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Thread: Obamacare is almost here

  1. #381
    Posting Addict Spacers's Avatar
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    If you signed up through the ACA website by the given date in December, your insurance WILL be effective January 1st. It is NOT up to the private insurance company to decide. Probably what happened is that the people in question don't yet have ID cards; the clinic could have, should have, called their insurance company to verify pending coverage. It's no different than if you take a newborn in and you haven't received the baby's ID card yet.
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  2. #382
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    Quote Originally Posted by Spacers View Post
    If you signed up through the ACA website by the given date in December, your insurance WILL be effective January 1st. It is NOT up to the private insurance company to decide. Probably what happened is that the people in question don't yet have ID cards; the clinic could have, should have, called their insurance company to verify pending coverage. It's no different than if you take a newborn in and you haven't received the baby's ID card yet.

    Nope this was very different. They had paperwork from the cover Oregon site, and then when the clinic called the company said they had no record. The cover oregon site is having a lot of issues similar to the Fed ACA site
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  3. #383
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    This is what happens during a large open enrollment time (1/1 is the most common enrollment date even for groups.)

    People (or groups..I'll use people from here out) sign up for a 1/1 start date. They can sign up on 10/31 (theoretically) or they can sign up on 12/23 on the deadline. The enrollment now has to be sent to the private insurer. The private insurer has to manually add all these people (trust me...it's not simple. At all. It's not just putting people in a database. You need to attach benefits, update claim platforms etc.) The people they received information on say...10/23 would more than likely have cards. 12/23 is 7 days (and that's not including weekends and 2 holidays!) to get all that done? Not happening. Even if the private insurer works the enrollment on 1/31 they will retroactively post to 1/1. They have to.
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  4. #384
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    I think it is supposed to work that way (I would assume), but from what I have read online, it seems as though doctors/hospitals are not seeing patients without proof of insurance.

    Doctor’s Office Spends 2 Hours On Hold With Health Insurer For Patient’s Surgery Authorization ? CBS DC

    'They had no idea if my insurance was active or not!': At Virginia hospitals, Obamacare confusion reigns as frustrated patients walk out | Mail Online

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  5. #385
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    Quote Originally Posted by mom3girls View Post
    Nope this was very different. They had paperwork from the cover Oregon site, and then when the clinic called the company said they had no record. The cover oregon site is having a lot of issues similar to the Fed ACA site
    When I had my dd 10 years ago we has issues. She needed meds when she was 3 days old. When the pharmacy went to fill the prescription, the insurance company had no record of her or any of the rest of us. We've run into insurance glitches from time to time... Champus, mediCal, kaiser, bc/bs. Things happen. I just can't jump on the blame ACA bandwagon yet.
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  6. #386
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    A doctor can't refuse you care for lack of payment. If you can't show your coverage, you may be asked to pay but you will get that money back from your insurer or once the provider can file the claim.
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  7. #387
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    Quote Originally Posted by Jessica80 View Post
    A doctor can't refuse you care for lack of payment. If you can't show your coverage, you may be asked to pay but you will get that money back from your insurer or once the provider can file the claim.
    Are you sure about that? A hospital can not deny you care, but I believe a doctor can. I have been at plenty of doctors where I have heard them say or seen signs where you need to pay in advance or reschedule your appointment. I also do not believe that a hospital will do a non emergency surgery without pre-payment or proof of insurance. I have also heard of many people going to the emergency room for non emergency situation because the emergency room has to treat them and the doctor does not. Perhaps it is regional?

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  8. #388
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    This isn't my area of expertise but I've never found health insurance companies to be efficient. I got COBRA coverage when I was laid off and everything was all set up but nothing was active the day my regular insurance ended and I had to get reimbursed for expenses. Then when we switched over to my husband's insurance, the same thing happened, his company is in the process of switching and so they couldn't give me any valid number to use when ordering a prescription; again I will have to get reimbursed. And this has nothing to do with Obamacare whatsoever. These companies are always a mess. Even when you get it through work, it's almost impossible to understand how the whole thing works. I always end up just picking stuff at random and hoping for the best.

    In Canada I was covered but when I moved to the U.S., I wasn't covered for years because I couldn't afford it. Then I got a staff job after years of working freelance, and I was given a huge stack of paperwork. I was completely unfamiliar with it so I asked my dad for help and he called me back a day later and said, "Well...I can't help you with your insurance, but I've found the cure for insomnia."
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  9. #389
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    Admittedly, enrollment can take awhile on the insurance end. Especially paper enrollment. However, most of the time it's sent over "late" (as in you want a 1/1 start date and it is received by insurance on 12/27).
    Mom to Elizabeth (6) and Corinne (4)

  10. #390
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    Quote Originally Posted by AlyssaEimers View Post
    I think it is supposed to work that way (I would assume), but from what I have read online, it seems as though doctors/hospitals are not seeing patients without proof of insurance.

    Doctor’s Office Spends 2 Hours On Hold With Health Insurer For Patient’s Surgery Authorization ? CBS DC

    'They had no idea if my insurance was active or not!': At Virginia hospitals, Obamacare confusion reigns as frustrated patients walk out | Mail Online
    Regarding your links, it's essentially you the patient's responsibility to know if their insurance is active or not. And also, prior authorizations have always taken a long time, at times. I remember being on the phone for a prior auth for an hour and this was years ago. And it was just for a medication.

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