What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session.

[Northeast Agent]

What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session. — ProPublica

New Jersey’s health plan for school employees pays out-of-network providers virtually whatever they want. Dozens of acupuncturists and physical therapists earned more than $200,000 in 2018 from school staff alone. One brought in $1 million.

 

[somarco]

First, seems a bit surprising, even for a govt entity, to have carte blanche with taxpayer dollars.

Second, when did Pro Publica become a bastion of truth?

Third, what does Last Dollar have to say about this?

 

[Northeast Agent]

somarco said:

First, seems a bit surprising, even for a govt entity, to have carte blanche with taxpayer dollars.

I work as a 1099 occastionally for a TPA. Last year I worked on a big project for retired schoolteachers in NJ.regarding their retiree benefits. They have it made there (and I hear CT and some other States do, too) where they even get IRMAA reimbursed.

Second, when did Pro Publica become a bastion of truth?

I just discovered Pro Publica, so I don't know.

Third, what does Last Dollar have to say about this?

He's probably at lunch right now, it's 12:30pm his time.

 

[leevena]

Article is a bit misleading. The problem is not the fact that the health plan has no limits, that is a symptom. This is a example of elected officials pandering to a union, using public monies. They have no financial skin in the game.

 

[somarco]

@leevena you beat me to the punch. I was going to mention to @Northeast Agent that they probably have very strong teacher unions there.

 

[Markthebroker]

Third, what does Last Dollar have to say about this?

 

[Northeast Agent]

somarco said:

I was going to mention to @Northeast Agent that they probably have very strong teacher unions there.

Hell, yeah they do (why do think they pay a fortune in property taxes to live there?).

And not to be mean, but it was kinda funny when at the meetings I attended last year they learned their retiree coverage doesn't cover LTC. Know-it-alls thought the skilled nursing in their plans was LTC. The union reps and local legislators came in and pretty much told everyone to shut up; they have no idea how good they still had it compared to others.

Totally entitled and they are trying to contain it.

 

[leevena]

Must be nice to eat at the taxpayer public trough.

 

[somarco]

they learned their retiree coverage doesn't cover LTC. Know-it-alls thought the skilled nursing in their plans was LTC.

Most public school teachers here are covered by the SHBP (State Health Benefit Plan).

In 2014 the plan was revamped eliminating all copay plans. The 2014 benefits given to all state employees and teachers for the Nov open enrollment.

By March 2014 the teachers were enraged about THEIR copay's being eliminated. Apparently they didn't realize this until they went to the doc. They protested at state and local meetings, formed a FB page to cry about the plan change claiming that NO ONE told them.

Eventually the state capitulated and reinstated copay plans RETROACTIVE from May to January!! Claims had to be refiled. A total mess.

I think they agreed to have at least one copay plan going forward . . . because the TEACHERS could not afford to take their kids to the doc unless they had a copay.

My wife was on a copay plan with the state for several years before she finally agreed to switch to the HRA plan. Saved several hundred per year in premiums plus the unused HRA dollars that rolled over.

I have been trying to get her off the group plan and on to Medicare for 3 years. Perhaps in a few more years she will change her mind.

Stubborn, but I love her.

 

[InsuranceGuy29]

somarco said:

I was going to mention to @Northeast Agent that they probably have very strong teacher unions there.

Hell, yeah they do (why do think they pay a fortune in property taxes to live there?).

And not to be mean, but it was kinda funny when at the meetings I attended last year they learned their retiree coverage doesn't cover LTC. Know-it-alls thought the skilled nursing in their plans was LTC. The union reps and local legislators came in and pretty much told everyone to shut up; they have no idea how good they still had it compared to others.

Totally entitled and they are trying to contain it.

A privately-funded pension (like Teamsters) is one thing, but when tax dollars are involved, there's no accountability to be found, because (Democrat) politicians need to pander to get votes, and it isn't their money, and they come and go.

This creates a HUGE accountability problem, and taxpayers are always left footing the ever-increasing bill. It has to stop somewhere. Public union employees are some of the most entitled and pampered people on the planet, and all they seem to do is piss and moan.

I think most of them have absolutely no clue about how much money they REALLY make, when you factor in the cost of all their free (or nearly free) benefits.