Serious question. Anyone in here actually signed up for Obamacare yet?

[CosmicCowboy]

How was it? were you able to sign up painlessly?

[CosmicCowboy]

I have looked online and haven't found any real assistance of exactly what information you have to have access to when you go online to enlist. Has anyone seen a worksheet?

It's a serious question.

I want to run the numbers on my employees and see if it works for them and me.

[CosmicCowboy]

Has anyone seen signs in their doctors office that they won't be participating in it? My wife has. I haven't been to any doctors since it went into effect.

[CosmicCowboy]

Trolls, please stay the fuck out of this thread. It's a serious question.

[Blake]

Has anyone seen signs in their doctors office that they won't be participating in it? My wife has. I haven't been to any doctors since it went into effect.

I thought Obamacare meant you pick an insurance company from the marketplace.

How will the doctor know if the patient is participating in it? Are there more stringent laws on doctors accepting Obamacare patients?

I got through half of page 1 of the first 140 pages before i gave up.

[CosmicCowboy]

I thought Obamacare meant you pick an insurance company from the marketplace.

How will the doctor know if the patient is participating in it? Are there more stringent laws on doctors accepting Obamacare patients?

I got through half of page 1 of the first 140 pages before i gave up.

As I understand it, the marketplace plans are tied to reimbursing doctors at medicaid rates which are massively discounted form regular insurance rates and the paperwork is onerous for them to even get that. If anyone knows differently please feel free to correct me.

[ElNono]

I started the registration process back in October(?) since I wanted to see what plans were offered, but the website was too broken and couldn't finish. Later on I found out you could access some of that data without registering, and never went back.

We work with doctors, and have not heard they won't be accepting any of those plans. Insurance claims also go through the normal claim process. No new paperwork required.

[FuzzyLumpkins]

As I understand it, the marketplace plans are tied to reimbursing doctors at medicaid rates which are massively discounted form regular insurance rates and the paperwork is onerous for them to even get that. If anyone knows differently please feel free to correct me.

Um no. You sign up for Aetna, BCBS, etc and their regular plans. How on fucking Earth did you get this notion that there were forcefed medicaid plans?

The insurance companies are given directives in terms of how much of the premium goes to cost and coverage mandates but the consumer deals with BCBS and not the feds. That goes for all insurance plans regardless of source. What the marketplace does do --when it works-- is automatically apply any subsidies you are eligible for. That as opposed to going through the insurers themselves and having to obtain the subsidies independently.

They use the same plans though. You can call AETNA or BCBS and get the same plans that you find on the marketplace. You would then just have to go back to the feds to get your subsidies.

Now healthcare.gov does still hang at various points but the medicaid fearmongering has got a hold of you.

[CosmicCowboy]

Um no. You sign up for Aetna, BCBS, etc and their regular plans. How on fucking Earth did you get this notion that there were forcefed medicaid plans?

Wrong, asshole. They aren't all regular plans

The insurance companies are given directives in terms of how much of the premium goes to cost and coverage mandates but the consumer deals with BCBS and not the feds. That goes for all insurance plans regardless of source. What the marketplace does do --when it works-- is automatically apply any subsidies you are eligible for. That as opposed to going through the insurers themselves and having to obtain the subsidies independently.

They use the same plans though.

they are not the same plans. the ACA are all pre screened and approved by ACA

You can call AETNA or BCBS and get the same plans that you find on the marketplace. You would then just have to go back to the feds to get your subsidies.

Wrong. The subsidies are calculated when you sign up for ACA and they are automatically paid to the insurer

Now healthcare.gov does still hang at various points but the medicaid fearmongering has got a hold of you.

Go fuck yourself asshole.

I'm not fear mongering and you are the one that has his facts wrong. Asshole.

Maybe you should get off Boutons RSS feeds and read some legitimate news.

The doctors on ACA plans supposedly DO have lower reimbursement rates than regular plans.

http://www.kaiserhealthnews.org/stories/2013/november/19/doctor-rates-marketplace-insurance-plans.aspx

[CosmicCowboy]

I asked a serious question waiting to hear personal experience with sign up and plan costs and specifically asked to keep it non-political, so take your partisan ill informed fuzzy rhetoric and shove it up you ass.

[CosmicCowboy]

I started the registration process back in October(?) since I wanted to see what plans were offered, but the website was too broken and couldn't finish. Later on I found out you could access some of that data without registering, and never went back.

We work with doctors, and have not heard they won't be accepting any of those plans. Insurance claims also go through the normal claim process. No new paperwork required.

Do you mind me asking where you found that information? Was it on your state website or the big fed website that we have to use in Texas?...

[RandomGuy]

I have looked online and haven't found any real assistance of exactly what information you have to have access to when you go online to enlist. Has anyone seen a worksheet?

It's a serious question.

I want to run the numbers on my employees and see if it works for them and me.

I'll look into it.

How soon do you need an answer?

[CosmicCowboy]

I'll look into it.

How soon do you need an answer?

Probably by the end of the month at the latest. I'm looking at a March 1 renewal on my current insurance.

[RandomGuy]

I have looked online and haven't found any real assistance of exactly what information you have to have access to when you go online to enlist. Has anyone seen a worksheet?

It's a serious question.

I want to run the numbers on my employees and see if it works for them and me.
Off the top of my head:

Fair place to start is your local Insurance Department, although I am not sure how much help the Governor has told them to be. Part of the problem is that the state government has been pretty openly hostile to the ACA, so they [read: governors office] are essentially trying to make it difficult in an attempt to sabotage it.
[edit: that sounds political, but it is more in the line of a dry observation; it is what it is, and whether one agrees with it or not, it is what I think is a reasonable interpretation, politics aside-RG]

http://www.tdi.texas.gov/

I haven't toodled around very much on the website to find specifics, but I would guess they have at least some information. All insurance regulation is carried out at the state level, so that is where the rubber will meet the road.

[RandomGuy]

Has anyone seen signs in their doctors office that they won't be participating in it? My wife has. I haven't been to any doctors since it went into effect.

That has been reported, and I would be fairly certain that some medical professionals will certainly be opting out.

Providers are having some pressure put on them to lower rates, and that has made some that were sitting on the fence to reject the plans outright.

That said, it isn't much different than signing up to any given HMO and limiting yourself 80% of the time to contracted providers for that plan. Not all doctors in any given geographical area, will be on all companies' provider lists.

It might help my search and/or recommendations if you could add:

How many employees are you looking to cover/help?

