ACA and after. My plan is ACA compliant. Sounds like the broker sold you a plan that he or she claimed was ACA compliant, but wasn't. The broker could have done that out of ignorance or on purpose. See whether you can discuss your situation with regulators, but given that Chris Christie, an ACA foe, is in charge, I don't expect that you will have much luck. My guess is that you are stuck until November when you can enroll in another plan. It is possible that if you were lied to, you can get the plan voided and sign up in an ACA compliant plan. I hope that you or a member of your family doesn't have a serious medical emergency, my guess is that there are more hidden surprises in your policy. Be cautious when dealing with brokers, unless you live in a state like the one I live in where they can't make false claims and get away with it, you can end up getting ripped off.

just sayin' / askin'

I plug in a family of 4 with an income of $200,000 and the highest silver plan is $614 per month.

My child brings it to 837

Silver plans start as low as $490.

Still, take the advice in this thread. First check up is free, and routine blood work is covered.

Someone obviously made a error.

but that would be a first on the new DU.

broker in New Jersey. Chris Christie is a foe of the ACA, he isn't doing much to make the ACA work for citizens of his state. I am venturing the OP purchased a policy from a broker that claimed that it was ACA compliant when it wasn't - a lot of that type of ignorance or outright fraud is going to take place when Governors and/or legislatures are hostile to the ACA, miscreants find a gap that they can exploit.

someone obviously had an error in judgement in passing this shit to us for a pity party for him/her?

who knows. Cept there are critters out there and here that want everything Obamacare to look bad.

I want to see scans of documents of people making these claims, not that I would know to decipher them but someone here would!

Let us see your papers.

was exactly like and complies with the ACA when they could have just gone through the
ACA in the first place. That is like buying a ETF through a broker and paying a commission rather than just buying from Vanguard or whatever. Why pay a broker a fee when you could get it straight off the ACA web site.

Contact your doctor's office to have them resubmit with the correct coding showing that it was a annual physical.

My sister is studying to become a medical coder.

once she passes the course... (she will) she has been informed that the USA is being required to haul it's ass up to meet international standards for medical coding and billing. (the thing I learned last week while visiting her, it was very interesting. )

This actually sounds like bad billing coding.

I like the idea of international standards.

ICD-10 is coming and it's going to drive a lot of the older coders to retirement. There aren't enough coders to fill the jobs now, and it's only going to get worse.

Get certified and you can name your starting salary practically.

I'm proud of her. She knows it will give her a bump in Salary, but I mentioned to her that I thought she could really go places after !CD-10.

There is a LOT of stuff in those books! I think I am going to buy her a medical dictionary as a gift.

The problem, as I understand it is, Obamacare covers routine screening labs. Check cholesterol, glucose, etc.
If a patient already has a documented illness (for example high cholesterol or diabetes) it is no longer considered screening. It is now considered diagnostic.
For a screening lipid panel, the code would be V77.91, if the patient has high cholesterol and is being treated for it already then the code is 272.0. Once you have a documented illness, it is no longer screening, and to say otherwise (just for the sake of insurance coverage) is considered fraud and abuse. Medicare has extremely strict guidelines on fraud and abuse, and you don't want to be caught doing it just so a patient can get there yearly lipid panel paid for.

addition, 1200 dollars for "routine lab" work is way out of line.

You can go right now and get lab work done for far less:

https://www.lef.org/Vitamins-Supplements/ItemLC381822/Chemistry-Panel-Complete-Blood-Count-CBC-Blood-Test.html

physical, and if not, it need to be corrected.

In addition, a person can pay the following out of their own pocket if they want to get routine work done:

https://www.lef.org/Vitamins-Supplements/ItemLC381822/Chemistry-Panel-Complete-Blood-Count-CBC-Blood-Test.html

Nor do the premiums you pay go towards you deductible.

I call BS on your story.

and if you are paying 800+ dollars a month, then I'd say you're making quite a bit of $$ and can afford it. I'm pretty sure Obama care caps premiums at no more than 9% of your income.

"and if you are paying 800+ dollars a month, then I'd say you're making quite a bit of $$ and can afford it. "

What health insurance plan do you have?

Obamacre is a law, not a health plan. Could you provide more information? When did you sign up? Do you have employee provided insurance or did you buy your own?

Did you use the exchanges? Did you purchase insurance thru a broker? When did your insurance plan go live?

I think some more details would help.

Its the exact same policy being sold on the healthcare.gov without the subsidies. Which I wouldn't qualify for anyway..

must meet a minimum standard, one of those minimums is that routine physicals and bloodwork are free. You plan may look the same, but likely isn't. I suggest that you get in touch with your Insurance Commission office, unless you are unlucky enough to be living in a red state or republican controlled state - in that case, you may be screwed until November when you can sign up for another plan.

