The President has earned his drop in credibility because based on what was said, pushed, sold to the American people, and its stark contrast to the truth that has emerged about the PPACA, at this point it should be obvious that either the President was lying or he didn’t know what he was talking about. Either way, the gig is up and most sensible people realize that what the President said and says is inaccurate.
Sure, the President will continue repeating lies and finding pathetic consumers eager for their 15 minutes of fame willing to say that Obamacare saved their lives. But for me, while I don’t believe the President is stupid, I do believe he’s been sneaky regarding ACA at our expense. He’s a good salesman.
There are things we can do to be SMART about living with the consequences of the deceit.
What we didn’t know or pay attention to is that Obamacare is a lengthy solution to a single prioritized political goal, and that goal was to reduce the number of uninsured. A bunch of lies were told to emphasize how the President’s goal of passing reform that reduced X number of uninsured to some lesser number Y that are uninsured would somehow promote our goals of reforming the healthcare system so that we could obtain affordable care in a timely fashion when we need medical care and treatment.
Today, as we begin living with it, consumers must find the time and better their chances of physical and financial survival within the healthcare system. While we’re limited by the current law, there are things we can do, but they require that we be SMART, not trusting of politicians with different goals from ours.
The first two steps include changing our attitudes about healthcare paperwork so that we keep records and second that we keep those records in order to protect our wallets. Just like clipping coupons, by incorporating keeping paperwork and taking steps based on that paperwork, you’ll find you save a lot of money throughout the year.
FIRST: The first issue is MOTIVATION to keep records. If you’re assuming you’ll be fine showing your card and getting treated then you’re not being smart. By changing your healthcare experience into a “shopping” experience, you’ll save hundreds if not more on the cost of obtaining medical services. Don’t be too busy for paperwork.
If you absolutely cannot keep track of your own medical paperwork, or you believe that you can ignore incorporating a medical paperwork trail into your recordkeeping, find someone who is willing to do it for you. It’s critical because it will affect your care, your liability, your credit score and ultimately your physical and financial health.
SECOND, know what you’re doing. The biggest pitfall under Obamacare regardless of what plan you purchased or whether you’re part of the health exchange entitlement is whether and HOW you are covered. THINKING YOU’RE COVERED WHEN YOU’RE NOT IS A HUGE PITFALL.
A- PREVENTIVE vs DIAGNOSTIC: When you make your appointment for a preventive checkup, it’s likely your provider will confirm, “Yes, your checkup is preventive.”
What is less likely is that if during your preventive exam, those “free” services you can get under Obamacare are blended with services that are NOT part of your FREE service. The distinction is PREVENTIVE vs DIAGNOSTIC.
For instance, if you go for a preventive exam and the healthcare provider decides to do a few other tests based on something he/she sees, they may want to do more tests…THERE’S YOUR SHIFT, NO MORE FREE PREVENTIVE BUT PAY-FOR DIAGNOSTIC.
Ask whether any service being provided under your “free” preventive care is outside of preventive and is instead diagnostic. You can always have the test run somewhere else by obtaining a prescription for it. You do not need to help the doctor pay for his equipment by having it done in his office.
B-KNOW WHAT COUNTS TOWARDS YOUR DEDUCTIBLE: The most uniform exception to amounts that count towards your deductible, that amount you must pay to receive coverage are premiums. Be aware that some health plans have additional expenses that you’ll pay that won’t count towards your deductible. If you’re unsure, call your insurance company.
C-KNOW WHAT COUNTS TOWARDS YOUR OUT OF POCKET MAXIMUM: If you listened to the President repeat his lie that thanks to Affordable Care individuals and families will no longer be one illness away from financial ruin, you’d be wrong and wanting to believe it doesn’t make it so.
I covered one of his recent repetitions of this lie in my post of 7/28/2013, “Insurance Companies Created Obamacare,” (http://conoutofconsumer.blogspot.com/2013/07/insurance-companies-created-obamacare.html ) in response to the President’s nonsense on 7/24/13.
You might think that every cent you pay for medical care and treatment out-of-pocket should count towards reaching the out-of-pocket maximum for the year, currently capped at $6,350 for an individual and $12,700 for a family plan but, that’s not true.