[boutons_deux]

that sounds political, but it is more in the line of a dry observation; it is what it is, and whether one agrees with it or not, it is what I think is a reasonable interpretation, politics aside-RG"

the TX Repugs refusing Medicaid expansion, creating numerous bureaucratic obstacles to ACA (expensive, long training for navigators, including denying them from working before 1 Jan 2014 AFTER the initial signup period) is not "political"? GMAFB :lol

[RandomGuy]

that sounds political, but it is more in the line of a dry observation; it is what it is, and whether one agrees with it or not, it is what I think is a reasonable interpretation, politics aside-RG"

the TX Repugs refusing Medicaid expansion, creating numerous bureaucratic obstacles to ACA (expensive, long training for navigators, including denying them from working before 1 Jan 2014 AFTER the initial signup period) is not "political"? GMAFB :lol




Well, what I meant was it isn't political on my part. I am a Democrat and solidly so at this point, but what I meant was I try to set my politics aside insofar as possible when I offer narratives like that.

Republican hostility to the ACA is evident to even the most apolitical, uninterested observer, so I think I can offer that observation without being partisan. :)

[scott]

CC, I'm able to go to HealthCare.gov and get basic individual quotes for non-smoker plans, but for the Small Business plans you still have to contact an Agent or Broker (who will likely end up trying to sell you something else anyway, depending on the demographics of your employees).

Personal anecdote: my current group plan for my employees is significantly cheaper than a Small Business plan through the ACA.

For individual plans, I compare against Gold plans, since that's the equivalent of what I offer my employees. The Cheapest ACA Gold plan (who happens to be Humana just like our group plan) is about 50% more for a 34-year old non-smoker (me) that my group plan. Even the ACA Bronze and Silver plans are more than my group plan.

On the other hand, I was looking at ACA for my mom, 59-year old with a pre-existing condition. I can get an ACA-Platinum zero-deductible plan for the same price as what we pay for her COBRA (recent disability retirement) group insurance which is the equivalent of a top Gold plan. She's already met her out-of-pocket maximums for the year (which starts in Sept) so we'll stick with that plan until renewal and then probably switch to that ACA Platinum plan.

This is all anecdotal and your mileage may vary, but hopefully these examples are helpful.

[CosmicCowboy]

That has been reported, and I would be fairly certain that some medical professionals will certainly be opting out.

Providers are having some pressure put on them to lower rates, and that has made some that were sitting on the fence to reject the plans outright.

That said, it isn't much different than signing up to any given HMO and limiting yourself 80% of the time to contracted providers for that plan. Not all doctors in any given geographical area, will be on all companies' provider lists.

It might help my search and/or recommendations if you could add:

How many employees are you looking to cover/help?

Eleven, currently

[scott]

That has been reported, and I would be fairly certain that some medical professionals will certainly be opting out.

Providers are having some pressure put on them to lower rates, and that has made some that were sitting on the fence to reject the plans outright.

That said, it isn't much different than signing up to any given HMO and limiting yourself 80% of the time to contracted providers for that plan. Not all doctors in any given geographical area, will be on all companies' provider lists.

It might help my search and/or recommendations if you could add:

How many employees are you looking to cover/help?

This is where the ACA failed greatest. It's not health care reform, it's health insurance reform. There is a huge level of variation for the same procedure in the same hospital, and folks who researched it can't find a consistent rationale for the variances.

http://www.nbcnews.com/health/whats-it-cost-have-baby-try-3-000-or-37-2D11936130

The Affordable Care Act should be called out for what it is: Health Insurance reform that doesn't tackle the heart of the problem that is really facing the US: health care costs rising out of control. With that said, the pre-ACA system was equally as broken. We replaced one broken system with another.

[scott]

Eleven, currently

Do you do your payroll in house or do you use a service? You may be able to look into a PEO with a company who provides such a service (we use Paychex, though we don't use their PEO, our group plan is actually chaeper). Basically you join a larger group (made of of the PEO company's other clients) to get group savings.

[CosmicCowboy]

CC, I'm able to go to HealthCare.gov and get basic individual quotes for non-smoker plans, but for the Small Business plans you still have to contact an Agent or Broker (who will likely end up trying to sell you something else anyway, depending on the demographics of your employees).

Personal anecdote: my current group plan for my employees is significantly cheaper than a Small Business plan through the ACA.

For individual plans, I compare against Gold plans, since that's the equivalent of what I offer my employees. The Cheapest ACA Gold plan (who happens to be Humana just like our group plan) is about 50% more for a 34-year old non-smoker (me) that my group plan. Even the ACA Bronze and Silver plans are more than my group plan.

On the other hand, I was looking at ACA for my mom, 59-year old with a pre-existing condition. I can get an ACA-Platinum zero-deductible plan for the same price as what we pay for her COBRA (recent disability retirement) group insurance which is the equivalent of a top Gold plan. She's already met her out-of-pocket maximums for the year (which starts in Sept) so we'll stick with that plan until renewal and then probably switch to that ACA Platinum plan.

This is all anecdotal and your mileage may vary, but hopefully these examples are helpful.

Thanks Scott. I am thinking that at least half of my employees will qualify for some assistance as they are in the 40-60K range with families. The thought was to give them raises that would cover their out of pocket cost for a silver plan plus the additional tax they would pay on the raise.

[CosmicCowboy]

Do you do your payroll in house or do you use a service? You may be able to look into a PEO with a company who provides such a service (we use Paychex, though we don't use their PEO, our group plan is actually chaeper). Basically you join a larger group (made of of the PEO company's other clients) to get group savings.

I tried that once with Administaff. They baited and switched. First year health insurance was cheaper than I could get on my own and the second year was a lot more.

[boutons_deux]

This is where the ACA failed greatest. It's not health care reform, it's health insurance reform. There is a huge level of variation for the same procedure in the same hospital, and folks who researched it can't find a consistent rationale for the variances.

http://www.nbcnews.com/health/whats-it-cost-have-baby-try-3-000-or-37-2D11936130

The Affordable Care Act should be called out for what it is: Health Insurance reform that doesn't tackle the heart of the problem that is really facing the US: health care costs rising out of control. With that said, the pre-ACA system was equally as broken. We replaced one broken system with another.

ACA was written by a health insurance industry exec/lobbyist chosen by DINO Baucus who killed any talk of public opiton, so for-profit health insurance reform was never in the cards.

the heart of the problem is NOT the ripoff, gouging middleman of for-profit health insurance, but the ripoff, gouging, for-profit health care providers.

