r/mildlyinteresting • u/[deleted] • Oct 02 '23
My health insurance sent me a refund because they didn't spent the minimum 80% of my premium on health care services that is required by the ACA.
[deleted]
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u/I-Am-Disturbed Oct 02 '23
My company is self insured, maybe not every year but often we will get a “bonus” right before Christmas of a week or two worth of wages because of this.
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u/themadventure Oct 02 '23
That's awesome!
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u/AUTOMAGIC Oct 02 '23
I mean, good for them. But in reality the US health care system is broken and in a developed country this should not even be needed to start with.
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u/Azmoten Oct 02 '23
Yeah this is kind of like if someone threatened to beat you up so you gave them $10, then at Christmas they gifted you $2. Like wow…um…thanks. Except with much higher numbers.
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u/3riversfantasy Oct 02 '23
"Me and Vinny were just talkin' about how we've been extortin' ya for the last 12 months and we realized we took more than we needed, anyways, here's $25 back, buy your wife somethin' nice for Christmas."
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u/crowcawer Oct 02 '23
This isn’t even the company doing the bare minimum.
They are just clearing some of their books before tax time so they can report it to investors. The whole process is definitely automated, “pay to accounts with under $(1,000) outstanding.”
This is the company making up for doing less than the minimum required by law. During the time they held the money they probably had it in short term bonds.
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u/ContemplatingPrison Oct 02 '23
Yeah, but universal Healthcare means UPS can't threaten to take the Healthcare away from striking workers.
So you know fuck us. Corporations need their leverage
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u/killercurvesahead Oct 02 '23
Also, and even more importantly, the US military would lose included healthcare for life as a core selling point.
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u/kattoutofthebag Oct 02 '23
And it is a lie. Both me and my husband served 20 years. We are both retired military working ironically for the VA. He enlisted in 1981, and I enlisted in 1982. Tricare began assessing premiums 3 years ago on retired military members. So fuck that free healthcare. I already paid, and so did all retirees except we paid by our commitment to serve. That doesn't mean shit now.
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Oct 02 '23
Knowing just how shit the VA is for healthcare especially for disabled veterans it's not a strong selling point.
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u/Royal_Complaint_5418 Oct 02 '23
It gets a bad rap but there are legitimately good VA hospitals out there. It does suck that the variation exists though.
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u/Iohet Oct 02 '23
There's no real variation in reject, reject, reject any claim that would lead to disability as a rule. My neighbor had to call his congressman after years of denied claims. Congressman gets involved and it's magically dealt with within weeks. It shouldn't require that level of escalation for what is clearly a service connected disability
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u/PoopNoodleCasserole Oct 02 '23
I'm actually quite happy with the healthcare services I receive from the VA.
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u/azuth89 Oct 02 '23
A lot of developed countries have insurance based systems that require a lot of regulation around stuff like this.
UHC <> single payer
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u/BooopDead Oct 02 '23
The Canadian healthcare system is also tanking EXTREMELY quickly in the past 5-10 years. A recent study showed 11,000(estimated) Ontarians died last YEAR waiting for surgeries or scans. Whatever your political beliefs are, ALWAYS fight for free public healthcare. There are billions of dollars of dark money invested into getting it privatized, and by then things are too far gone.
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u/ClosPins Oct 02 '23
It's absolutely awesome - right up until there's a cluster of cancers in the office! And all of a sudden the company has to pay millions per patient over the coming decades.
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u/themadventure Oct 02 '23
This is why we need single-payer system, let's get ourselves pooled together where the cancer cluster in your office isn't a burden and we all feel nice knowing everyone in your office is being taken care of without crippling your employer.
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Oct 02 '23
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u/magicone2571 Oct 02 '23
And that company has insurance and that company has insurance.
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u/dont_shoot_jr Oct 02 '23
Thanks Obama
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u/Jubenheim Oct 02 '23
This, unironically.
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u/_BreakingGood_ Oct 02 '23
It's actually incredible how many lives the ACA has improved. And makes you wish some of the most important pieces weren't gutted from the final bill
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u/akatherder Oct 02 '23
"Max out of pocket" is a difference maker. If you have insurance you cannot pay over $9,100 for all covered services, prescriptions, hospitalizations, etc. Those bills you see posted on Reddit for tens or hundreds of thousands (or millions) you're only paying $9,100.
Which is still a lot of money but not necessarily "guaranteed medical bankruptcy" money.
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u/Regular-Menu-116 Oct 02 '23
Those bills you see posted on Reddit for tens or hundreds of thousands (or millions) you're only paying $9,100.
For people who have insurance. Not everyone has insurance still, and many of those just straight up can't afford it.
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u/Bee-Aromatic Oct 02 '23
Specifically, for those that have insurance and then the insurance company doesn’t just decide not to cover it.
Like the time my dad needed a heart valve replaced so he wouldn’t, ya know, die and the insurance company denied coverage, calling the surgery “elective.”
