Obamacare

[Big girl]

How are they involved?

[Big girl]

Kimberly guilfoye said today that the VA is one big obamacare.
politifact : pants on fire. I mean blazing
. The V A employees are government employees.
"Obamacare" is run by the private insurance sector. I was an employee of molina healthcare, not the government.

[LumRaiderFan]

Kimberly guilfoye said today that the VA is one big obamacare.
politifact : pants on fire. I mean blazing
. The V A employees are government employees.
"Obamacare" is run by the private insurance sector. I was an employee of molina healthcare, not the government.

So the private insurance sector is mandating what must be covered and who does or does not receive a subsidy?

[Big girl]

This is so disheartening. You guys are in direct opposition to something you dont know anything about. Please review the ACA.
ACA 101
The federal government mandated that pre-existing condition clauses are now illegal; as well as, maximum out of pocket benefits, amount of subsidies etc.
the federal government does not dictate standards of care
example:
Susan J has chest tightness and shortness of breath.she goes to Methodist hospital in Houston. She has the blue advantage plan 003 and that hospital is in their network. She is placed in an ER bed. The nurse checks on her two hours later and she is dead.
who is to blame for this? The Methodist hospital staff or "obamacare"? The hospital staff is to blame. They did not find out what her 02 sats were, ABG's, they didnt start her on steroids etc
the ACA does not dictate what hospitals are allowed in blue advantage's provider network. A hospital has to apply and is solely up to the credentialing department to say yea or nay.

[stevenash]

Give me the same scenario as you just painted with one exception.  The Methodist Hospital is NOT in the network.

[Big girl]

Second scenario ( insurance side)
Yatisha S, Registered Nurse, at Molina healthcare, receives that John Q was admitted to Memorial Hermann hospital with severe crushing chest pain. The doctor orders a battery of test. John's trop levels as well as his ckmb levels are normal. It is determined that he did not have a NSTEMI or STEMI (heart attack). He stays in the hospital for 2 days in spite of the results. .. I call the Registered Nurse case manager at the hospital and tell her that the inpatient stay will be denied, but I will pay for a 48 hour observation stay.
the federal government nor "obamacare" had nothing to do with my decision.

[Big girl]

Receives notification

[Big girl]

If the Methodist hospital is not in network they are still liable. A hospital cannot turn a patient away. They have to stabilize he or she and then transfer the patient to an in network facility if they so desire.

[stevenash]

If you  find out you have a very deadly form of cancer, isn't it a shame that you cannot be treated at M.D. Anderson?

[Big girl]

This was a law long before obama came into office, because you had people going to out of network hospitals or they were uninsured and as a result the hospital would not treat them. People were dying on the front lawns of hospitals

[Big girl]

Steve who said you cant be. Insurance companies have 1000's of hospitals in their network, not just one so.......what are you talking about?

[Big girl]

Tttttt

[Baba Ganoush]

As long as John Q is in a government funded health plan, that is who Molina deals with. You just described a typical reimbursement tactic. Code and charge as something that is covered instead of eating the cost. And if you are good enough at beating the system, government and private insurers, then you get paid. But after a while the plans will see what is being paid so often and will change guidelines and codes. Then new training comes in to try to find the next way around the government placed hurdles.

[Big girl]

What the heck are you talking about or do you know? John is not receiving any treatment his doctor jeeps him in the hospital so that the nurses can "observe" him to make sure that he does not exhibit any more symptoms. Why would we pay for an inpatient stay as opposed to an observation stay.they are only observing him.

[Big girl]

Keeps. Blue cross/ blue shield, Aetna, united healthcare, molina etc all use the same guidelines for everyone it doesnt matter if you bought insurance on the exchange or not.

[Big girl]

Plans dont come up with guidelines. Smh

[77]

The VA situation is exactly what the dems want in a single payer system. So look at the VA and you have the future Obamacare!

[stevenash]

Steve who said you cant be. Insurance companies have 1000's of hospitals in their network, not just one so.......what are you talking about?

The Obama Administration has been claiming that insurance companies will be competing for your dollars under the Affordable Care Act, but apparently they haven't surveyed the nation's top hospitals.

Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies. Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare.

 

 

If you get coverage under Obamacare, less than half of the plans in the Houston area will pay for care at MD Anderson.

[Baba Ganoush]

What the heck are you talking about or do you know? John is not receiving any treatment his doctor jeeps him in the hospital so that the nurses can "observe" him to make sure that he does not exhibit any more symptoms. Why would we pay for an inpatient stay as opposed to an observation stay.they are only observing him.

He is not receiving treatment because he has Molina, company dealing w Government programs like Medicaid. But the hospital needs money because that is how they stay open. So nurses "observe", I see you put quotes to imply that the observing is just a billable term and used loosely. Plan guidelines state what is reimbursable, found in the plan's SPD. Too much minutia to get in to insurance coverage. Yes, I am familiar with "managed care". I wonder why it is never referred to as "Properly Managed care"? Government guidelines! Not specific to party, just too much government involvement.

[Big girl]

He is not receiving treatment because he has Molina, company dealing w Government programs like Medicaid. But the hospital needs money because that is how they stay open. So nurses "observe", I see you put quotes to imply that the observing is just a billable term and used loosely. Plan guidelines state what is reimbursable, found in the plan's SPD. Too much minutia to get in to insurance coverage. Yes, I am familiar with "managed care". I wonder why it is never referred to as "Properly Managed care"? Government guidelines! Not specific to party, just too much government involvement.

it is obvious that you dont know what you are talking about. An observation stay merely means that a patient is being monitored. Molina has several plans, the one on the exchange is not a Medicaid him. What government guidelines are you referring to? Do you know the name of the guidelines insurance carriers use?

[Big girl]

The Obama Administration has been claiming that insurance companies will be competing for your dollars under the Affordable Care Act, but apparently they haven't surveyed the nation's top hospitals.
Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies. Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare.


If you get coverage under Obamacare, less than half of the plans in the Houston area will pay for care at MD Anderson.

have you looked at every single plans provider network that participates on the change to see if md Anderson is in network? There are commercial plans not on the exchange that dont use md anderson. The aca does not stimulate who a plan designates who a carrier puts in their provider network.

[Big girl]

You guys are really stupid when it comes to healthcare. Smh

[Big girl]

The aca does not mandate who is allowed into a private insurance companies network. Steve your source is whak The ACA is a good thing period. The president is the man. :)

[Baba Ganoush]

You guys are really stupid when it comes to healthcare. Smh

Good debate.

"It ain't what you don't know that gets you into trouble, it's what you know for sure that just ain't so."
Mark Twain

[new tobie]

http://www.huffingtonpost.com/2013/10/01/jimmy-kimmel-obamacare-prank_n_4022424.html