Hurricane Harvey is looking big and ugly. If you are anywhere near coastal Texas, keep on heading inland and to higher ground. Everyone else, let’s talk health insurance.
The European is the worst case scenario for #Texas with TWO landfalls over the course of the week, both as Cat 2/3 hurricanes. #Harvey pic.twitter.com/F2fttNyW0M
— Ed Vallee ? (@EdValleeWx) August 25, 2017
If this is the scenario that plays out, people will be kept away from their coastal homes for a week because of the storm and who knows how long due to emergency recovery efforts from the floods, storm surge and wind damage. If that is the case, people with narrow network health insurance will be in a pickle.
Almost all coverage will have an out of area component for emergency services. If an evacuee from the coast has a heart attack in Austin, they will be covered. That is not the concern.
Instead the concern that I have is for urgent but not life threatening emergency care. If an evacuee has an asthma attack and needs to go to an urgent care, that clinic might not be in network although every in-network clinic could be under water. If someone is having a significant anxiety flare-up and needs to talk with a mental health professional and there are no in-network mental health professionals within 100 miles that is currently open, that is a problem. If someone has a tumor where the current course of guideline concordant care is watchful waiting and needs an advanced scan to continue the watchful waiting, the nearest available in-network scanner might be seven counties away.
These are the tough cases of narrow networks in a major, prolonged evacuation. Most people in a short term evacuation will be able to defer their care needs without significant harm. But there are a class of cases which are urgent and should not be deferred but will not qualify as standard emergency care. These are the problems.
If you are in this class of people, the first thing to do is call your insurance company and try to get a pre-authorization. They don’t want to pay out of network prices but they really don’t want to be sued for breach of contract for denying you medically necessary care that their network is incapable of providing. They really don’t want to be highlighted on the 6 o’clock news for doing that. You might not get pre-authorized to the doc that you want but you should get a pre-authorization. Secondly, save the bills. Save all your documentation. Save your notes from the phone calls including the first and last name of the person you talked with, time, date, questions, answers and follow-up questions needed for clarification. If things get messy, a complete contemporary paper trail is a wonderful thing.
Finally, stay safe.
JPL
David, Good advice!
MomSense
What about the people who don’t have the resources to evacuate? This is Texas which is the biggest of the poor shaming states. They didn’t expand Medicaid because fuck you poor people. They closed the low cost family planning/PP clinics preferring increased infant and maternal mortality. Do we have any confidence that the state will make sure everyone gets out of the path of this hurricane? I don’t.
JPL
Maybe someone should mention to the president, that he should tweet about the hurricane. He has had plenty of time to bash senators this morning.
Betty Cracker
Was just looking at our benefits package from my husband’s employer, and I’m astounded yet again by how much the insurance companies are charging. The premium for family coverage under an HMO is $24K a year, considerably higher for a PPO. The employer kicks in too, but our share is still more than our mortgage payment. Even the shitty HDHP is absurdly expensive. That just seems unsustainable. I know this is nothing new, but I happened to have the figures at hand and was marveling at the absurdity of it all. Good luck to the folks who will be affected by the storm.
rikyrah
You make me think of things that had never crossed my mind, Mayhew. Thank you.
MomSense
@Betty Cracker:
During my as yet unsuccessful job search I’ve been looking at some of these employer benefit plans and ObamaCare is better. I don’t know what is going on in some of these HR departments, but they are doing it wrong.
?BillinGlendaleCA
@Betty Cracker: Somebody’s got to pay for the “hookers and blow”.
Betty Cracker
@MomSense: I’m going to look into that as well. We checked it out a few years back, but the employer-based deal was better at that time. Maybe not now. It’s just fucking ridiculous! $24K for a crappy HMO? GTFO!
MomSense
@Betty Cracker:
If it makes you feel better, I was paying just shy of that 10 years ago on the individual market.
ETA The thing that I complain to my Congress critters and state reps about is that health care prices are higher in non expansion states. More poor uninsured means more uncompensated care. Providers increase their prices to the insured to cover their losses.
Jerzy Russian
Forgive my crappy eyesight reading on a phone, but does that tweat say “European” instead of “Hurricane “?
I have Kaiser through my employer, and they pay over $1000 per month, while I kick in a few hundred. I don’t want to get out of bed to check the pay stub, but the plan is close to $20,000 per year.
Schlemazel
@JPL:
It will be exciting to see who he balmes when his damaged FEMA botches the operation
But David, thanks for the excellent advice & warnings. Sadly I am guessing not many of those folks are juicers and are not being helped with this sort of info from their government agencies.
