Healthcare deductables

azhiker96, BSN, RN · Jan 29, 2015

Disproportionate funding was not eliminated. My facility still receives it. Not everyone is eligible for insurance under the ACA (eg: undocumented immigrants). Also, I believe Medicaid qualifies under disproportionate funding. Maybe if Jan Brewer weren't so crazy, your facility would still have its funding.
Edited to add: color me surprised! I just googled after posting this, and I see she voted for expansion. She's such an avowed Obama-hater I just assumed she didn't!

I was pleasantly surprised when Jan Brewer did opt for the medicaid expansion. The state is having budget problems so perhaps she thought it would help with that.

And yes, there is a way to get DSH payments but there are some issues in the state that need to get worked out for our hospital to get fully reimbursed for the care we provide. The COO came to our department meeting to present and answer questions. I don't want to speak out of turn so that's all on that.

I'm confident that they will get things worked out but worse case; I have experience, degrees and certifications that would allow me to land another position.

elkpark · Jan 30, 2015

Here's a short description with an attached detailed policy statement that represents moves in the right direction.
Yes, Mr. President: A Free Market Can Fix Health Care | Cato Institute

The Cato Institute piece states right up front (the second paragraph), "First, Congress should give Medicare enrollees a voucher and the freedom to choose any health plan on the market. Vouchers would be means-tested, would contain Medicare spending, and are the only way to protect seniors from government rationing."

Conservatives who want to privatize Medicare always seem to forget that the whole reason Medicare was started in the first place was because the private insurance market doesn't want to insure the elderly. They cost too much (use too much care), and the insurance companies can't make big enough profits off of them. The insurance companies only really want to cover young, healthy people who never get sick and don't need health care, but they're willing to put up with older non-seniors as long as they can charge high enough premiums. But they really don't want anything to do with the elderly. That's why the Republic Medicare Advantage plans, which were created as a demonstration project to show everyone how great privatizing Medicare would be, ended up having to build in excess payments to the insurance companies which are basically bribes to get the insurance companies to participate and guarantee them profits (so much for the glories of the free market ... :sarcastic: )

JenERally · Jan 30, 2015

Wow, reading the horror stories on this thread makes me really grateful for my employer-sponsored health insurance! $120 biweekly for myself and daughter. In network, no deductible, $10 PCP copay, $20 specialist, 5/10/20 prescriptions. Thousands of dollars+ for a deductible is ridiculous!

allnurses Guide · Jan 30, 2015

I'm pretty sure a Medicare Advantage plan killed my Daddy.

He once told me his "Gatekeeper" primary physician told him his PSA was elevated. The following year it had gone up significantly. (He had no symptoms)

I told him he should see a urologist. His primary doctor told him there was no need. The following year it was much higher. The primary did a 'biopsy' in the office. It was negative. I suggested that since he had money he should go to a urologist. He said he trusted his doctor, who was an amateur musician so had something in common with my Dad.

He fell playing tennis and developed shoulder and arm pain.

The doctor did an X-Ray. It turned out to be bone cancer metastases, primary cancer was the prostate. That was in September. He died on Christmas Eve.

I later found out that the Medicare Advantage primaries were paid more if they didn't do "unnecessary" referrals to specialists.

With regular Medicare the patient sees the provider and Medicare pays.

Or they don't if the treatment is deemed not needed. My dermatologist told me to have an eye doctor look at something on my eyelid. Next time i went I showed it to the doctor. He told me it was probably nothing and that cancer never has hair growing through it, but to make an appointment to have him look at it in six months. When I returned he told me it was gone. Medicare declined to pay for that visit. I paid nothing and changed to a different eye doctor.

I wrote about my Daddy here. It is the first post after the original.

https://allnurses.com/nurses-rock/nursing-pride-and-971004.html

azhiker96, BSN, RN · Jan 30, 2015

I'm sorry that happened with your father. My mom has a primary who is "managing" her HTN. The only issue is it is not controlled. I've asked her to either ask him to change her meds or go to a different doctor. She likes him so she doesn't want to speak up. To me, her SBP in the 160s and up speak for themselves. She should know better. She's a retired RN.

