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09.04.19, 21:44 PM General Topics
17 replies
Something new companies are doing. They offer choice “PPO” plans to cover out of network benefits. But they set the allowable costs as Medicare rates. So the amount they will apply to deductibles and coinsurance is ridiculously low, impossible to even meet the deductible. I’m not sure why they market these as PPOs still. [ Reply | Watch | Flag ]
General Topics 09.04.19, 09:44 PM Flag
 

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Sounds like they cover something. Don’t know any company that covers out of network 100%. That’s why need to READ details. Dh and I both work for insurance companies and we still pay $800 month toward our plan. No free ride. [ Reply | More
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General Topics 09.04.19, 09:49 PM Flag
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actually my company offered two out of network plans. One only covered the Medicare rates and the other covered based on URC. And for example, the URC allowable rate for my child’s psychiatrist was like $260, while the Medicaid rate was 90. For my therapist the URC was 200, while the Medicare allowable was 71. It was worth it for me to pay extra to get the better coverage. [ Reply | More
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General Topics 09.04.19, 10:02 PM Flag
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This is not new. This has been the same for years. The insurance has never covered out of network providers at anything but Medicare rates. [ Reply | More
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General Topics 09.04.19, 09:52 PM Flag
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And they market them as PPOs as you can choose your provider without being approved or referred to by your primary physician or HMO. You just need to know how much you are willing to pay out of pocket. [ Reply | More
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General Topics 09.04.19, 09:53 PM Flag
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This isn’t true. I have a plan that covers way more than Medicare rates. [ Reply | More
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General Topics 09.04.19, 09:58 PM Flag
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Then you have one of the rare Cadillac ones. Every PPO plan I have ever had pretty much covers Medicare negotiated rates for out of network providers. [ Reply | More
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General Topics 09.04.19, 10:03 PM Flag
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np: I’ve always had better than medicare reimbursement. The deductibles and coinsurance have increased a lot though. [ Reply | More
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General Topics 09.04.19, 10:07 PM Flag
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I also have a plan that reimburses at 80% UCR percentile which is way better than Medicare. What would be the point of out of network at Medicare rates? The deductibles for out of network are so high to begin with. [ Reply | More
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General Topics 09.04.19, 10:06 PM Flag
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Medicare pays so little that DH's cardiologist "fired" him as a patient when he turned 65. I think of that when I hear anyone tout Medicare for All as a panacea. [ Reply | More
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General Topics 09.04.19, 10:01 PM Flag
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Universal healthcare would greatly reduce or eliminate the need for malpractice insurance for doctors. Your husband's cardiologist probably pays an enormous amount for this. [ Reply | More
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General Topics 09.04.19, 11:08 PM Flag
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Would they just get away with malpractice then? Who would be liable? [ Reply | More
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General Topics 09.04.19, 11:12 PM Flag
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http://blog.petrieflom.law.harvard.edu/2016/09/13/medical-malpractice-under-a-national-health-system-and-the-aca/ [ Reply | More
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General Topics 09.04.19, 11:13 PM Flag
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Some of the reasons for malpractice would be eliminated. There would be centralized medical records. [ Reply | More
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General Topics 09.04.19, 11:17 PM Flag
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^^^ Doctors would tend to focus on basic healthcare and less on riskier procedures. [ Reply | More
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General Topics 09.04.19, 11:18 PM Flag
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actually read this whole thing. The conclusions are different [ Reply | More
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General Topics 09.05.19, 12:04 AM Flag
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Really, I wouldn't think you'd have much of a cardiology practice if you didn't accept medicare! The vast majority of patients have to be over 65.... [ Reply | More
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General Topics 09.04.19, 11:59 PM Flag
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OR: My thought exactly, although he's in the east 70s, so maybe lots of patients can/are willing to pay out of pocket. [ Reply | More
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General Topics 09.05.19, 12:04 AM Flag
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