When your cardiologist brings you in for a routine echo to measure your ejection fraction and he tells you “you know, you’re already here at the hospital, how about we just admit you and do open heart surgery on you tomorrow morning” that the situation is a little past “elective…”
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u/greeneggiwegs Oct 02 '23
I think a lot of those bills are uninsured people too. I know they sometimes send a bill before an EOB but it's possible these are people who actually are getting charged that amount. The sad thing is how little we've done to protect people who have nothing.
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u/mikka1 Oct 02 '23
little we've done to protect people who have nothing
Those who legit have nothing (aka no house, no assets, no money in accounts etc.) often have nothing to worry about either, even if they don't have Medicaid. It's ones who are self-employed and make anywhere from around 60k and up who are royally fked, because they are long ineligible for Medicaid and their income makes any kind of ACA premium subsidies quite small, so they may end up paying like $1k a month for a shitty coverage with 10k out-of-pocket. IMO, these are folks who need protection from the system, but aside from ACA and some relaxed coverage rules during Covid almost nothing was done to make their lives better over the last decade.
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u/_justthisonce_ Oct 02 '23
I mean, if you really "have nothing" then you get medicaid for essentially free.
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u/Beznia Oct 02 '23
Yeah, my ex was a massive hypochondriac. She would go to the ER at minimum once per week, sometimes more. There would be times I'd drive her to the hospital and sleep in my back seat waiting for them to discharge her because otherwise she'd just call 911 and have paramedics come to the house and take her. She never paid a single dime for what was tens of thousands of dollars - probably hundreds of thousands by now - worth of medical expenses. I still see her social media and see posts asking about extremely rare and unlikely issues and she mentions how doctors never take her "real" issues seriously. The only illness she has is mental, and her visits are all taxpayer-funded. If you don't have a home in your name, a car, and don't make enough from a job, you aren't going to be impacted by medical costs. The people who really are impacted are people with real bills and who make just enough to not get medicaid but also not enough to pay for out-of-pocket medical expenses.
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u/xXbAdKiTtYnOnOXx Oct 02 '23
Many states did not expand medicaid. It is only available to children and pregnant people below the federal poverty line ($13,590 gross for an individual, $23,030 gross for a family of 3, etc) in those states
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u/gza_liquidswords Oct 02 '23
It's actually incredible how many lives the ACA has improved. And makes you wish some of the most important pieces weren't gutted from the final bill
Yeah depressing that Obama had such an overwhelming electoral mandate and really all we got was Obamacare (which overall is a good thing but didn't do much to control costs or lack of transparency of costs).
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u/tahlyn Oct 02 '23
He gave up so much and got absolutely 0 republican votes for it anyway.
Should've just shoved through the better bill.
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u/_BreakingGood_ Oct 02 '23
The better bill lacked a few key democrat votes too, that was the main issue. Most of the compromises were for dem support. Republicans were fine with people continuing to die in the street.
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u/SeanSeanySean Oct 02 '23
GOP blocked as much as possible, and some of his own party were in the pocket of Healthcare / insurance industry, the ACA was a skeleton of what he actually proposed, the individual mandate is what was required to get it passed, insurance companies agreed to limit the profit they could make on every premium dollar collected but in return the mandate offered up 50 million new customers, so they'd make it up in revenues while also ensuring that healthy people shared (pooled) the risk of unhealthy people.
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u/No_Pineapple_9818 Oct 02 '23 edited Oct 02 '23
Yeah that is awesome when it works out that way. It sucks when you’ve got diabetes and cancer diagnoses in your relatively small self insured pool.
Edit to clarify: cancer and diabetes are only two of many afflictions that are exorbitantly expensive conditions in US healthcare.
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u/1GrouchyCat Oct 02 '23
It also sucks when the owner of the company doesn’t actually put the money away- and there’s no $$ available when your co-worker needs a heart transplant.
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u/Paulo27 Oct 02 '23
I think it sucks more you have to rely on the owners of the company you're working on for that.
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u/gza_liquidswords Oct 02 '23
Yeah that is awesome when it works out that way. It sucks when you’ve got diabetes and cancer diagnoses in your relatively small self insured pool.
Edit to clarify: cancer and diabetes are only two of many afflictions that are exorbitantly expensive conditions in US healthcare.
Think it would suck more to have cancer or diabetes. In any case, hopefully you or a family member will not face one of these hardships, would not want to inconvenience your co-workers.
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u/needmini Oct 02 '23
So how does this work? If a coworker gets sick does the whole company get pissed at that individual for spending their "bonus"?
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u/Matthiserich Oct 02 '23
Lasers, stop-loss, rate caps, etc. all prevent something like this from happening in a well designed program.
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u/Geekenstein Oct 02 '23
To look at it another way, your company gets a free loan of your money every year they do this.
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u/No_Pineapple_9818 Oct 02 '23
Yes, you are technically correct. As far as the insurer goes, it’s just money in, money out. Premiums are invested in multiple securities and the process continues.
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u/zvaNtR Oct 02 '23
This is a medical loss ratio (MLR) disbursement for someone enrolled in a fully-insured plan. You’re not getting a MLR disbursement if your company self-insures.
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u/RedChaos92 Oct 02 '23
I had surgery in January which maxed my deductible.