[scott]

Thanks Scott. I am thinking that at least half of my employees will qualify for some assistance as they are in the 40-60K range with families. The thought was to give them raises that would cover their out of pocket cost for a silver plan plus the additional tax they would pay on the raise.

I think the easiest way (though time consuming) would be to go one-by-one on the site and see what it tells you for each one given their ages, keeping in mind that the rates quoted on the site are non-smoker rates. I found the site pretty good for looking up the individual plans, it will give you all the detail you need on the plans themselves.

I like your idea, and it still gives your employees a chance to get a better plan. One caution: I'm not totally sure of how it's going to work, but employers under 50 employees may have some responsibility for providing coverage in 2015, with a lookback period covering 2014. If all your employees are full-time or salary, it will be really easy for you to meet your "Employer Shared Responsibility". Because I have a mix of full and part timers, hourly and salary (and sometimes one employee is FT, then next month they go to PT, then the next month they go back to FT) it's more complicated to keep track of, so Paychex does it for me. That way we can make sure we are offering a compliant plan.

[scott]

I tried that once with Administaff. They baited and switched. First year health insurance was cheaper than I could get on my own and the second year was a lot more.

That sucks. I've been really happy with Paychex, and haven't had any bait-and-switch. Been with them since 09

[scott]

And as an aside for anyone shopping HealthCare.gov (in Texas anyway), I think Humana's Platinum Zero-Deductible plan is the best bang-for-the-buck offered. It has a $1,500 Out of Pocket max and it's only slightly more expensive than a Gold Plan with a $2,500 deduct/$5,000 out of pocket max.

[CosmicCowboy]

And as an aside for anyone shopping HealthCare.gov (in Texas anyway), I think Humana's Platinum Zero-Deductible plan is the best bang-for-the-buck offered. It has a $1,500 Out of Pocket max and it's only slightly more expensive than a Gold Plan with a $2,500 deduct/$5,000 out of pocket max.

Thanks for the heads up.

[Fabbs]

How was it? were you able to sign up painlessly?
100% painless.
1st i called the 800 # and got an entirely competent cust service rep. Very little wait time for her to come on live too.
At the site, it clearly spelled out my options, including staying with the same insurer if i chose to.
They also offered a boatload of local centers where one could attend in person for a Q and A if they had questions on ACA.

Perhaps seeing how it went with fellow Texan scott......
Otherwise, while we want to keep this non partisan are the bitter Texas Repugs making it harder then shit in Texas.
Ultra smooth sailing here so far.

[CosmicCowboy]

100% painless.
1st i called the 800 # and got an entirely competent cust service rep. Very little wait time for her to come on live too.
At the site, it clearly spelled out my options, including staying with the same insurer if i chose to.
They also offered a boatload of local centers where one could attend in person for a Q and A if they had questions on ACA.

Perhaps seeing how it went with fellow Texan scott......
Otherwise, while we want to keep this non partisan are the bitter Texas Repugs making it harder then shit in Texas.
Ultra smooth sailing here so far.

So you signed up on a state exchange?

Shouldn't be any harder in Texas than the other 33 states that are using the federal exchange.

How do you think bitter republicans could hamper the federal exchange?

[Fabbs]

So you signed up on a state exchange?
I didn't even pay that much attention but yeah i think it was a Calif site.
I thought it was in conjunction with Fed but maybe it was a Calif only.

[Fabbs]

Update yes it was the Calif website.

Texass doesn't have its own?

[SnakeBoy]

Thanks Scott. I am thinking that at least half of my employees will qualify for some assistance as they are in the 40-60K range with families. The thought was to give them raises that would cover their out of pocket cost for a silver plan plus the additional tax they would pay on the raise.

You can view bcbs plans here...
http://www.bcbstx.com/coverage/individual/index.html?WT.svl=button

[SnakeBoy]

And if they qualify for subsidies here...
http://www.bcbstx.com/coverage/premium-tax-credit-eligibility/

[SnakeBoy]

The Affordable Care Act should be called out for what it is: Health Insurance reform that doesn't tackle the heart of the problem that is really facing the US: health care costs rising out of control. With that said, the pre-ACA system was equally as broken. We replaced one broken system with another.

As much as I despise the ACA, I haven't heard of any plan that will address the primary drivers of cost. Exploding elderly population supported by an increasingly unhealthy younger population equals higher costs.

[CosmicCowboy]

Crap.

Went in to sign up and play around and look at costs for myself.

Got all the way through the signup information 20+ pages and then it crashed and wouldn't let me sign the application. Lost everything.

[boutons_deux]

"Exploding elderly population supported by an increasingly unhealthy younger population equals higher costs."

http://www.washingtonpost.com/business/economy/the-history-of-health-care-spending-in-7-graphs/2012/01/09/gIQAFlCCmP_gallery.html#photo=1

[boutons_deux]

Obamacare Couldn't Stop Drug Company From Charging $13,700 for a Drug that Costs $300 http://www.alternet.org/obamacare-couldnt-stop-drug-company-charging-13700-drug-costs-300

[Th'Pusher]

As much as I despise the ACA...

:lol emo

[RandomGuy]

ACA was written by a health insurance industry exec/lobbyist chosen by DINO Baucus who killed any talk of public opiton, so for-profit health insurance reform was never in the cards.

the heart of the problem is NOT the ripoff, gouging middleman of for-profit health insurance, but the ripoff, gouging, for-profit health care providers.

There are inefficiencies through the system from top to bottom.

One bit not much considered when we talk about cost inflation: We can treat more things than we used to be able to.

50 years ago, treatment for a lot of things was "here is an aspirin", and testing was very, very limited both in terms of data provided and what was looked for. Easy to get low per capita figures based on that level of treatment.

Now that we can address a host of things, we do. That means a LOT more consumption of heath care.

You have that demand curve moving upwards, even if our demographics weren't changing to being older and sicker, which we are.

You have higher education costs, which eats into the ability to produce doctors, lowering supply of providers, who are themselves aging out and retiring in large numbers.
https://www.aamc.org/download/296002/data/aibvol12_no2.pdf

You have health insurance company profit margins.

You have the bewildering array of billing standards from a bazillion companies and the huge administrative burden on providers.

You have hospital systems, required to accept all patients, and who then have to shift costs around when they aren't paid.

