lo
Lv 6
lo asked in Business & FinanceInsurance · 5 years ago

Health insurance out-of-network costs?

Why doesn't Obamacare limit out-of-network costs? The healthcare.gov website shows in large print that someone making $17,000/yr. has low deductible and low out-of-pocket limits (under $1000). BUT that doesn't limit the out-of-network costs, which climbed to $16,950 under my Anthem Blue Cross policy last year. That's not affordable health care!

Update:

By the way, while a patient is being ambulanced from one hospital to another one for treatment, the notion of insuring that his/her insurance covers the medical service doesn't hold much priority. Even looking back now, the life-saving help just wasn't available with in-network providers.

Update 2:

The system has an incentive to reduce one's income to $16,000 and have Medicaid coverage which is far better.

Update 3:

Thanks for your expertise viewpoint, Karnev.

Frankly, I was surprised that Medicaid has been accepted for everywhere I've needed, after leaving Anthem Blue Cross which left me holding a balance of $6000 out-of-network deductible plus $10,000 out-of-network "out-of-pocket" limit.

That would be very hard to pay out of a $17,000 annual income, right?

9 Answers

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  • 5 years ago
    Best Answer

    Why don't you appeal the payment with the insurance company, that it was medically necessary and there wasn't a situation to evaluate in-network vs out of network options. Additionally, even after the fact there is no in-network facilities in the area that would have been able to support your medical needs.

    • lo
      Lv 6
      5 years agoReport

      Good suggestion. It hadn't occurred to me that these things can be appealed.

  • Zarnev
    Lv 7
    5 years ago

    There are limits to out of network costs. If you have a plan that covers out of network providers you'll have an out of network maximum that you'd be required to pay before the insurance company will start picking up the remaining charges. This was the case even before the ACA rules and regulations became effective.

    If you didn't decide to buy a plan with out of network coverage it is not the insurance companies fault, nor is it the new laws fault. That is totally on you for not getting such a plan.

    Welfare is ≡NOT≡ accepted everywhere. In most places doctors do not accept welfare, or if they do they limit the number of welfare patients that they will take. The reason for this is because welfare only pays pennies on the dollar. The younger, less experiences doctors are usually the ones that take welfare, and once they gain the experience they move on to better paying situations. The only exception is some of the low income areas.

    If you were taken by ambulance to out of network providers, especially if it was a life threatening emergency and especially if there were not any life saving help in network you have grounds to appeal the decision. This is a good time to get your agent involved.

    There are people that will limit their income so that they can stay on welfare. I'll hold back responding to this notion.

    Source(s): Independent Ägent
    • lo
      Lv 6
      5 years agoReport

      My dire emergency got me sent to the nation's best hospital for that category, and I am so glad that expanded Medicaid saved me from the $16,950 balance due after Anthem Blue Cross. How could I have paid that bill, out of a $17,000 annual income? Impossible. Thank you, Obama!

  • 3 years ago

    I might suggest that you visit this site where you can get quotes from different companies: http://insure-cheap.info/index.html?src=2YAkuvAp8t...

    RE :Health insurance out-of-network costs?

    Why doesn't Obamacare limit out-of-network costs? The healthcare.gov website shows in large print that someone making $17,000/yr. has low deductible and low out-of-pocket limits (under $1000). BUT that doesn't limit the out-of-network costs, which climbed to $16,950 under my Anthem Blue Cross policy last year. That's not affordable health care!

    Update: By the way, while a patient is being ambulanced from one hospital to another one for treatment, the notion of insuring that his/her insurance covers the medical service doesn't hold much priority. Even looking back now, the life-saving help just wasn't available with in-network providers.

    Update 2: The system has an incentive to reduce one's income to $16,000 and have Medicaid coverage which is far better.

    Update 3: Thanks for your expertise viewpoint, Karnev.

    Frankly, I was surprised that Medicaid has been accepted for everywhere I've needed, after leaving Anthem Blue Cross which left me holding a balance of $6000 out-of-network deductible plus $10,000 out-of-network "out-of-pocket" limit.

    That would be very hard to pay out of a $17,000 annual income, right?

    Follow 8 answers

  • Anonymous
    5 years ago

    If the selection of out-of-network services were beyond your control, your first step should be appealing the insurer's claim processing. All insurers have an appeals process - use it, justify why you couldn't stay "in network" and request that the claim(s) be reprocessed as "in network." If that doesn't work, you can try filing a complaint with your state's insurance commissioner or office.

    Source(s): I've successfully done this
    • lo
      Lv 6
      5 years agoReport

      Thanks. I didn't know appeal was possible, or likely to make any difference.

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  • 5 years ago

    Obamacare is a law, not healthcare insurance.

    That said, the healthcare insurers were heavily impacted by the law and "pushed back" by limiting provider networks.

    Regarding that, there are states that are attempting to limit the healthcare insurer provider network limiting, so to speak.

    It is a valid point

    and

    if those States are successful, probably it will be part of a future Federal law,

    that is

    if we can keep the ACA.

    • lo
      Lv 6
      5 years agoReport

      Thanks.
      By the way, I'm grateful for the safety-net of Medicaid, which was available simply by reducing annual income by only $1,000 (escaping the $16,950 medical bill under Anthem Blue Cross).

  • Flower
    Lv 7
    5 years ago

    The rates and costs are up to each insurance company plan. If you dont have unlimited funds you dont go to an out of network provider, thats the solution.

    • Flower
      Lv 7
      5 years agoReport

      The federal legislation, Obamacare, does not regulate insurance. That is done at the state level.

  • Anonymous
    5 years ago

    Then use IN-NETWORK services if you want them to be covered, Einstein!

    People who only make $17,000 a year can't AFFORD to pick & choose...you either need to MAKE MORE MONEY or accept what you are being offered in the way of SUBSIDIZED health insurance coverage...

    Your question is fundamentally no different than asking why Food Stamps aren't accepted in Five-Star restaurants! Why WOULD they be?

    • lo
      Lv 6
      5 years agoReport

      Thanks, Anonymous. You brightened my day.

      Anyway, the system has an incentive to reduce one's income to $16,000 and have Medicaid coverage which is far better.

  • 5 years ago

    What you consider to be affordable and what the law states may not be in line. Its just a name anyway, so don't get too worked up.

    Don't go out of network.

    Are you unable to qualify for Medicaid in your state?

    • lo
      Lv 6
      5 years agoReport

      Yes, there is a strong incentive to reduce income to $16,000 and qualify for Medicad, which has no co-insurance, not copays, no deductibles, and seems to be accepted everywhere (unlike Anthem Blue Cross).

  • Murzy
    Lv 7
    5 years ago

    the in-network providers agree to accept much lower payments for their services

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