Schlemazel
@?BillinGlendaleCA:
That is soooooo unfair! Not always hookers and blow. The CEO of Unitedhealth Group spent several hundred million to buy something really critical to America’s well being, an NHL franchise in St. Paul.
raven
@Betty Cracker: Damn, so the $5000 I pay for both of us on BCBS HMO isn’t bad?
Schlemazel
@Jerzy Russian:
I was wondering about that but assumed I was missing something. The post also says “floor” when it meant “flood” but its not a big deal
OzarkHillbilly
@MomSense:
Sounds to me like “making US subsidies for Obamacare a better deal than corporate subsidies for crappy insurance and thereby improving our bottom line” is an example of them doing it right.
greengoblin
@Jerzy Russian: European is the weather model predicting the path of Harvey.
p.a.
@Betty Cracker: @MomSense: @raven: @OzarkHillbilly:
They out-and-out say they want ‘consumers’ to have more ‘skin in the game’. They don’t mention they also want flesh, muscle, blood, bone…
Betty
@Betty Cracker: The system remains broken. Only major surgery will cure it. It’s not clear how bad it has to get before real change is made. One might think big business would be interested in reducing these costs, but it doesn’t seem to be a priority for them.
Coffee at dawn
Good morning folks. Noob here. Did I read here last night that the border patrol is going to try to catch immigrants fleeing what could be a killer storm? The evil sickens me.
(Thank you, David, for all you do, and, of course I am voting for Baud.)
chopper
@JPL:
if trump decides to tweet something meaningful it’ll definitely be a first.
Matt McIrvin
@Schlemazel: Trump’s FEMA director at least seems much more competent than Brown–he’s one of Trump’s few genuinely sensible appointments. Leaving the agency otherwise understaffed may actually be better than the alternative of packing it with hacks and sycophants.
chopper
@greengoblin:
The Euro is a heavy hitter in the computer model world. Certainly worth paying attention to esp as the storm is not a week out.
Matt McIrvin
@MomSense: The worst thing is that ICE is keeping immigration checkpoints running, so undocumented immigrants in the area may have to choose between being deported or drowning.
OzarkHillbilly
@p.a.: I love how they say, “We want to reduce healthcare spending by making people pay more for it so they will use less of it.”
OzarkHillbilly
@Matt McIrvin: Yeah, IIRC he has considerable experience with this shit. Now whether that will translate into him getting the necessary resources to deal with this…. What am I saying, it’s Texas, not California or Massachusetts.
Boatboy_srq
@MomSense: Employer-provided health insurance is less of a racket than the individual market, but – thanks to O’care – a lot of the shortcomings of the health-insurance-as-benefit model are coming to light. One reason O’care is so powerful is that it encourages migration to the private market (theoretically as both better coverage and more affordable coverage) and away from employer-provided plans.
Given how US businesses tend to operate thoigh, I fully expect employers to start eliminating health insurance as a benefit without improving wages. Employer-provided health insurance began as a cheaper alternative to increasing compensation (“sorry, we can’t pay you more in salary but hey, your healthcare is now nearly free!”). The single biggest insult to US workers over the last three decades is that this supposedly cheaper compensation item has become progressively moved to the employees to pay: it’s the 47% solution for workers.
I can remember when employers covered 100% of premiums for all their plans, and co-pays were pennies. Shoving the burden of the premiums onto employees without real wage growth is doubly insulting – they offered free healthcare instead of better earnings, and now they’re taking that away without replacing the indirect income and expecting their workforce to be grateful they’re not “uninsured.”
Schlemazel
@OzarkHillbilly:
In English, “Please die faster”
Betsy
Out of network is a huge problem, thanks for reminding us. Most of us have plans that pay differentially for services provided in or out of network. it’s a problem when you’re away from home or if you or a family member need specialized care. Thanks for the reminder.
Citizen_X
@Jerzy Russian: It means the European weather model; the graphic is from the ECMWF, the European Centre for Medium-Range Weather Forecasting.
texasboyshaun
@MomSense: Our local governments (county and city) are pretty good at helping the most destitute get shelter and needed essentials. That’s how we were able to resettle 150,000 people from NOLA in 2005 after Katrina. The state gov’t, OTOH, I wouldn’t trust to change a flat tire.
texasboyshaun
@Coffee at dawn: If Baud! doesn’t run for Prez maybe we can run him for guv here in 2018.