It is complex, but a lot of the trends one can observe all point to higher costs, and an overall inefficient system.

[RandomGuy]

As much as I despise the ACA, I haven't heard of any plan that will address the primary drivers of cost. Exploding elderly population supported by an increasingly unhealthy younger population equals higher costs.

Start page
http://www.pwc.com/us/en/publications/research-and-insights.jhtml

goes to:
http://www.pwc.com/us/en/health-industries/behind-the-numbers/index.jhtml?WT.ac=TL+library_Browse+by+issue_Opera tions


Factors affecting 2014 Medical Cost Trend

For 2014, PwC's Health Research Institute (HRI) projects a medical cost trend of 6.5%.
Defying historical patterns—and placing added tension on the health industry—medical inflation in 2014 will dip even lower than in 2013. Aggressive and creative steps by employers, new venues and models for delivering care, and elements of the Affordable Care Act (ACA) are expected to exert continued downward pressure on the health sector.

To be clear: just pointing out the data available in case you want it, there is a detailed whitepaper available there to read if you want actual data. They do it every year. I think they get a fair way to getting some handle on some other underlying causes besides the one you named, and I agree with.

[RandomGuy]

The Affordable Care Act should be called out for what it is: Health Insurance reform that doesn't tackle the heart of the problem that is really facing the US: health care costs rising out of control. With that said, the pre-ACA system was equally as broken. We replaced one broken system with another.

The ACA doesn't really replace the current system, it merely slaps a band-aid on the worst parts of the old system, IMO, but I fully agree with the sentiment.

I think until we go to single payor, we will have to suck it up, and we will never get there because the right would scream bloody murder about it.

We all share in all the costs, as they are embedded in the cost of everyfuckingthing we consume, so we might was well get the real costs out in the open, where we can deal with them.

But I have said this before. sorry CC, I will try to stop throwing that into the thread asking about mechanics of signing up.

[CosmicCowboy]

The ACA doesn't really replace the current system, it merely slaps a band-aid on the worst parts of the old system, IMO, but I fully agree with the sentiment.

I think until we go to single payor, we will have to suck it up, and we will never get there because the right would scream bloody murder about it.

We all share in all the costs, as they are embedded in the cost of everyfuckingthing we consume, so we might was well get the real costs out in the open, where we can deal with them.

But I have said this before. sorry CC, I will try to stop throwing that into the thread asking about mechanics of signing up.

Meh, if Boutons stays out of the thread we can talk about it in a civil fashion. The real problem is that health care is too damn good. People are living into their 90's and there is an expensive pill or surgical procedure for everything that ails you. This creates a moral dilemma vs. a financial dilemma. Health care is the only thing where everyone thinks they should have the best available. People understand that we can't all live in the Dominion and drive Ferraris, but it's "immoral" that everyone can't get the best health care available. We as a nation could afford health care back when if you got cancer or had a heart attack you just died. Now the medicines and treatments have just gotten too good. People just keep on living way into non-productive years sucking up expensive health care like crazy. My mom is in her late 80's and my Dad will be 94 in a couple of months and I guarantee you Medicare has kept them alive and spent at least a million dollars on them since they turned 65. It buys them heart surgeries, valve replacements, knee replacements, hip replacements, rotator cuff surgeries,hearing aids, pills by the hundreds of thousands, walkers, then scooters, chairs that stand them up...hell, my horndog dad probably has a penis pump stashed in his night stand. It's going to bankrupt the country when the meat of the baby boomers hits their 70's. It's unavoidable IMHO. I don't see a solution except "death panels". Send em home with an aspirin. If they can afford to buy their own healthcare, fine. If not, it sucks to be you.

[boutons_deux]

GFY

"The real problem is that health care is too damn good"

bullshit. The real problem is that health care is $1T+ too expensive overall and per capita 50% too expensive, and that's with 50M not insured.

yes, if an American can live until 65 and gets access to health, the US longevity is close to adult, serious countries with universal health care. But keeping a 65+ alive in USA who has diabetes, CVD, etc, etc due to a life pre-65 shitty diet and no exercise is very expensive. That's the health care dream: don't cure them, just keep the alive as a revenue stream (same story in retirement homes).

[CosmicCowboy]

GFY

"The real problem is that health care is too damn good"

bullshit. The real problem is that health care is $1T+ too expensive per capita, and thats with 50M not being insured.

yes, if an American can live until 65 and gets access to health, the US longevity is close to adult, serious countries with universal health care. But keeping a 65+ alive in USA who has diabetes, CVD, etc, etc due to a life pre-65 shitty diet and no exercise is very expensive. That's the health care dream: don't cure them, just keep the alive as a revenue stream (same story in retirement homes).







So, do you advocate death panels?

[boutons_deux]

So, do you advocate death panels?

straw man

of course not, but I do strongly want to see the end-of-life wishes of patients respected, rather than kept alive artificially for many $1K/day.

Seniors are ATM for BigPharma



"On average, individuals 65 to 69 years old take nearly 14 prescriptions per year, individuals aged 80 to 84 take an average of 18 prescriptions per year."

https://www.ascp.com/articles/about-ascp/ascp-fact-sheet

The "prescribing cascade" and nursing home residents

With more than 15% of hospitalizations involving elderly patients caused by or related to adverse drugs reactions, and the increased risk of drug-drug interactions or adverse drug reactions associated with polypharmacy, Knight noted it is especially important to be aware of what he called “the prescribing cascade” with elderly patients, wherein the side effects from one prescription medication beget a prescription to counteract them, which leads to more side effects, and still another prescription, and so on and so forth. This is especially common among nursing home residents, whom Knight said are prescribed more medications than patients in any other setting. In particular, he noted that certain drugs such as antibiotics and PPIs are overprescribed in this population. He said that studies have shown that more than half of nursing home residents had experienced an adverse drug reaction, and that patients who are taking nine or more medications are 2.3 times more likely to experience an adverse drug reaction. Guidelines for effective medication management and monitoring in this population call for physicians to prescribe only medications that are clinically necessary to treat the patient’s assessed conditions; to consider non-pharmacologic interventions, where appropriate; to minimize risks for adverse consequences; and to re-evaluate the patient’s medication regimen when there is a change in the patient’s condition. “Analyze the problem; don’t just treat the symptom,” monitor for continued need and effectiveness, and “consider the patient’s age and co-morbidities when choosing the medication and dose,” Knight said. - See more at:

http://www.hcplive.com/conferences/aafp_2010/How-Many-Pills-Do-Your-Elderly-Patients-Take-Each-Day#sthash.d0QigrY1.dpuf

etc, etc.


