You know fixing on the price prior to adjustment is just a waste of time. Could be that is the max allowable from medicare that there reimbursement will cover (with the discount) above that, maybe the insured's cost as that may be the top of their U&C.
The ACA is simply a plan change that we get every year from carriers. That wasn't anything new. The only new about it for some states it took the cheap deal low coverage things away. My state WA, already had most of those requirements in place, so there was no real sticker shock. In fact, so far the last two years renewal rate average had been around 5%. I actually had rate reductions for medical plans. I can count on one hand how many years I had rate reductions for clients. Usually the renewals ran 8-15% a year.
You're not doing clients a favor with limited benefit plans. If they get sick the costs rise so fast, that it might be better to die.
I type this as I sit in a hospital bed with half of my right foot gone. I blistered my feet camping last July and have been dealing for months with the treatment. 3 days from a clean bill of health an infection came up, we treated it, everything looked good. I went home with a picc line and home infusion of antibiotics. Within 12 hours what was left of my infection (super infection) actually blew through the top of my foot to get away from the antibiotics.
Well I am well over 200k in medical costs for just this year. I have a personal case manager from the insurance company over this because of the cost. My cost for the year? $3500. Imagine how screwed I'd be if I capped at 50k, 100k?
Don't do that to your clients. A blister from flip flops turned into a bone infection and $$ of treatments, to finally an amputation. Something so simple ends up costing so much money before you know it, you have a case manager simply because I have unlimited coverage because of the ACA.
Imagine if their obligation ended at 100k?
Look at the ACA as a plan change. We've had them before with every carrier we sell insurance through. Look at it that way as it will change some more and eventually become a better working model.
I hadn't seen your post before I posted mine yesterday-I'm really sorry for what you have gone through and hope all will be well in spite of your loss.