Jerzy Russian
@greengoblin: Thanks for the clarification. A normal person would have said “The European Model prediction is the worst case …”. Fucking Twitter. It will be the death of intelligence, if not the actual death of us all.
JPL
@Jerzy Russian: I thought that European Models were becoming more dependable, though.
Schlemazel
@Boatboy_srq:
In the mid-2000s I worked for a company that offered a ‘high deductible” plan. It was dirt cheap because you paid the first $20,000 before any benefit kicked in (at which point it was about the same as the regular coverage) and it had one of those stupid tax-free savings accounts (that paid no interest and any unused portion was taken away at the end of the year). I worked with a lot of young guys who thought this was a great gamble. I told them about an accident that fractured my pelvis & just the surgeon’s fee was $80,000. If that happened to them they would be on the hook for the first 20k and about 20% of everything else which would have totalled about $50k for them to pay. But of course they could not imagine a thing like that happening to them. Betting against the insurance company is like betting against the house in Vegas. You might win but odds are pretty heavily stacked against that happening
cmorenc
QUERY David: What % of health care costs are due to fees paid to the front-line care-givers (physicians, nurses, OR techs) vs various other overhead costs (medications, hospital infrastructure /maintenance, administrators, insurance company personnel, etc)? A related, but not necessarily identical question is: how much of health insurance costs are due to the same factors (e.g. insurance actuaries gotta be paid somehow).
sharl
That seems to be how folks are interpreting – reasonably I think – an announcement from the Border Patrol:
Border Patrol says Texas checkpoints to remain open during Hurricane Harvey
Jerzy Russian
@Jerzy Russian: What the tweet should read is: “The European Model prediction is the worst case scenario for Texas with the hurricane making TWO landfalls over the course of the week, both as Categories 2 or 3.” If one must use 140 characters, then perhaps “The FORECAST is the worst case scenario …” would be better.
Please forgive my grumpiness. My therapist says I should focus more on things I can’t control, like embedded tweets in front-page posts on Balloon Juice. My doctor also has advised me to take up smoking to deal with the stress of it all.
ETA: Hmm, this is a response to JPL at number 33.
Salty Sam
@Jerzy Russian:
Forgive my crappy eyesight reading on a phone, but does that tweat say “European” instead of “Hurricane “?
“European” refers to the European GOES satellite data- one of the more accurate predictors.
We live(d) on our sailboat in Fulton Harbor, which is dead center of the landfall forecasts. We spent the last 36 hour removing everything from the boat, snugging her down for the blow, and then evacuating north to Austin. It was hard to leave her to fend for herself- it is doubtful anything in the harbor will survive the expected 120 mph wind, and worse, the expected 8-12 ft storm surge.
Wish us luck
sharl
@Salty Sam: Damn. Best wishes to you guys. I hope your boat makes it, despite the expected storm conditions.
greengoblin
@Salty Sam: Good luck, Salty Sam. I hope your sail boat makes it through and all is well for you.
JPL
@Jerzy Russian: lol. You are doing just fine.
Kelly
Since we are active, outdoorsy, kinda adventurous retirees we’ve always picked a broad plan with statewide coverage. We have plenty of opportunities to scuff ourselves up far from home. Never needed to see a doc hours away from home but I don’t want to worry about it. This could also be handy when the great Cascadia earthquake hits.
Good Luck Texas!
TriassicSands
@Betty Cracker:
I make a point of telling everyone I can how much various treatments cost — especially health care professionals, who rarely seem to know what the services they are providing cost. When people are shielded from the actual cost of their care, they are likely to ignore it. But that cost is still real and has to be paid by someone. The more people are aware — and shocked — by the price tag on the treatment they and family members receive, the better prepared they may be to be responsibly involved in efforts to contain and even lower prices.
One thing I find outrageous is the unwillingness of Medicare to give a patient precise (or any) information about what Medicare will “allow” for a visit, test, or treatment. They will insist that your doctor has to call on the dedicated provider line. That is both obnoxious and indefensible. Republicans are always talking about the need for patients to be “better consumers of health care.” You can’t be a good consumer if you can’t find out what something will cost. Most Americans don’t even try to find out 1) what the hospital will bill or 2) what the insurance will allow, which is the most important number. I’ve had much better luck finding out what a hospital or clinic will bill, than what Medicare will allow. Medicare has always steadfastly refused to give me, the patient and bill payer, any information at all about what they will allow a provider to actually bill for a service.
Coffee at dawn
@texasboyshaun: We need him here in CT, too. Our dem governor is being blamed for a decades long slide.