Nursing homes, some now owned by private equity/hedge funds/Wall St for their guaranteed cash flow, pump their residents full of pills, courtesy of Medicare.

[SnakeBoy]

Crap.

Went in to sign up and play around and look at costs for myself.

Got all the way through the signup information 20+ pages and then it crashed and wouldn't let me sign the application. Lost everything.

From what you've said in the past about your income you aren't getting any subsidies so why are you trying to go through healthcare.gov?

[boutons_deux]

So, do you advocate death panels?

your Repug buddies fabricated a huge blast of bullshit noise of "death panels" when someone told them ACA was JUST RECOMMENDING that docs, patients, and families discuss end-of-life care.

[SnakeBoy]

Nursing homes, some now owned by private equity/hedge funds/Wall St for their guaranteed cash flow, pump their residents full of pills, courtesy of Medicare.

Which pills would you deny those nursing home residents?

[CosmicCowboy]

From what you've said in the past about your income you aren't getting any subsidies so why are you trying to go through healthcare.gov?

Because I'm currently paying 100% of the health insurance for 11 employees and their families and it's about to go up another 28% including the 4% "fee" that is supposed to pay for Obamacare. My premium would be well above $100,000 on my March renewal. I was checking out the system to see how hard it would be to navigate my employees through and I'll just give them all raises to cover their subsidized ACA premiums.

[CosmicCowboy]

your Repug buddies fabricated a huge blast of bullshit noise of "death panels" when someone told them ACA was JUST RECOMMENDING that docs, patients, and families discuss end-of-life care.

Death panels would be the only salvation of Medicare.

[boutons_deux]

Which pills would you deny those nursing home residents?

I wouldn't deny any of them, but I would, having seen how the nursing home fucked up my mother with too many pills til my sister and I told them to stop, like to see every nursing home patient's pill monitored by an outside authority.

[boutons_deux]

Death panels would be the only salvation of Medicare.

so killing people because they cost too much is preferable to forcing the cost of health care because they charge too much

[CosmicCowboy]

so killing people because they cost too much is preferable to forcing the cost of health care because they charge too much

Technically they wouldn't kill them...They would just give them the Kia health care instead of the Mercedes health care and nature would take it's course.

[ElNono]

Do you mind me asking where you found that information? Was it on your state website or the big fed website that we have to use in Texas?...

it was actually on healthcare.gov itself...

https://www.healthcare.gov/find-premium-estimates/

[SnakeBoy]

Because I'm currently paying 100% of the health insurance for 11 employees and their families and it's about to go up another 28% including the 4% "fee" that is supposed to pay for Obamacare. My premium would be well above $100,000 on my March renewal. I was checking out the system to see how hard it would be to navigate my employees through and I'll just give them all raises to cover their subsidized ACA premiums.

Oh ok, I thought you were shopping for yourself. It'll be interesting to see if it works out to where they don't eat some of the cost since you'll give them a raise to cover the subsidized premium which will then lower their subsidy.

[CosmicCowboy]

Oh ok, I thought you were shopping for yourself. It'll be interesting to see if it works out to where they don't eat some of the cost since you'll give them a raise to cover the subsidized premium which will then lower their subsidy.

Good point. I will have to play with that.

[EVAY]

I think that people are increasingly supportive of 'end-of-life-discussions'. It would really help if people didn't call them 'death panels', but some folks are just not gonna make the decisions that some others of us are willing to make. I believe that you and I had a conversation before, CC, wherein we both said that we have/had made it clear to our eventual heirs that we want to be allowed to die rather than be kept alive as a vegetable. But for every two of us, I fear there are two others (or more) that feel like it is their moral or familial responsibility to 'fight' death with every fiber of their being and to every last penny of whatever medical care is available.

That ('fight') is a cultural value that lends itself to fears abut 'death panels', and blocks hope for much change. I have excellent health care insurance now (and I pay dearly for it), but I have learned over the last ten years or so that I have to be the one to stop some of the medical testing that some docs want for no reason other than to pad their costs and get their new machines paid for. If those guys stop providing care because of the ACA, I'm not sure it would be such a bad thing.

[Das Texan]

Obamacare offered me some fucking shitty HMO plan that was a platinum plan, because the old lady is convinced that since we were paying out the ass previously (mostly due to her getting ass fucked by all insurance companies for having a surgery to make her healthier, that they paid for in the beginning), that it was quite ok for us to get a plan that we would pay the same for monthly. The only thing they really offered that offered the coverage she wanted were fucking HMO plans which I'd rather kill myself before dealing with that shit again.

So went out and found my own shit on the open market and am paying the same, well I get more, lower deductible and dental coverage also for about 20 bucks less a month for the old lady and I.

My overall impression: Obamacare is great if you get a subsidy or like HMO plans. If you make too much, go find your own shit. (I literally only had about 20 plans to choose from because I didnt qualify, not the 100s of plans they go on about)

[TeyshaBlue]

I wouldn't deny any of them, but I would, having seen how the nursing home fucked up my mother with too many pills til my sister and I told them to stop, like see every nursing home patient's pill monitored by an outside authority.
Sorry to hear that, boutons.
My medical power of attorney pretty much guarantees that no meds are prescribed for my Father that I dont know about. I stay on top of his situation though...going through some issues with staffing ratios. They pretty much cringe when I show up.:lol

[scott]

CC, one other thing to factor in is you'll lose the small employer heath care tax credit if you just give them a raise to buy their own. So a credit will get turned into a deduction

[CosmicCowboy]

CC, one other thing to factor in is you'll lose the small employer heath care tax credit if you just give them a raise to buy their own. So a credit will get turned into a deduction

Yeah, we are jumping into uncharted territory here but I have the advantage of having a grandfathered corporate fiscal year that ends Feb 31. Gives me time to play the tax games.

[FuzzyLumpkins]

Go fuck yourself asshole.

I'm not fear mongering and you are the one that has his facts wrong. Asshole.

Maybe you should get off Boutons RSS feeds and read some legitimate news.

The doctors on ACA plans supposedly DO have lower reimbursement rates than regular plans.

http://www.kaiserhealthnews.org/stories/2013/november/19/doctor-rates-marketplace-insurance-plans.aspx

Eat a dick, bitch. At least you stopped coming here to bitch about worker safety during the workday after a work site accident. Perhaps with your head out of your ass, you can do your job and not risk the safety of your workers.