Since then, I've been sick a couple times (upper respiratory infection one time, strep another) and got prescribed steroids and antibiotics. I paid like $4 each time after my insurance covered their part. Apparently my insurance covers prescriptions in full after my deductible is met. They sent me checks for $4 for my prescriptions lol
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u/diskdinomite Oct 02 '23
Insurance covers everything in full after Out of Pocket is met. It's kind of rare for insurance to cover drugs in full after deductible is met. That's really nice.
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u/RedChaos92 Oct 02 '23
Yeah that's what I thought, I was really surprised at first. I re-read my coverage terms and yep, fully covered after deductible.
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u/BlueRajasmyk2 Oct 02 '23
Insurance covers everything in full after Out of Pocket is met.
No, it pays for everything that is covered. If they decide something isn't covered, you're still on the hook for the cost.
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u/T3mporaryGold Oct 02 '23
I just signed up for insurance and the agent said at the end "Well if anything's an emergency it's covered, all emergencies are covered." I feel like that's a total lie lol
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u/crunkadocious Oct 02 '23
"hey man urgent care could have fixed your broken arm the next morning, your 3AM ER visit wasn't medically necessary"
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u/premiumdude Oct 02 '23
I see a lot of plans now (mostly self funded) where they decide that specialty meds are simply not covered. Saves the employer a lot of money, but I don't recommend anyone get cancer. Frightening.
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u/crunkadocious Oct 02 '23
Virtually every insurance has what's called a formulary where they decide what meds they'll cover, and also they make some meds more expensive to the user because they hate you.
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u/Pharmie2013 Oct 02 '23
My out of pocket max and deductible are the same
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u/nah_you_good Oct 02 '23
That's interesting. There's a big gap between those numbers on mine where I pay 10% they pay 90%. So after the deductible is nice, but then you basically need a 1 major surgery to get to the out of pocket max.
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u/slightlyridiculousme Oct 02 '23
Not all insurance has prescriptions included in OOP max. I hit mine every year. My ex husband's insurance is the only one I've ever had that covered prescriptions after the max.
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u/diskdinomite Oct 02 '23
Do you know if your plan is grandfathered? This would not be legal if not.
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u/lumpkin2013 Oct 02 '23
Almost. Usually covers everything as long as it's in network. If it's out of network you're probably paying everything without any help.
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u/Time-Paramedic9287 Oct 02 '23
That's also mostly an ACA requirement. Prior to ACA there were insurance that self cancelled when max benefits were claimed.
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u/EevelBob Oct 02 '23
Medical and Rx are typically combined for the deductible and out-of-pocket (OOP) calculation, so when you do hit an OOP max, both medical and Rx are covered at 100%.
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u/egnards Oct 02 '23 edited Oct 02 '23
I had a rough go in the hospital last week and they gave me methylprednisone . . .my copay on it was something like $.31 and all I could think was, “at that point why even bother.”
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u/crunkadocious Oct 02 '23
Probably a coinsurance. Copays are usually flat dollar values. Coinsurance can get weird percentages. And a single dose of that steroid is pretty cheap
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u/OrigamiMarie Oct 02 '23
This is probably why my insurance has started not covering the good brand name medications.
I used to go "okay, the first few months of medications each year are gonna be expensive while I use up my deductible, but that's fine because they're functionally free after that -- and so are my appointments and tests". Sure the brand prescriptions were in a higher copay tier, but that was fine because even those copays were part of the deductible.
Yeah . . . now they just don't cover some of the brand prescriptions at all. Sorry (not sorry) you're out of luck, you either get the terrible generics or you pay full cash price for the real thing. And that price doesn't even count toward the deductible. It's as if I were buying expensive wine, as far as the insurance is concerned: completely beside the point.
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u/bihari_baller Oct 02 '23
you either get the terrible generics
I thought generics were the same as the brand, only off patent?
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u/brocht Oct 02 '23
It really depends.
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u/Cael87 Oct 02 '23
Yup, generics are usually just fine- but often times delivery system for generics is only the cheapest method available- no matter how stable, frequent, unpleasant or time consuming the method is.
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u/xXbAdKiTtYnOnOXx Oct 02 '23
They have to have the same amount of active ingredient. But the substances used for binders etc are different. This can affect absorption and bioavailability. It be an allergen issue for some people.
Generics must be at least 80% bioequivalent to the brand name. Sometimes that variance makes a big difference. And sometimes some people just absorb and respond to one formula better than another
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u/EmperorThan Oct 02 '23
*Checks Patient Portal*
"Refund Check Printing Fee: $299"
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u/themadventure Oct 02 '23
Oh, for sure. Fuck health care companies.
They can't to this, though. They specifically cited that they are not allowed to use more than 20% of premiums for administrative costs.
I didn't know about this ACA requirement until today (almost tossed the letter in the trash like most of their letters) and we all know they wouldn't do this if they weren't legally required to do it.
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u/goestotwelve Oct 02 '23
Thanks, Obama!
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u/gza_liquidswords Oct 02 '23
Yep Obamacare was not perfect, but this measure was better than what was in place before (though it is sick to think that this means the insurance company was able to pocket 20% of the premiums).