On the other hand, my NP has been a great advocate for me. I get keratoses due to many sunburns in my youth. They freeze them off annually. When I went in and asked about one that had come back she asked if it bled sometimes and was painful. I said no, it just seems suspicious to me. She then slowly said, "Does it sometimes bleed and cause discomfort?" I replied yes so she smiled and said she'd excise it. Pathology confirmed SC CA with clean borders. She just needed to get me to say what insurance needed so they'd get paid.

Tenebrae, BSN, RN · Jan 30, 2015

Here's a short description with an attached detailed policy statement that represents moves in the right direction.
Yes, Mr. President: A Free Market Can Fix Health Care | Cato Institute

Coz free industry helped sooooo much before.......

PixieRN14 · Jan 30, 2015

I personally have not seen a $300 deductible plan since 2004.
Individual insurance plans purchased in the marketplace exchanges tend to have higher deductibles and premiums than group insurance plans offered through larger workplaces. It has always been this way. I was this way when I had private insurance purchased through an insurance agent in 2005.
I pay about $50 every two weeks for a group health insurance plan through my employer. The deductible is $1,500. Without my employer's contribution, this insurance would cost me $700 per month. Most employees do not know how much their insurance really costs them due to the employer's contribution.

Wow! I must be blessed. I pay 44.00 each pay period and my deductible is only 400.00

vintagemother, BSN, CNA, LVN, RN · Jan 30, 2015

Welcome to the brave new world so many of you voted for. Enjoy.

We finally agree on something!! Lolol!

Red Kryptonite · Jan 30, 2015

Coz free industry helped sooooo much before.......

Coz the market was soooo free before the ACA....

LAM2010, BSN · Jan 30, 2015

Anyway..... :) I think all companies are going the way of the CDHP (consumer-driven health plan) and trying to pressure us into taking them. I hate it. I am going from paying $186 a paycheck for a family plan PPO to $348 a paycheck. The CDHP they just started offering and are begging us to choose is $136 a paycheck but the deductible is $2400 for medical and prescriptions, with NO copays, and we only start paying 20% after the ded is hit. My company is contributing money towards our deductible (between $900 and $1200, depending on whether I do biometrics testing or not) in a pre-tax Health Savings Account, which is nice I guess. But I had to choose the CDHP because I absolutely cannot afford the PPO premium now that my company changed our insurance. I took a pay-cut! So I got a job at the VA. Their deductible is zero or $300 or something... I am leaving a job I love because of this. It sucks. I don't like what ANY of the politicians are offering us for health care. Unfortunately Obamacare is the lesser of two evils... which really isn't saying much. -- And I love the way our company puts it like "we want you to take better care of yourselves to avoid health problems" and jacking up our rates I guess is the way to motivate us to do this? I guess if I get the flu or measles it's my fault I didn't wash my hands enough or something.

Tenebrae, BSN, RN · Jan 31, 2015

Coz the market was soooo free before the ACA....

you want a system that is unregulated by government. Prior to the ACA you had a healthcare system that was free to do and charge what ever it liked.

Some examples of this free market that immediately come to mine

- US friend who was a naturalised NZ citizen. Diagnosed with terminal cancer. Made the decision to die in NZ because to go home would have meant leaving her loved ones with a legacy of debt.

- The husband of a friend was refused a bone marrow transplant by his insurance company on the grounds that it was an 'experimental procedure" despite the fact that all the evidence that said a bone marrow transplant was the best treatment for his type of cancer. Hes dead.

The ACA is a great idea however it doesnt go nearly far enough in terms of fixing the ****** up mess that is the health system in the US currently

Red Kryptonite · Jan 31, 2015

With all the regulation that existed prior to ACA you're really going to try and say that healthcare existed in a free market? I don't think that word means what you think it means.