Just went to the BCBS website.

www.bcbstx.com

Now I see plans that are not eligible for the premium credits. There are one per tier versus 6 plans that are on the exchange. But what gets me is that I think we can all agree that health care costs need to come down. Now how in the fuck do you plan on doing that? You just want it to be magic?

Doctors, hospitals and pharmaceuticals need to be paid less.

[Trainwreck2100]

just looked at what i would get cheepest is a catastrophic plan which charges

:lol 113 a month plus a $35 deductible thanks for nothing obama

[SnakeBoy]

Doctors, hospitals and pharmaceuticals need to be paid less.

How much should a doctor be allowed to make?

[DUNCANownsKOBE]

Eat a dick, bitch. At least you stopped coming here to bitch about worker safety during the workday after a work site accident. Perhaps with your head out of your ass, you can do your job and not risk the safety of your workers.

Just went to the BCBS website.

www.bcbstx.com (http://www.bcbstx.com)

Now I see plans that are not eligible for the premium credits. There are one per tier versus 6 plans that are on the exchange. But what gets me is that I think we can all agree that health care costs need to come down. Now how in the fuck do you plan on doing that? You just want it to be magic?

Doctors, hospitals and pharmaceuticals need to be paid less.

The right wing plan is always "lessen the med malpractice laws!" :lol

[ElNono]

How much should a doctor be allowed to make?

Doesn't the government make that kind of decisions all the time for Medicare/Medicaid patients and also public workers, military, etc?

Apparently a decent living wage and good benefits is enough?

[SnakeBoy]

Doesn't the government make that kind of decisions all the time for Medicare/Medicaid patients and also public workers, military, etc?

Apparently a decent living wage and good benefits is enough?

How much?

[boutons_deux]

Sorry to hear that, boutons.
My medical power of attorney pretty much guarantees that no meds are prescribed for my Father that I dont know about. I stay on top of his situation though...going through some issues with staffing ratios. They pretty much cringe when I show up.:lol

final, next chapter with my mother:

One visit to the nursing home (alzheimer's care), I suspected they were feeding my mother a lot of food. She overall was bedridden for 5 years and down to 90 pounds or so. Why does a totally inactive 90-pound woman need so much food, I asked my self?

Had a meeting with several of the staff, told them that my mother's will said she was not to be kept alive by artificial means, and the 3000 calories/day was "articificial", and thereby violated my mother's will.

They said she was so deteriorated and incapable of processing protein that they had to overfeed her to provide enough protein (iow, keep that $3000+/month bed occupied). Ice cream and cake and LOTS of protein.

I lost that battle because my sister had power of attorney/guardianship and thought letting our mother die a natural death was inappropriate or cruel whatever.

Finally, after burning through $250K+ of her savings and liquidating her house, for 5 years of Alzheimer's care, my mother died.

afterword: funeral home charged $800/night for two nights to keep my mother's body in a refrigerated drawer until the burial. They also offered me the option of burying my mother so I could share the same grave, next to my father. That gem was, IIRC, about $3K. No thanks. Sunset Funeral Home/Cemetery, Austin Highway.

[SnakeBoy]

final next chapter with my mother:

One visit to the nursing home (alzheimer's care), I suspected they were feeding my mother a lot of food. She overall was bedridden for 5 years and down to 90 pounds or so. Why does a totally inactive 90-pound woman need so much food, I asked my self?

Had a meeting with several of the staff, told them that my mother's will said she was not to be kept alive by artificial means, and the 3000 calories/day was "articificial", and thereby violated my mother's will.

They said she was so deteriorated and incapable of processing protein that they had to overfeed her to provide enough protein (iow, keep that $3000+/month bed occupied).

I lost that battle because my sister had power of attorney/guardianship and thought to let my mother die a natural death was inappropriate or cruel.

Finally, after burning through $250K for 5 years of Alzheimer's care, my mother died.

afterword: funeral home charged $800/night for two nights to keep my mother's body refrigerated in a drawer until the burial.

So are you are upset they didn't let her starve to death or just that your mothers death cost you money?

[boutons_deux]

So are you are upset they didn't let her starve to death or just that your mothers death cost you money?

it wasn't starvation, it would have natural death due to metabolic, organ failure, as she wished. Since my sister had guardianship (complete financial control), I wouldn't have seen any left over funds, anyway.

[SnakeBoy]

it wasn't starvation, it would have natural death due to metabolic, organ failure, as she wished. Since my sister had guardianship (complete financial control), I wouldn't have seen any left over funds, anyway.

Sorry boutons, organ failure due to imposed starvation is not considered a natural death.

[boutons_deux]

Sorry boutons, organ failure due to imposed starvation is not considered a natural death.

sorry, asshole, force feeding someone because one can't process food to support life is artificial sustenance.

[SnakeBoy]

My german grandmother was 86 years old, perfectly healthy, very active life. She fell and had a lot of pain in her hip. She went to the hospital were they gave her pain killers and told her to come back if the pain got worse, no xrays were taken. The next morning she was delusional and had massive bruising around her hip so my uncle took her back to the hospital. They did xrays and determined that she had broken her hip, was bleeding out, and there was nothing they could do for her. Hooray for the cost savings of socialized medicine.

[boutons_deux]

My german grandmother was 86 years old, perfectly healthy, very active life. She fell and had a lot of pain in her hip. She went to the hospital were they gave her pain killers and told her to come back if the pain got worse, no xrays were taken. The next morning she was delusional and had massive bruising around her hip so my uncle took her back to the hospital. They did xrays and determined that she had broken her hip, was bleeding out, and there was nothing they could do for her. Hooray for the cost savings of socialized medicine.

A single anecdote to condemn all of socialized medicine? :lol

Here's a system-wide problem with over-priced for-profit health care: too-early-release followed often much more expensive re-admission.

Person is admitted, treated, released, and then re-admitted (perhaps, maybe often, for the very same problem) in a few days or weeks.

ACA/Medicare is trying to penalize health providers for the often very expensive re-admissions.

for-profit health care scam: there are now stories around where patients can spent 1 or more nights in the hospital without being actually "admitted", to minimize the chance of the providers being dinged for re-admission.

Never admitted? so can never be re-admitted. cool

btw, the ANECDOTE of this lady (not the ACA attack on system-wide too-early-releases+re-admission) included her being directly charged many $10Ks, because she was never admitted, her (hospitalization?) coverage did not apply.