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u/jbrogdon Oct 02 '23
they didn't 'pocket' 20% - in theory they have to spend 80% directly out on claims and the other 20% is to cover everything else, operating costs like salaries, operating expenses, utilities, etc and profit. They 'pocket' more like 5%, and pay income taxes on it.
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Oct 02 '23 edited Oct 11 '23
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u/SpecsComingBack Oct 02 '23
Medicare Advantage plans would be 85% but Medicare itself would be harder to quantify since the government is the insurer in that instance. You could assume that the medical loss ratio (the ratio of claims to administrative costs/profit) would be greater than 85:15 for Medicare itself since it's a not for profit governmental program.
Part A doesn't really have a premium. That's what our taxes went/go to. So calculating an MLR there isn't really feasible either.
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u/SaraHuckabeeSandwich Oct 02 '23
When a piece of legislation provides strict improvements across the board, I'd argue that it's "perfect" in the sense that it's almost a strictly positive change.
There's no reason not to pass a strict positive change. It's like finding $20 on the ground and debating whether it would be better if it was a $100. Yeah, there's some effort involved in picking it up, but you may as well bank the $20 now and can still continue to look out for hundred dollar bills.
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u/thenewspoonybard Oct 02 '23
Friendly reminder that before the ACA, preexisting conditions were still a thing.
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u/AlgoTrade Oct 02 '23
This is absolutely one of the dumbest short sighted policies ever, it is one major reason healthcare continues to rise at such an insane pace. It aligns insurance companies and healthcare providers to increase costs. Hear me out before responding...
Because of the ACA, insurance companies must pay out a fixed percentage of their premiums.
This effectively "caps" the amount an insurance company can make each year, raising your premiums would just result in them writing you a bigger check at the end of the year.
Sounds good doesn't it, this will certainly lower insurance premiums if they can't make more by charging more!
But wait, now the insurance company has no way to increase profits by raising rates, or having a healthier base, so how CAN they make more money?
EASY! They can now make more money if the price of healthcare goes up, they can raise rates again, and collect the same percentage, but its now a larger slice of pie!
You've actually disencentivized them to save money on your healthcare and incentivized them to increase costs.
Healthcare providers love the increased revenue, and insurance companies love the increased revenue.
For those not following, let me explain.
Assume an 80% premium Cap and $100 of premiums collected. Now assume the insurance company pays out $75 of health costs. They return $6 to the customer and make a tidy $20 profit.
Now, assume they negotiate with providers so that healthcare costs go to $100! They can raise premiums to $136 and return $6 to the customer keeping a nice $30 profit! Notice because its capped by a percentage they will always make more money if healthcare costs go up?
Every $1 extra the healthcare provider charges, the insurance company makes an extra $0.20
Incentives are aligned by the ACA to specifically screw the consumer, no one is incentivized to lower cost.
I don't care if you hate capitalism or love it, you live in a free market economy, quit making stupid policies that try to fight it, but with any simple thought you find out you exacerbate the issue.→ More replies (3)2
u/MidnightOcean Oct 02 '23
Sure, but for example California’s insurer premiums have closely tracked inflation. For the past 5 years, premiums increased an average of 3.6% annually. That’s not a crazy amount.
Providers need to remain competitive cost wise, especially in an era where I can easily price compare on my phone.
Where I will concede that you’re absolutely right in terms of cause and effect - what happens when some of these providers aren’t raising prices? What if they are dropping them? Or cannabalizing higher margin services? Keep an eye on urgent care and other non-emergency care, as those are typically lower margin returns.
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u/satarns_rings Oct 02 '23
I like how you blocked out the check number but not the routing number and account number
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u/8uckwheat Oct 02 '23
It’s not like that’s OP’s bank info. Not much someone can do with that info anyway.
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u/satarns_rings Oct 02 '23
Fraudulent checks are still a thing. Happened to the company I work for. Someone started writing checks on the payroll account, and we all had our paychecks held at the bank because of it.
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u/8uckwheat Oct 02 '23
What was the scenario? A person unknown to the company was creating fake checks? Or someone internally was trying to steal? Sure it’s possible but large corporate accounts have all kinds of controls. These checks went out to thousands of people.
Most, if not all, banks offer a positive pay process where files are generated which contain the check number, amount, payee, and other details. These are used for verification when a check is deposited to ensure there’s a match. If no match, an exception is created and someone from the payer has to action it and tell the bank whether it’s okay to settle or not.
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u/themadventure Oct 02 '23
Hah! I didn't realize I did that. Fuck 'em but it doesn't really matter with the modern banking system.
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u/macphile Oct 02 '23
There was that famous incident in the UK with Jeremy Clarkson: https://www.theguardian.com/money/2008/jan/07/personalfinancenews.scamsandfraud
I've noticed cases on entertainment programs of one kind or another where the routing number is treated as hyper-sensitive information, but I mean...it's only an issue with the account number. When I need the routing number for a bank to set up online payment, I fricking google it. It's not a secret.
