Overheard: ACA policy networks are confusing


Posted by admin | Posted in ACA-Obamacare, Samaritan Perks | Posted on

I was sitting at a sporting event this weekend and overheard some people sitting in the stands nearby talking about an ER visit their child had 5 months ago. Fortunately he is fine, but I specifically heard one of them say, “I don’t know if we took him to the right place for our insurance.” There was confusion about whether the ER and subsequent doctor visits were part of their insurance plan network. The matter was further complicated by a disagreement between a hospital group and their insurance company so facilities which are normally “in-network” aren’t necessary that way today (or during that visit) and they didn’t know what would happen billing wise because of that. Take note, this was 5 months ago and they still had questions.

I didn’t lean over and ask questions, but from the bits and pieces I heard it became clear to me that having an insurance policy was now a nightmare if you needed to use it. Not only are premiums expensive, but the little details are so frustrating at a time when you just want to take care of your family. Having to wonder which hospital is in-network vs out-of-network is NOT something I would even consider if my child was sick or injured. It’s just not. In an emergency I would take him to the closest place that could treat his needs. Especially if I’m on vacation.

Those poor people have the potential of paying a significant amount for those visits because of insurance fine print. Maybe they’ll get lucky, but odds are not in their favor. The hospital is already promising to balance bill (at full rack rate) anyone who has that particular insurance company, so they could be facing something very expensive completely on their own. As I listened I felt a deep sense of relief and calm that we have Samaritan. The network question isn’t even part of the equation, and any event happening 5 months ago would have already been paid 2-3 months ago. There wouldn’t be anything dragging on that long unless the hospital billing was slow. Samaritan’s processes and guidelines are so freeing when it comes to our family’s health care.

The changing landscape of health care in this country is breathtaking. It’s hard to keep up. There are big decision coming from the SCOTUS this month and that will only rock the boat even further. Once again, our membership in Samaritan is keeping us afloat and gives us a lifeline to people who care and are there to help.

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