[TSA]

Socialized medicine might work here if not for the 15-20 million illegal aliens.

[TeyshaBlue]

final, next chapter with my mother:

One visit to the nursing home (alzheimer's care), I suspected they were feeding my mother a lot of food. She overall was bedridden for 5 years and down to 90 pounds or so. Why does a totally inactive 90-pound woman need so much food, I asked my self?

Had a meeting with several of the staff, told them that my mother's will said she was not to be kept alive by artificial means, and the 3000 calories/day was "articificial", and thereby violated my mother's will.

They said she was so deteriorated and incapable of processing protein that they had to overfeed her to provide enough protein (iow, keep that $3000+/month bed occupied). Ice cream and cake and LOTS of protein.

I lost that battle because my sister had power of attorney/guardianship and thought letting our mother die a natural death was inappropriate or cruel whatever.

Finally, after burning through $250K+ of her savings and liquidating her house, for 5 years of Alzheimer's care, my mother died.

afterword: funeral home charged $800/night for two nights to keep my mother's body in a refrigerated drawer until the burial. They also offered me the option of burying my mother so I could share the same grave, next to my father. That gem was, IIRC, about $3K. No thanks. Sunset Funeral Home/Cemetery, Austin Highway.
Truly sorry you had to endure that, boutons. Im walking the late stage alzheimers path with my father. It's a very unique pain and in spite of our differences, you have my complete sympathy for what you had to wade through. I certainly cant fault your wishes or supporting logic. Sucks that you didn't have the control your mother deserved.

[ElNono]

How much?

There doesn't seem to be a single value. Medicare, Medicaid, the VA, etc, however, seem to know how to do it all the time.

[FuzzyLumpkins]

How much should a doctor be allowed to make?

:lol at the notion of poor doctors. such a sorry lot in life is theirs. the shitty doctors that are general practice or the like get paid $189k. These are the guys that take medicaid and provide only very basic services. poor them. i bet you shit all over teachers unions too don't you? love you some doctors.

That is besides the point I am making which is that doctors, hospitals and pharmaceutical companies are making too much money as in 17% of gdp goes to them overall. Now if you want to change that then doctors, hospitals and pharmaceuticals are going to have to get less.

The notion that the health care system is broken and spiraling out of control is hardly new. The notion that the system is set up such that the consumer cannot negotiate on his own behalf is not new either.

[ElNono]

Related:

Patients’ Costs Skyrocket; Specialists’ Incomes Soar
http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html

[ElNono]

:lol at the notion of poor doctors. such a sorry lot in life is theirs. the shitty doctors that are general practice or the like get paid $189k. These are the guys that take medicaid and provide only very basic services. poor them. i bet you shit all over teachers unions too don't you? love you some doctors.

That is besides the point I am making which is that doctors, hospitals and pharmaceutical companies are making too much money as in 17% of gdp goes to them overall. Now if you want to change that then doctors, hospitals and pharmaceuticals are going to have to get less.

The notion that the health care system is broken and spiraling out of control is hardly new. The notion that the system is set up such that the consumer cannot negotiate on his own behalf is not new either.

I was going to say, the better question is, "how much do they really make?".

It's almost impossible to get a price list, or to know beforehand what you're going to be charged. Especially if you need some sort of procedure in a hospital or clinic. Having been without insurance for a long time, I've asked many times what the price of procedure X is before having it done, and if I'm lucky enough to get an answer, it either does not match or does not include other charges that are added on the bill I get later on. I even had the luck to have some really nice doctors that would write off or discount some procedures, but then the billing department would bill me for the full amount anyways. Then, you're left arguing with the billing department. This was a problem before the ACA, and will still be a problem with the ACA.

[pgardn]

final, next chapter with my mother:

One visit to the nursing home (alzheimer's care), I suspected they were feeding my mother a lot of food. She overall was bedridden for 5 years and down to 90 pounds or so. Why does a totally inactive 90-pound woman need so much food, I asked my self?

Had a meeting with several of the staff, told them that my mother's will said she was not to be kept alive by artificial means, and the 3000 calories/day was "articificial", and thereby violated my mother's will.

They said she was so deteriorated and incapable of processing protein that they had to overfeed her to provide enough protein (iow, keep that $3000+/month bed occupied). Ice cream and cake and LOTS of protein.

I lost that battle because my sister had power of attorney/guardianship and thought letting our mother die a natural death was inappropriate or cruel whatever.

Finally, after burning through $250K+ of her savings and liquidating her house, for 5 years of Alzheimer's care, my mother died.

afterword: funeral home charged $800/night for two nights to keep my mother's body in a refrigerated drawer until the burial. They also offered me the option of burying my mother so I could share the same grave, next to my father. That gem was, IIRC, about $3K. No thanks. Sunset Funeral Home/Cemetery, Austin Highway.



OK.

This is time for my condolences.
Sorry you had to endure all that Boutons.
Seriously.

[SnakeBoy]

I was going to say, the better question is, "how much do they really make?".

It's almost impossible to get a price list, or to know beforehand what you're going to be charged. Especially if you need some sort of procedure in a hospital or clinic. Having been without insurance for a long time, I've asked many times what the price of procedure X is before having it done, and if I'm lucky enough to get an answer, it either does not match or does not include other charges that are added on the bill I get later on. I even had the luck to have some really nice doctors that would write off or discount some procedures, but then the billing department would bill me for the full amount anyways. Then, you're left arguing with the billing department. This was a problem before the ACA, and will still be a problem with the ACA.

That wasn't the question. Fuzzy believes doctors salaries are driving healthcare costs and they should be paid less and my question to him is how much should they make. You are responding about an entirely different topic. You would be hard pressed to find a doctor that believes our system isn't seriously fucked up.


:lol at the notion of poor doctors. such a sorry lot in life is theirs. the shitty doctors that are general practice or the like get paid $189k. These are the guys that take medicaid and provide only very basic services. poor them. i bet you shit all over teachers unions too don't you? love you some doctors.


How much should a family or general practitioner make?

[ElNono]

That wasn't the question. Fuzzy believes doctors salaries are driving healthcare costs and they should be paid less and my question to him is how much should they make. You are responding about an entirely different topic. You would be hard pressed to find a doctor that believes our system isn't seriously fucked up.