So I asked the administrator what the co-pay would be. She said she couldn't tell me since she didn't have my specific plan information, but she could tell me the cost of the blood test and the co-pay would probably be in the 20-30% range. I asked her to look it up since I had decided to stay and get it over with. Until she told me the cost of the blood test: $1,132.

Needless to say, I had no problem putting on my sweater, hat, gloves and scarf and braving the wind chills to drive to an in-network lab to pay nothing.

and use their lab services through a LabCorp drawing station, and get routine blood work for less than 200 dollars. The doctor's who authorize the work are at LifeExtension:

https://www.lef.org/Vitamins-Supplements/ItemLC381822/Chemistry-Panel-Complete-Blood-Count-CBC-Blood-Test.html

There are other ways also.

this guy got out of network bloodwork done and wants to blame it on "Obamacares"....Or as Nancy Pelosi said...they didn't want Americans calling it the AFFORDABLE Care Act...so they named it Obamacare.

bucks. That is worse than gouging.

That needs to be reported.

It should cost him at max less than 200 dollars, and more like 100 dollars

immediatly he is calling "bloodbath" then we find out it is NOT through the exchange...and the guy is paying really big premiums and admits he doesn't qualify for subsidies. Apparently he earns a substantial salary.....he happens to pay a get a big bill (and pretends its some huge amount of money for him to elicit sympathy when he writes about it) then gleefully rushes off to write a post on DU because he thinks HE has discovered the proverbial "smoking gun" about what is wrong with the ACA! That's an agenda if I ever heard one...It is not like that is unheard of around here lately is it?

I Guess you need to be in my shoes to feel ripped off..

happening

to determine what might have happened....even mistakes YOU possibly made...However you DID think to rush off to DU to write a hair on fire about Obamcares post! YOU immediatly think you found the "smoking gun" that "finally finally" supports your narrative!

Not buying...

You did not do your homework. You did not research your coverage, you did not make sure you were using your in network providers. You did not go through the healthcare exchange. You did not ask questions. Now it's Obama's fault?

Go sell it somewhere else buddy. No sympathy here.

for the plan you mention.

Last edited Fri Mar 21, 2014, 09:34 PM - Edit history (1)

in perfect disharmony:

spider senses are up too.

The hospital charge was several hundred dollars, then came the doctor's bill. Luckily I didn't take an ambulance.

speak to. I dealt with things like this for years....before Obama became President. Never occurred to me to blame Bush - I just blamed the insurer, and fought for my rights. You have the right to an appeal, and be a pain in their backsides. Why they said it can't be applied to your deductible doesn't pass the smell test - fight them, threaten to turn them into your state's insurance consumer protection bureau. Also, I've had hundreds of blood tests thru the years - you need to complain about those costs.

That the law required me to purchase

DID you or did you not get this bloodwork done out of network?

Did you purchase this insurance on the exchange or through an employer?

I went to lab attached to the medical group ..

It never even crossed your mind that it might be a clerical error....or you might have gotten it out of network...you NEVER thought of either of those or anything else that has gone wrong in healthcare and Insurance for ever....YET you were sure quick on your feet to dash off to DU to write a post proclaiming you thought you found the ACA smoking gun! In fact you were pretty gleefully proclaiming it a coming "bloodbath".

Because it supports your pre-established narrative....In fact you also very smugly said "I thought the ACA was going to stop all this"

So because you a single person had an issue with a medical bill.....suddenly Obamacares is an abject failure. Sounds like an agenda to me...

Most people aren't going to rationalize in a calm way ...more likely than not they are going to point to an easy target and pull the trigger...


It might not be fair ....but I think the pukes have loaded up the bases anticipating teething problems.... And we night just walk in to the trap ...

because you listened to fox news and all the right wing talking points.

Then you came here to pull the trigger because you thought we were all easy targets. Too bad you pointed the gun right in your own face.

Otherwise there will be a bloodbath!

but mistakes do happen. Unfortunately it's up to the patient to double check behind them before you move an inch. Very easy thing to have happen.

Last edited Fri Mar 21, 2014, 08:18 PM - Edit history (1)

health insurance issue that you have on DU. If you do... look out because it's bombs away.

Because it will be quickly verified against the facts.

Democrats have learned hard lessons about letting Republican lies go unchallenged. The same thing applies to Green Party/Naderite lies as well.

So don't come onto this site and peddle that shit. It just won't fly.