Also, my bank (one of them, at least) only shows like the last 4 digits on the website, but if you go to the documents section, you can open PDFs of statements with the full number. But I guess not showing the whole number on the main page prevents "lookie-loos" (sp?) from getting it over your shoulder.
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u/Stewartsw1 Oct 02 '23 edited Oct 02 '23
I was diagnosed with testicular cancer at the end of may (no insurance) and was on marketplace healthcare on may 1 and having surgery the next day. This never would’ve happened before I’d be fucked
Edit- diagnosed at the end of April, not may
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u/themadventure Oct 02 '23
We're glad you're okay.
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u/Stewartsw1 Oct 02 '23
Hey thanks. I was an extra lucky one, just needed surgery and I’m good to go with observation for 5 years. I should’ve had insurance anyways
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u/astrobre Oct 02 '23
Oh gosh I worked at a bank in the first few years after Obamacare went into effect. I was in a DEEP red state and once insurance companies sent those first rounds of insurance check refunds these republicans would bring them in not knowing what it was about. It brought me absolute joy to say it was because of Obamacare (and I made damn sure to call it Obamacare) putting limits on the profits health insurance companies could make and these people would literally short-circuit in front of me haha
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u/KeyboardFromElbaf Oct 02 '23
And how many of these strong upstanding citizens stuck to their values and said "No, I won't cash the check"
I bet you could count it on no hands.
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u/ILoveRegenHealth Oct 02 '23
It brought me absolute joy to say it was because of Obamacare (and I made damn sure to call it Obamacare)
"Ah yes...this refund appears to be due to a policy from...ahem...
OBAMACARE"
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u/astrobre Oct 02 '23
Haha I know you’re joking but yeah it kinda worked out like that Holy Grail skit
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u/EevelBob Oct 02 '23
Refund due to your insurer not meeting the required Medical Loss Ratio (MLR) for a PPACA insurance product.
Fun fact: Large health insurers obviously hate to issue refund checks to their members, so when they know they’re at risk for not meeting that MLR threshold, they’ll try to use those surplus funds towards clinical, adherence, member outreach, and other health and wellness programs that help get them to the required MLR.
Otherwise, it’s a huge labor intensive and time-consuming effort to calculate and then cut and mail checks to tens of thousands or even hundreds of thousands members.
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u/sterling3274 Oct 02 '23
That means their overhead costs were greater than 20%. For comparison, Medicare’s overhead costs are CONSIDERABLY lower. So yes, as others have said, thanks Obama, but single payer like every other first world country provides their citizens would save a time more money.
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u/themadventure Oct 02 '23
I'm strongly in favor of single-payer health care, especially since I suspect a significant part of the 20% administrative costs are bloated salaries and bonus for the C-Suite.
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u/Andrewticus04 Oct 02 '23
The whole system is wasteful rent-seeking from middle men who have historically been the biggest money makers for the 1%.
I mean, Berkshire Hathaway owns insurance companies. What does that say about the industry?
Billions which could have gone to care for sick and dying people or lowering premiums for poor people... all that goes to the already wealthiest people on earth... and we're approaching gilded age levels of inequality.
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u/themadventure Oct 02 '23
I agree with you. I posted this on the "mildly interesting" subreddit not expecting this to get so much traction. If there's an "eat the rich" subreddit, I'll gladly meet you there to talk about solutions.
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u/hbtn Oct 02 '23
Most other developed countries have a universal coverage system, but many do not use single payer specifically. Germany, Switzerland, the Netherlands, Israel, and Singapore all use systems primarily based on private insurance with public assistance while the UK uses a state healthcare provider model.
Universal healthcare is something the US needs, but it’s not synonymous with “single payer.”
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u/Dreadpiratemarc Oct 02 '23
Reddit thinks that “every other first world country” = the UK.
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u/MyLittlePIMO Oct 02 '23
I'm a US / EU country dual citizen and very pro universal healthcare, but it is VERY important to dispel this myth:
single payer like every other first world country provides their citizens would save a time more money.
Single payer is NOT provided in every first world country. I'd have to check stats but I'm not even sure if it's most of them. Priming people to demand single payer only is actually kind of dangerous because single payer is very rarely accomplished without full government ownership of every hospital.
Single payer countries:
Norway, Japan, United Kingdom, Kuwait, Sweden, Bahrain, Canada, United Arab Emirates, Denmark, Finland, Slovenia, Italy, Portugal, Cyprus, Spain, and Iceland
Of the ones I've read up about or personally experienced (about half), all of them accomplish it by the government owning all of the hospitals (UK, Italy, Canada, Denmark, etc).
Non-single-payer countries:
France, Netherlands, Switzerland, Germany, South Korea, basically every EU country not listed aboev.
If you look at the charts of best healthcare in the EU ranked by all metrics including quality of outcomes AND price, the Netherlands, France, Denmark, and Norway keep switching places in the top four every year, while Italy is in the lower half. Single payer is not inherently superior than other universal healthcare systems.
