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View Diary: ACA Question (28 comments)

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  •  Your friend needs to see another (7+ / 0-)

    doctor with a better attitude.  Seriously.  I am not joking.  I would not want a doctor operating on me with the attitude that she isn't quite worthy because he won't make any money off of her.  I'm not shocked.  There are a lot of really negative attitudes from medical "professionals" regarding the ACA.  Find one who can at least show a little compassion.  Greed, unfortunately, has infiltrated the medical profession too.  Doctors with that attitude shouldn't be practicing.  

    My brother was diagnosed with cancer in November, got coverage through the ACA for $19 a month, which covered his treatments.  His tumors (with fingers crossed) are gone, and his doctor and the staff were angels in human form.  I know they're out there.

    The GOP will destroy anything they can't own.

    by AnnieR on Fri May 16, 2014 at 06:49:22 PM PDT

    •  I want to know who told the friend her surgery (3+ / 0-)
      Recommended by:
      mumtaznepal, Pluto, AnnieR

      wouldn't be covered.  It sounds like it was the doctor rather than insurance company.  And it sounds like he's trying to discourage her from having the surgery because his contractual fee is lower than he would like so he won't make as much money as he would like on the procedure.

      Insurance companies negotiate the amount they will reimburse for various procedures.  One of the ways they held down premiums for in-network plans was to negotiate lower reimbursements, or fees-for-service with their in-network doctors.  ll insurance companies have these agreements with all their in-network doctors - they have for years.  That's why my explanation-of-benefits statement says my doctor charged $110 for my visit but the insurance only paid her $37.  That (plus my $10 co-pay) is the amount she agreed to accept in exchange for being in their network.  

      It sounds like your friend's doctor is having buyer's remorse over the reimbursement schedule he agreed to with this company.  So if the standard fee for this operation is, say, $8,000 (which nobody with insurance pays; they all have a negotiated fee structure), he will get 5% or $400.  He may be used to getting 7% or $560 per procedure.  Now he's blaming the ACA rather than the fee structure he's been a part of for decades.

      She should find another in-network doctor and as someone else said, she should call a Navigator.

      The past 50 years we: -Ended Jim Crow. -Enacted the Voting Rights Act. -Attained reproductive rights (contraceptive & abortion). -Moved toward pay equity. Republicans want to take our country back. I WON'T GO BACK!

      by petesmom on Fri May 16, 2014 at 10:49:01 PM PDT

      [ Parent ]

      •  It's not my friend, but I certainly (0+ / 0-)

        agree with what you have said.  And I certainly do agree that she needs to find another doctor.  I can't imagine a professional treating a patient like this.  

        The GOP will destroy anything they can't own.

        by AnnieR on Sat May 17, 2014 at 05:45:29 PM PDT

        [ Parent ]

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