- C.D. Proud Member of the Reality Based Community

Civil DUers may decide to talk to the OP and figure out what's going on.

http://www.democraticunderground.com/10024705734#post83

Autumn. Proud Member of the Civil DUers Community who doesn't call everyone a liar because she doesn't like what they have to say.

...attempting to disparage the law in an outrageously false manner, there wouldn't have been the response there was.

If the OP had started out with "I got a huge bill. I don't understand" and actually discussing their situation, most DUers would be happy to respond entirely positively. But we've seen so many lies about the ACA by now, that if you just start screaming that the ACA doesn't cover something we know it does, people are going to call you on it. Period.

What's next? Someone posting "Obamacare has death-panels" and then explaining later on that their cat died?

- C.D. Proud Member of the Reality Based Community

is that the medical facility where you had it done, did NOT code it correctly.

First call the insurance company, and tell them the lab work is part of your yearly physical.

They should be able to tell you if the clinic coded it wrong. If they did, then you should call the clinic and tell them to correct it.

In addition, if you are talking about routine bloodworm, that is chemistries and CBC, at the maximum that should retail about 250 dollars. There are reference labs which are accredited where you can actually have lab work done for a lot less, but the 1288 for routine lab work cannot be correct, and if it is, that is price gouging, and that need to be reported. Provided we are not talking biopsies or other more esoteric procedures or work.


For Example:

https://www.lef.org/Vitamins-Supplements/ItemLC381822/Chemistry-Panel-Complete-Blood-Count-CBC-Blood-Test.html

It might also be that the lab used for the bloodwork wasn't in network... It was attached to the medical clinic ...I assumed that since the doctor was in network the lab was in network too..

I need to get answers ...but I can't call up ..because their offices are currently closed

dollars.

Right now anyone can go to a reference lab and get routine for a lot less

https://www.lef.org/Vitamins-Supplements/ItemLC381822/Chemistry-Panel-Complete-Blood-Count-CBC-Blood-Test.html

for a routine blood test to the tune of $800, so if someone gets billed $1200 6 years later, it would not surprise me. Some labs do charge a fortune.

Don't know about them

It was the lab my medical clinic used, and it was the first blood test I received in the US after I had lived in another country for several years. I had no idea it would cost that much - and for only 3 vials of blood. 10 years prior to that, I would get charged one set price from the clinic which back then was cheap compared to now. Now labs bill separately. I have seen other people get gouged like that, you really do have to call around and see who's more reasonable. It can happen where you as a cash paying patient or one with insurance that won't pay will sometimes receive bills that high.

bloodwork. Meaning they sent me in for a CBC (complete blood count) and it only covered 1 of the 10 tests included. Same with lipid panel, only 1 of the many tests were included. I talked to the clinic who ordered it and the lab who did it, all part of the same healthcare conglomeration. They sent me to billing where I filled out paperwork and got a bunch written off.

I think the doctor who ordered it did not know the specifics of what was covered, neither did I.

Work your way through the system, it sucks to have to do it but good luck.

my insurance <United> doesnt seem to know what they cover and what they dont.

1. You must not complain about ObamaCare.

Maybe the first rule should be to get your facts straight.

"he feels ripped off" and claimed that Obamacares was supposed to prevent this!


hahahahahahahaha

On Page 292 of the document.

it turns out they are wrong....EVERY.SINGLE.TIME

Every single one on DU and every single person appearing in a Koch funded commercial...

You think that hasn't earned a great deal of skepticism?

But I am not personally invested in most of the things said on a message board.

it supports your position....I wouldn't expect any different....

FACTS are still facts...EVERY SINGLE TIME

But not my point.

YOUR narrative, it seems, is to prove this story to be BS or to prove this OP wrong or to prove this OP has an "agenda".

My point is that I am not that invested in this OP or this thread.

If this thread is BS, fine. Wouldn't be the first time a thread on a message board is made up.

That's why I tend not to take threads or posts on a message board seriously.

thats pretty clear evidence that there are alot of people that just have an agenda....

Its called connecting dots!

As, in this case, either a coding error or going out of network.

an ACA identical plan from a private insurer.

It's very confusing.

There likely is no state exchange. If the OP purchased a policy before the federal ACA site got corrected, he would have had to go through a broker. One can blame the OP for not reading the fine details before signing on the dotted line, but how many of us have skills in all areas of business? I know from fact that I face contracts and policies that cause my eyes to cross, but I am able to hire Attorneys that specialize in the area of the contract to provide me with advice, most people don't have that option.