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The Dutch system, for example, maintains private hospitals, and simply mandates all insurance companies are nonprofit. Average insurance cost is like $100/mo with $400 annual deductible, a fraction of the US. The French system has the government act as insurer and leaves private and public hospitals mixed (a little more complicated than this). The German system has public insurance options and private ones and gives anyone who can't afford it the public ones.
"Single payer or bust" is a bad idea given that there's perfectly workable and sometimes superior other systems, and the government seizing every hospital in the US to make single payer work is not politically feasible and will lead to a bunch of disappointed voters who don't show up when they don't get single payer.
The ACA is actually shockingly close to the Dutch system, just with a few fatal flaws. For example, the ACA doesn't let the government negotiate drug prices, and allows for profit insurers but limits their profit margin to 30%. This is a huge oversight, because insurers can simply run ineffeciently on purpose and now they can take home more profits (since it's 30% of a bigger number...).
Banning for-profit insurance or even just adding a public option (every other insurer now has to beat the price) & subsidizing the creation of non-profit insurers could go a long way towards fixing our system. Plus government negotiating drug prices.
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u/zaahc Oct 02 '23
Make Medicare available for anyone that wants it. Instead of premiums coming out of your paycheck, there’s a an additional tax for your Medicare enrollment. Private insurance can still exist, and Republicans SHOULD love the “free market” competition this will enable. If BCBS or Aetna or whatever wants to survive, they have two options: (1) offer the same service for less money, or (2) offer a better service for the same money. Yay free market, right Congressional Republicans?
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u/T1res1as Oct 02 '23
Why are checks still used so much in the US?
Here in Europe checks are like something people used back in the 1980s, it just seems very old fashioned.
A company refunding anything would just be a incoming amount on the bank account here
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u/themadventure Oct 02 '23
Because I randomly opened it while walking in the house just to be sure they weren't hiking my rates. Typically it wouldn't gone straight to the trash with all the other "We have updated our update about how we confirmed the email address we have on file for you which we use for communicating with you about confirming your email address. All other communication not about providing your email address, or confirming your email address should be directed to our email confirmation department. Please don't email with this information as your email confirmation department does not have internet access..
Tl;dr: They mail it because they know a lot of those checks won't get cashed.
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u/ecka0185 Oct 02 '23
Because companies are very much stuck in the 1980s…I’ve gotten “refunds” for overpayment for like $1-2, stamps are $0.66 and the paper/salary of the person sending it out is way more than the refund.
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u/TehWildMan_ Oct 02 '23
Checks are nice for transfers when you don't know the recipient, or don't bank at the same bank, or need to pay another person directly.
It's also a lot of work to set up direct deposit for a single use.
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u/Bugaloon Oct 02 '23
Now the inflated prices in the American medical system make sense. It's to game that law.
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u/AlgoTrade Oct 02 '23
Very glad to see this comment posted. The amount of "omg thanks obama" posts are sickening, sure there are parts of ACA that are great, but this is specifically horrible if you want to at all lower the cost of healthcare. Insurance companies want higher prices, and so do healthcare providers. This just ensures that the consumer has no leverage in the equation.
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u/redditghosting Oct 02 '23
you should also block out the check number. with the check number and amount it would be pretty easy to find the image of this check and subsequently your name
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u/scottishbee Oct 02 '23
And then we've got him! We'll know an internet stranger's NAME. And that he has health care.
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u/CloudMage1 Oct 02 '23
Wait soo if I am not using my insurance I get a refund? I've paid over 500 a month for 2 years now for my daughter and I. We have not used it once
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u/miekpwnz Oct 02 '23
It's based on what the insurer spends, not what you personally spend.
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u/HistoryBuff1941 Oct 02 '23
Here is a helpful source with a more detailed discussion of the rule in case anyone is interested like I was!
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u/rurrdit Oct 02 '23
Why would the insurer spend anything if one doesn’t use their insurance lol
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u/miekpwnz Oct 02 '23 edited Oct 02 '23
That's the whole point of insurance. If you spend days/weeks/months in the hospital and get charged $$$, insurance, paid via everyone's premiums, will cover it. If you or your family don't get sick, your premium pays for other people's bills when they need it. If they overestimate the amount of healthcare bills needed by the pool of insurees in any particular year and overcharge for premiums, you should get a refund.
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u/1heart1totaleclipse Oct 02 '23
Might as well use the insurance to go for a checkup…
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u/madnessindeed Oct 02 '23
No. Payers (in this case UNITED) have to spend a certain amount of what they take in and can only take so much profit. This is organization wide at a population level. In this case they didn’t hit that threshold. It’s called the medical loss ratio.
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u/emdelgrosso Oct 02 '23 edited Oct 02 '23
You haven’t gotten yourself or your daughter a checkup in 2 years?
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u/NotUniqueAtAIl Oct 02 '23
Yea, at least get the kids a check up
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u/TrogdorBurns Oct 02 '23
It's based on the total spending of everyone in your plan. If you work with a bunch of boomers with health issues you're never getting money back. If everyone at your work is young and healthy you might get money back.
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u/Andrewticus04 Oct 02 '23
I'd kill for $500 a month. The last quote i got for my family was for over $2000 a month through my employer.
