No where does it say ACA. We just got our new rates and for now we are sticking with dh's company but will probably jump ship next year.
Every doctors office will KNOW if it's ACA or not, and many don't accept the ACA versions. It's unfortunate, but it's the truth.
To keep costs down, many of the ACA plans use what they call "narrow networks" which means that they don't have access to as many providers as the group plans.
BINGO, this is the truth, however, one of the major reasons why the network is so small is because these plans are reimbursing less than medicaid, so doctors can't afford to accept it.
All this. Not one of my Dr's accepts ACA. A family member just went through this trying to get new insurance and we share most of the same docs.
The policy I picked said my doctor was covered...2 months later my Dr decided they didn't want to take ACA policy's anymore. It seems like more and more Dr's are deciding against taking it.
Which I guess is ok because I don't have any ongoing health problems so I don't mind seeing someone new every few months but if I did and had to keep switching Dr's ... it would really bother me. Don't get me wrong, I am happy to have insurance at all... but if I had a choice I wouldn't choose to get an ACA policy.
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| Posted 5/6/14 6:18 PM |
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ISpoilHim
I think I got this
Member since 11/10 1523 total posts
Name:
K
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Re: X Post: Family Medical Insurance
Posted by deekzee
Well when I called ACA they to me about their own plan call Child Health Plus so i think its a part of it. I'm glad that you are happy with it. I only researched Fidelis so far and the pediatrician I wanted doesn't take it. Then I found the list of 4 insurance companies they told me I could get there arent accepted by the dr. i want the baby to go to.
Child Health plus has been in existence before ACA. My brother had it when he was eligible and he is now 25. When I looked into exchange plans, kids were enrolled in child health plus and adults were enrolled in an exchange plan. Call the Dr's office and ask which child health plus plans they accept. Child Health Plus is administered through nys doh I think. That's separate from the health care exchange.
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| Posted 5/6/14 7:41 PM |
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blue11
LIF Adult
Member since 2/11 1706 total posts
Name:
kat
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Re: X Post: Family Medical Insurance
Posted by jessnbrian
Posted by BargainMama
3 Years ago no bill. I'm going with what I was told by both parties. Emergency visit covered in full by insurance, regardless if they are participating or not ;) This policy has no OON benefits either.
Then what likely happened was that Stony Brook waived the charges. They have the right to do that at any point (and I recommend that anyone who gets a bill from a hospital negotiate). When DH had no insurance in between jobs he was seen in the ER twice in one day, the bills would have been about $6K, he paid $200 total.
Every plan is different which is why it is so important to research. I have a high oon deductible but if I go to an emergency room oon it's covered and I only have a copay.
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| Posted 5/6/14 8:03 PM |
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blue11
LIF Adult
Member since 2/11 1706 total posts
Name:
kat
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Re: X Post: Family Medical Insurance
Posted by ISpoilHim
Posted by deekzee
Well when I called ACA they to me about their own plan call Child Health Plus so i think its a part of it. I'm glad that you are happy with it. I only researched Fidelis so far and the pediatrician I wanted doesn't take it. Then I found the list of 4 insurance companies they told me I could get there arent accepted by the dr. i want the baby to go to.
Child Health plus has been in existence before ACA. My brother had it when he was eligible and he is now 25. When I looked into exchange plans, kids were enrolled in child health plus and adults were enrolled in an exchange plan. Call the Dr's office and ask which child health plus plans they accept. Child Health Plus is administered through nys doh I think. That's separate from the health care exchange.
I
Child health plus is for children that don't qualify for Medicaid but don't have insurance. There's a sliding scale for how much you pay. It's been around for a long time but starting this year you apply for it through the exchange.
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| Posted 5/6/14 8:11 PM |
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