The OP is screaming about Obamacare and calling for a blood bath and he does not have a plan that he could have bought on the Exchange. I did it and hundreds of thousands of people in NJ did it and they are covered 100% for their blood testing. I bought mine in October. The site has been up and running for months. There is no reason for him to have bought a plan from a broker and then blame the Exchange for his bad judgement or inability to read and understand his coverage.
One thing that the ACA has done for people who want to buy private insurance is require that policies are written in easy to understand language. Who doesn't bother to read their policy and call their insurance company to get a list of providers? That's like writing a blank check and handing it to a stranger.

I live in a state that has standards, I get the personal insurance policy that is promised. I do read business policies, I promise you, they are a confusing read. At some point, unless one is an insurance agent or hires an Attorney skilled in insurance, a person will get ripped off if not lucky enough to be dealing with an honest agent.

Yet I have no problem reading and understanding it. Yes it is 80 pages long and dry but it's an important document. Do people really make decisions that effect their lives without knowing what they are signing and paying for? I find that unbelievable.
I read my mortgage and my car insurance policy too. I just don't understand people bitching about a problem when they caused it by not taking care of their own business.

and my doctor's visit (including the trip to draw blood plus the follow up) is a $10.00 co pay, not counting the one free visit a year.



Did you bother reading what the policy covered?



Just exactly who is your insurance company and what plan are you on? I would love to research this myself.

You can also buy it from health care.gov ... For NJ ...its called the NJ amerihealth silver advantage tier 1 ...

I am sure bloodwork is covered ...but probably only from certain lab

And if they're not, call your doctor's office and let them know not to send it there again. Also, ask why the cost is so high for routine blood work.

Look like the broker pulled a fast one on you. Plans can only be listed under the ACA site if they meet minimum criteria, free physicals and routine bloodwork being among the criteria

health care. Some of us (me for instance, I am not as swift as I used to be) need help in understanding the process. It can be confusing.

I just got my check up, and blood work for the physical plus blood work for my endocronoologist. Not sure the spelling is correct, I am sure the entire bloodwork cost to me was less than $40.

I have a silver plan in Maryland, with a $1300 deductible.

The OP lives in Christieland, so getting the problem resolved may not be possible until November when the OP can get in to an ACA approved plan.

I'm seeing a lot people turning all their health insurance decisions over to a broker and are getting screwed. How are these brokers paid exactly?

brokers can be bad for people looking for insurance. Brokers represent the companies issuing the policy, they get a commission when a person buys a policy. Honest brokers will lead people to a policy that fits their needs and won't rips them off, but those brokers are honest people who have empathy for all situations whether in their field or not.

plan before you signed up?

It is simply stunning to me... because, if it was not a billing code error, I would have thought that the lab should warn a person that their lab did not accept your insurance.

Good luck...

equivalent to a plan on the ACA site. I doubt that claim, the ACA plan had to meet minimum criteria, among which are free physicals and free or inexpensive bloodwork.

opposing the ACA. Bloodbaths work to Christies's advantage and proves his narrative.

and when new systems were instituted, there was a period of adjustment.. until everyone got with the program, so to speak.

I hope that the OP and his family can make the change into the ACA version of the plan.. if that is still possible, and if that was the problem.

Thanks for the help in understanding.

I saw Canadian Health Care Clinics there, do they operate through the Canadian government plan?

I had never heard of CanCare Clinics before, even having travelled to Florida.. so thanks for the opportunity to read about them.

Before leaving Canada and before leaving Canadian airspace private travel insurance should be purchased to theoretically cover costs if a Canadian requires health care outside of Canada. This is priced at a coverage cost per day based on one's relative health. Last year one question was: are you prescribed furosemide/Lasix, in addition to a very comprehensive questionnaire re various medical conditions and how long ago one encountered those medical conditions.

Also, some higher end credit cards carry medical insurance coverage for maybe 3-7 days.. which gives the more frequent cross border traveller, access to American health care.. Again, I do not know the extent of the coverage, but it is a private plan, part of a Canadian obtained high end credit card.

One is warned, before using the travel insurance, that you must call an -800 # to explain the medical condition and receive an authorization number and instructions.. probably which hospital, etc to use... or you will not be covered.

This is obvious to Americans, but Canadians are not used to that at all. Basically, any hospital accepts your Ontario Hospital Insurance Plan coverage. You see your physician and do not jump from physician to physician based on insurance plan inclusion or not.

CanCare Clinics seem to emphasize that their expertise is in dealing with private Canadian and other travel insurance coverage and they indicate they will help a person deal with insurance companies.. and somewhere down the page they indicate that if you have to go to a hospital, that they have access to people who can help with obtaining a hospital bed covered by Medicare rates.

I find myself nervous even thinking about it all... but it was an interesting read.