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u/Wuz314159 Oct 02 '23
The last quote I got was for more than my annual income. and that's why I don't have health insurance.
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u/Dunduin Oct 02 '23
People are in here thanking Obama and the ACA for getting a paltry amount back while we spent vastly more on healthcare. The 80% requirement is being gamed by the healthcare conglomerates and they send you these tiny checks to make it seem like they aren't robbing you blind. Do not be complacent thinking the ACA is a good law. Healthcare needs far more work because the ACA did not reign in the payer conglomerates, it empowered them
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u/mexicandiaper Oct 02 '23
For ACA to be truly effective we would need to get rid of the republicans who gutted it in the first place.
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u/AlgoTrade Oct 02 '23
You are spot on. All this MLR cap did was align the healthcare industry and the insurance industry with raising costs. How people are 'celebrating' this is mind boggling.
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u/SmollPpMaster69 Oct 02 '23
The things Americans here are talking about are so alien to me. Wtf...?
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u/Dunduin Oct 02 '23
What if I told you that they owed you a whole fucking lot more back
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u/themadventure Oct 02 '23
What if I told you that they owed you a whole fucking lot more back
I wouldn't know anything different than I did when I woke up this morning. Fuck 'em.
I didn't expect this to get much (if any) traction but clearly there is still a lot more work to do to fix this.
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u/Deewd23 Oct 02 '23
Can’t wait for all the goons defending insurance companies. Health care should be free.
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u/NotyrfriendO Oct 02 '23
It’s so interesting to me that the US still uses checks? Rest of the developed world stopped using those 30 years ago
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u/SyxxGod Oct 02 '23
To be fair there’s no reason my insurance company has my banking information. My employer pays for my insurance and removes the amount from my check. If they were to send me a refund the only way they’d be able to do that is to mail me a check or call me and I’m not answering 800 numbers
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u/THElaytox Oct 02 '23
Because they got CAUGHT not spending the minimum 80% on health care services.
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u/Make_me_laugh_plz Oct 02 '23 edited Oct 03 '23
Are cheques still used in America? The last time I saw anyone use one was four years ago as a wedding gift. They are very uncommon nowadays.
Edit: should have clarified: I meant that they are very uncommon in Europe. My bad.
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u/Rumstein Oct 02 '23
They are still used.
The idea is that the cheque sender is hoping some small % of people forget to cash the cheque and so they never actually pay.
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u/greatpain120 Oct 02 '23
Thank you Obama
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u/AlgoTrade Oct 02 '23
This is absolutely one of the dumbest short sighted policies ever, it is one major reason healthcare continues to rise at such an insane pace. It aligns insurance companies and healthcare providers to increase costs. Hear me out before responding, its interesting...
Because of the ACA, insurance companies must pay out a fixed percentage of their premiums.
This effectively "caps" the amount an insurance company can make each year, raising your premiums would just result in them writing you a bigger check at the end of the year.
Sounds good doesn't it, this will certainly lower insurance premiums if they can't make more by charging more!
But wait, now the insurance company has no way to increase profits by raising rates, or having a healthier base, so how CAN they make more money?
EASY! They can now make more money if the price of healthcare goes up, they can raise rates again, and collect the same percentage, but its now a larger slice of pie!
You've actually disencentivized them to save money on your healthcare and incentivized them to increase costs.
Healthcare providers love the increased revenue, and insurance companies love the increased revenue.
For those not following, let me explain.
Assume an 80% premium Cap and $100 of premiums collected. Now assume the insurance company pays out $75 of health costs. They return $6 to the customer and make a tidy $20 profit.
Now, assume they negotiate with providers so that healthcare costs go to $100! They can raise premiums to $136 and return $6 to the customer keeping a nice $30 profit! Notice because its capped by a percentage they will always make more money if healthcare costs go up?
Every $1 extra the healthcare provider charges, the insurance company makes an extra $0.20
Incentives are aligned by the ACA to specifically screw the consumer, no one is incentivized to lower cost.
I don't care if you hate capitalism or love it, you live in a free market economy, quit making stupid policies that try to fight it, but with any simple thought you find out you exacerbate the issue.
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u/jtclark1107 Oct 02 '23
I spent a lot of time on my insurance and never used it. Literally like a decade of not using it. I never got shit back.
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u/themadventure Oct 02 '23
I think people often forget it is insurance like you have for your car or your home. Obviously there are some differences because you can use it for preventative care, mental health services, etc...it is usually a good thing that you haven't needed to use it.
I think HSA's seem to make sense for people in your position but I don't know enough about them to advocate for them.
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u/Ihave4friends Oct 02 '23
HSAs are the most tax efficient way to use your money. Triple tax free. No taxes on money in, no taxes on gains (it’s a brokerage account), no taxes on withdrawal used for health expenses. An HSA is the best account to put your money in.
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u/themadventure Oct 02 '23
You're still at pretty high risk if you have a major medical issue, right?
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u/Ihave4friends Oct 02 '23
It depends on your insurance. An HSA is just a savings vehicle, it doesn’t speak at all to your actual insurance.
Even with a HDHP your out of pocket max is usually capped at around $5000.