But they are driving healthcare cost. 20% of total spending in healthcare goes to doctors, 2nd most after hospitals. It's not ALL doctors (you can get some numbers from the article posted above) that make half a million a year, but when you add up everyone, it turns out to be a good chunk. (http://www.aetna.com/health-reform-connection/aetnas-vision/facts-about-costs.html)

Of course doctors would like to charge whatever they want, and get paid whatever they want. On the other hand, you have customers that would like to pay the least possible. Then comes BigPharma wanting a piece of the pie too. And then there's a social interest in generally making sure access to care isn't reserved only to a very wealthy few (not merely for altruistic reasons, simply because a healthier society is a more productive society). It's a lot of pressures from different directions.

You're asking about general practitioner, and I know they're getting the shaft right now, because insurance companies don't want to pay much at all for an office visit. On the flipside, you have certain specialists making a boatload of money.

The answer to your question depends on a lot of factors. If you do what, say, Germany (since you brought up an anecdote from there) does, they do cap doctor's earnings to a certain amount depending on what they do. But it's more complicated, because German universities are mostly public institutions and charge about $100 for tuition. Doctors don't start off with a $150K debt due to their education.

Without some sort of price-control, it's spectacularly difficult to rein in cost while maintaining a decent amount of access to care, especially on a society with vast income disparity.

[FuzzyLumpkins]

That wasn't the question. Fuzzy believes doctors salaries are driving healthcare costs and they should be paid less and my question to him is how much should they make. You are responding about an entirely different topic. You would be hard pressed to find a doctor that believes our system isn't seriously fucked up.



How much should a family or general practitioner make?

You keep on moving the goalposts but the premise of your question is flawed. I see no 'should' there. The only 'should' I have in this national policy discussion is lowering the health care costs in the US.

It does not appear that the medicaid worker is going to be paid less. Medicaid pays what it pays.

[boutons_deux]

The best way to bring down costs is to create a parallel government health insurance (public option) system and provider system.

govt hospitals and clinics

govt employed doctors and staff

doctor, nurse education to be provided free in return for 20+ years of employment ( similar to ROTC/military academy scholarships requiring x? years of service )

govt single buyer of all drugs, devices, equipment, setting max profit margins for private suppliers

all of this is to be federal, not state.

above, none of this if for profit.

would be available to every citizen from cradle to grave.

for profit insurance and health care would still be available.

public health insurance wouldn't pay for-profit care beyond what the govt health care costs, so you exercise the "free market" option to buy for-profit insurance to pay for for-profit care.

Doctors would have no overheads, be strictly salaried as govt employees, where their priority is health outcomes, not personal wealth engorgement.

and of course, the entire system would completely computerized, with patients carrying encrypted health ID cards (just like you have to carry a for-profit insurance/prescription drug card) that allow any doctor to access your medical history and to prevent doctor shopping, straw buyers (eg, Michael Jackson drug use)

direct-to-consumer drug,device marketing would be forbidden.

[FuzzyLumpkins]

I was going to say, the better question is, "how much do they really make?".

It's almost impossible to get a price list, or to know beforehand what you're going to be charged. Especially if you need some sort of procedure in a hospital or clinic. Having been without insurance for a long time, I've asked many times what the price of procedure X is before having it done, and if I'm lucky enough to get an answer, it either does not match or does not include other charges that are added on the bill I get later on. I even had the luck to have some really nice doctors that would write off or discount some procedures, but then the billing department would bill me for the full amount anyways. Then, you're left arguing with the billing department. This was a problem before the ACA, and will still be a problem with the ACA.

I have a couple of friends that are doctors and a couple of friends that are nurses. Two of them work for privately-owned, local practices and they know generally what they charge for various services. OTOH, my other friends who work for various hospital wards and corporate clinics have absolutely no idea how much goods and services cost and two in particular who have tried to find out have been rebuffed. The closest to a price point that one could find was a patient talking about how they charged him several hundred dollars for a food replacement IV.

It's a serious problem that the ACA doesn't even address. They literally make it impossible for the consumer to negotiate because no one that the patient actually deals with so much knows the cost. It's fucked up. As you point out doctors, and the rest of the industry for that matter, want to be able to charge whatever they want and make it so that the consumer has zero say. Combine that with a persons health making them desperate, and you end up with a vertical demand slope

The minimum that doctors appear to make is $189k. That is the low end and those are the ones already working at locations that take the lowest insurance payouts from the government. That does approximate about what most other doctors in the first world make. The guys that make more in our country will guarantee that our doctors are the highest in the world by whole number multiples though.

[boutons_deux]

"It's a serious problem that the ACA doesn't even address."

ACA is getting hospitals to publish prices, even already months ago. google "comparative hospital prices costs ACA"

and there are anecdotes of people driving 100s of miles to cheaper hospitals


http://www.kevinmd.com/blog/2013/02/choose-hospital-based-price.html

http://www.paulsvalleydailydemocrat.com/statenews/x862192342/Patients-driving-hundreds-of-miles-to-OKC-and-elsewhere-to-save-on-medical-procedures

and of course there is medical tourism to central America and India, even to Europe.

[FuzzyLumpkins]

"It's a serious problem that the ACA doesn't even address."

ACA is getting hospitals to publish prices, even already months ago. google "comparative hospital prices costs ACA"

and there are anecdotes of people driving 100s of miles to cheaper hospitals


http://www.kevinmd.com/blog/2013/02/choose-hospital-based-price.html

http://www.paulsvalleydailydemocrat.com/statenews/x862192342/Patients-driving-hundreds-of-miles-to-OKC-and-elsewhere-to-save-on-medical-procedures

and of course there is medical tourism to central America and India, even to Europe.

Neither link says that. I googled 'hospital price ACA' and it came up with something saying that a Miami childrens hospital is conveying price information. I am not saying that you are lying but you have given nothing for me to believe that.

While that may be the case, you cannot go into a hospital to the best of my knowledge and choose goods and services based on price. There is no way to do that. When I for example am making a choice to have additional tests done or not, that decision should have cost considerations in addition to everything else.

Having to go overseas doesn't seem a tenable solution for most citizens.

[Fabbs]

Primary care M.D. made two timely referrals to specialists.

Specialist #1, Ear Nose Throat set up appt date pretty quick, like within 10 days.
Initial appt went well seemingly, detailed probing (no homo) to begin next appointment. Picking up where last insurance bottom line failed to follow thru.
There is where the proof in pudding will -or will not be- happening.

Specialist #2.
Appt supposed to be today.
Same scenario as #1.

So far it's been a positive change for me.