EVEN IF THEY WERE TRUE, look at those numbers for out-of-pocket maximum, that’s a huge amount of cash that represents your potential liability. In order to rely on the out-of-pocket maximum as a maximum liability you’d have to budget for $529.17 a MONTH to cover your medical expenses for an individual and $1058.33 a MONTH for a family in addition to your premium payments. Obviously even if you’re eligible for the Obamacare entitlement, you’re likely not expense free.
Then, examine the healthcare.gov website that explains that, “This limit never includes your premium, balance-billed charges, or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit,” https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/. These are amounts that you’ll spend that won’t count towards reaching that out-of-pocket maximum.
Finally, check your insurance plan and CALL THEM to verify whether a specific expense goes towards your out-of-pocket maximum. If you read your policy different from what you’re told, confirm what was told to you in writing to the insurance company to make sure you protect yourself in the event you have to pursue the matter.
D-Pay attention to the resurrection of pre-authorizations. For awhile this practice was on the decline because it was used as a tool for insurance companies to avoid paying their share of medical expenses. Pre-authorizations are those procedures that require a specific NUMBER be received by you that covers the procedure you’re getting, this is your preauthorization number. Many catscans and MRIs require such preauthorization. If your provider says that he or she will take care of it for you, be sure that you get a copy of that number since the obligation to obtain the number is YOURS not theirs.
E-KEEP A RECORD OF ALL THE MONEY YOU SPEND OUT-OF-POCKET: The President’s been great with “the technicality,” for instance promising no rise in income taxes but never mentioning the additional payroll tax, advocating protecting the middle class while raising the medical expense deduction to amounts over 10 percent of AGI rather than former levels of 7.5 percent. So, be smart, look for other laws that will help protect you.
For instance, don’t forget your taxes at the end of the year. Use sites that describe IRS Code Section 213(d) eligible medical expenses and IRS Publication 502, “Medical and Dental Expenses,” IF your expenses exceed 10 percent of your AGI then the amounts over 10 percent of your income are deductible, meaning they will reduce your taxable income by that amount.
In general, you can’t get a benefit twice, so for those people getting the Obamacare entitlement, their premium expenses will not be included. Similarly, anything covered by insurance.
BUT, since we know that insurance companies are covering LESS every day, it’s important to keep track of those expenses that are not covered to see whether you qualify for the deduction for expenses over 10 percent of your AGI.
You might find some eligible items that can contribute towards reaching your deduction that you didn’t consider before, so you’ll definitely want to keep those receipts in order to know if you exceed the 10 percent mark.
F- BALANCE BILLING: Balance billing are the amounts billed by healthcare providers who are not participating providers for the BALANCE of their fee after your insurance pays whatever it pays.
Since insurance is paying on the whole less than ever before when you use a non-participating provider, it’s important to KNOW that YOU are liable for amounts not covered by your insurance in the event you use a non-participating provider EVEN IF YOU DIDN’T KNOW THEY WEREN’T A PARTICIPATING PROVIDER. Yeah, it sucks, and there’s little to do but appeal to your insurer and/or the billing facility and its non-participating provider.
G-DON’T HESITATE TO APPEAL TO A THIRD-PARTY: “Ask the right questions,” is the overriding moral of the Presidential push for health care reform in order to avoid, “If we had only known.”
When it comes to appeals, your insurance company MUST provide you with a means of contacting a third-party organization to appeal their decision to if when you appeal to them about a denial of coverage you want to pursue your appeal to the next level.
While you must first appeal to your insurance company, if time is of the essence you can simultaneously appeal to the insurer and the independent review organization (sometimes referred to as IROs). You can also contact the providers themselves to voice your objection to balance billing resulting from situations where you didn’t know they were not participating providers.
It’s about what we miss out on when we don’t know, and if nothing else, Obamacare has proven that relying on a President who simply wanted to reduce the number of uninsured, we ended up with a law that created a new entitlement for some, raised the price of insurance for all and will likely result in still increasing costs for medical care and services.
Now we need to KNOW and we start by adjusting to the new system by paying attention to our healthcare paperwork and making sure we conserve our outlays of money.