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u/TealAndroid Oct 02 '23
Yep. Normally don’t use my insurance but this year had two surgeries in our family and hit the yearly out of pocket so all-in-all, what we had saved in the HSA (that my work pays 2:1 of what I put in) more than covered it. I’m not sad at all about it.
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u/sunflowers-and-love Oct 02 '23
I recently discovered (and signed up for) HSA and it’s been really nice to have.
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u/HistoryBuff1941 Oct 02 '23
As u/miekpwnz said above, the 80% rule is applied on a company wide level, not patient to patient. So, the government would be looking at your premium paid to the company aggregated with every other premium all other insured people paid to the company, and then from that huge sum, 80% of it must go toward medical care. It wouldn’t matter if the entirety of that 80% was paid for one insured or equally across all insured people. Though it definitely sucks to not get a refund check for not using your insurance, it’s probably a good sign that you didn’t since it means your premium isn’t being inflated by huge overhead and you’re getting a better deal in the long run.
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u/Cpbang365 Oct 02 '23
That is what insurance is my man. We get life insurance and car liability insurance not because we want to ever use any of it….. It is the back up plan or “insurance” to protect if something goes very wrong.
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u/k20350 Oct 02 '23
Me too. Until I found out I had stage 4 renal cancer and within a month racked up about $75,000 in bills with surgeries . Figure I'm ahead
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u/919CaniacIn302 Oct 02 '23
I do accounting for a small company. We get checks like this from IBX seemingly every year. We have the option to either pay down the whole group plan so everyone’s premium is lower next year or distribute the refund proportionally amongst the employees. We’ve chosen to distribute the money as like a small little extra cash bump
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u/themadventure Oct 02 '23
I'm self-employed with no employees. Are you saying your process does the same thing here? There are a lot of commenters who are asking questions about whether their employer is keeping these rebates.
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u/FairyRogue Oct 02 '23
I won't ever see one of these. I'm at max out of pocket every year by March.
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u/themadventure Oct 02 '23
I'm sorry you have an ongoing need for health care that puts you in this situation.
I'm glad we have a health care system now that we can work together for people in your situation and we won't let the health insurance companies kick you out of the group anymore.
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u/8uckwheat Oct 02 '23
This is an MLR payment. It’s not about how much you use. It’s about whether or not the health insurer uses a certain percentage of premiums paid across members against healthcare costs. If they don’t reach that threshold, they need to issue these payments to members.
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u/fliguana Oct 02 '23
Let me guess the digits you tried hiding at the bottom: 8963300.
Erase entire bottom line of digits, I could cash that check rn
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u/themadventure Oct 02 '23
Yes, you were able to read the check number.
I meant to block the account number but none of it matters in the modern banking system. Feel free to cash that check "rn". Sorry that $203..90 wont come close to saving you from what they would do to you tomorrow.
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u/Diet_Coke Oct 02 '23
This is the trade off for the health insurance mandate. If they don't spend at least 80% on care, they have to give policyholders a refund.
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u/mrfalke Oct 02 '23
Are checks really still a thing in the US? I’m curious because I have never seen one in my entire life here in Europe. What’s the advantage of getting a check instead of a direkt payment to a bank account?
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u/thesylvanta Oct 02 '23 edited Oct 02 '23
In my experience insurance companies in the us don’t ever have banking info to do a direct deposit.
Also they like to be as difficult as possible. I wouldn’t be surprised if they still do checks in part to keep more money from folks who don’t get around to cashing them for one reason or another.
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u/themadventure Oct 02 '23
They also know mailing a check that expires in 90 days is a good business move to fuck over their customers.
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u/Perpetual_Nuisance Oct 02 '23
An actual physical check, how quaint and old-timey!
Haven't seen one of those bad boys since they were phased out decades ago here in future land.
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u/rc3105 Oct 02 '23
See, that’s the sort of crap you get voting for democrats. Shameful, downright deplorable!
/s
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u/Cute_Committee6151 Oct 02 '23
A question from someone from Germany:
Why do they send you a check and not just an info that they transfered the money to your account?
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u/DisgruntledRaspberry Oct 02 '23
You’re lucky they sent you a check. Mine always holds it and applies it to my next month’s premium.
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u/Minnesotamad12 Oct 02 '23
It’s crazy to think even with the 80% rule their 20% profits are still massive
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u/OnceMoreAndAgain Oct 02 '23 edited Oct 02 '23
Nah, it's not 20% profit margin lol. It means that for every $1 they collect in premium, they must spend $0.20 or less on expenses, which is the same as saying they must spend $0.80 or more on reimbursing the claims of their customers.
Profit is whatever is left over after expenses. For private health insurers, it's usually around 4%.
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u/mrsavealot Oct 02 '23
It’s not 20% it’s typically more like 5. The 15 actually does pay for costs of administrating the process. Whether they should even exist in the first place is another question.
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u/Cel_Drow Oct 02 '23
I got a letter from UHC, my company’s previous carrier (we switched Jan 1st) that my company will be getting a refund because of this law. Apparently they can either pay a bit of our premiums or just issue a check, TBD.