@sharl Thanks for the link.
gene108
@MomSense:
As someone, who has been doing this for 19 out of the 20 years I have worked for the small business I am with, I am personally beyond my wits end on healthcare.
For comparison’s sake, when I started doing this in 1998, we were charged $100.83* for a single, which included medical, dental, and a $50,000 life insurance policy. The medical had no deductible, a $10 or $15 co-pay, all labs paid for 100%, and $10 copay for generics. We just renewed our medical only and we are paying $324 for a single, with a $3500** deductible and everything paid 100% after this.
I’ve been figuring out how to slash benefits, based on what we can afford to spend as a company for 19 years and it sucks. Spending July telling people their deductibles just went up and they will be charged more for it is no fun.
It’s a no win situation for employers. You can’t up benefits because it costs more every year just to keep what you have. For example, the same plan we have this year we had last year. We were hit with a 7.9% rate increase, and shopped around to keep the rates a bit lower than what we had, which is a little relief for people.
I don’t understand why more businesses aren’t bitching and complaining about the run away costs of healthcare. It really is killing the economy. We’re paying more than double*** for worse coverage than we had 19 years ago. Imagine if all the money wasn’t being sucked into healthcare what companies and people could spend it on?
* We paid 100% of the premiums back then. More money for people in their paychecks. And we still had more money left over for hookers and blow.
** We threw on an HRA at the back end of the deductible to help with anyone actually hitting the deductible, but that’s about all we can really do to soften the blow. And we’re charging people a part of the premium, less money in their paychecks and less money for us for hookers and blow.
*** I went on the internet and adjusted the premium price for inflation and it comes to $151 in 2016 dollars.
Jeffro
I am seeing pictures of gators in the streets in Texas (due to storm surge)
Can’t be good for tourism…
gene108
@TriassicSands:
No one knows what the fuck anything “costs” regarding healthcare. For one week of in-center dialysis, the center charges my insurance $21,000. They get $1500 paid by the insurance and write the rest off.
This is pretty standard for damn near everything involving heatlhcare. No one knows what things actually “cost” because what is charged by the provider, what is paid by the insurance, and what the costs of providing the service are, are basically dependent on (1) the providers cash rates for the service, which vary from provider, (2) the contract the provider has with the insurance carrier, and (3) a closely guarded secret by hospitals and providers that only the elite few may have the ability to gleam.
Yeah, some procedures cost more than others and there are some cheaper substitutes, but the way we price healthcare is so murky, it’s almost impossible for people to price shop.
WaterGirl
@Salty Sam: That would be very hard. Stay safe.
JPL
The President scheduled a rally in Springfield, MO next Wednesday. It seems like something else should be taking precedence.
Maybe he doesn’t want to get his feet wet.
Lahke
@gene108: It’s really hard to tell people pricing: I work for an insurance company and the negotiated fees for a given service are a function of product (HMO, PPO, etc), provider, place of service, member affiliation (are they part of your provider network or referred in), and maybe other stuff. And what if what you need isn’t fully anticipated? You go in for a screening colonoscopy and endoscopy up with polyp removal? Surprise! My company tries to put pricing on our website ( state law), but there are disclaimers everywhere.
J R in WV
@Jerzy Russian:
It does say “European” and because it is written for weather geeks it omits the word “Model” which is what he is talking about, the European Model shows the worst hit on TX. It looks like the Hillcountry won’t get hit too bad, more the eastern flat country, where the water stacks up fast.
We visited Houston decades ago, my first exposure to Texas, for the Bluebonnet Bowl, (in which WVU beat TCU 35 to something, big fun!) and I saw huge empty concrete troughs through town everywhere. I wondered what for.
The next day, thunderstorms and tornadoes, and the water got to within a few millimeters of the door threshold of the book store we were holed up in for the duration of the downpour. So I found out about what those concrete troughs were for – tropical scale storms.
Lahke
@Lahke: that was supposed to read “end up”.
Riley's Enabler
@Jeffro: Naw, gators are native to most of South Texas. We are used to them around here and generally only call the wildlife trucks when the gators hang out on the porch.
Supplies have been stocked, car is gassed up, bathtubs filled and pets settled. Looks to be a long weekend here (south of Houston). Confident we will do fine unless the gators learn how to work doorknobs.
sukabi
@MomSense: no confidence at all, especially since part of the overall strategy seems to be convincing immigrants that they will be rounded up while fleeing…so how many immigrants will go to ground instead of moving inland?
FlyingToaster (Tablet)
@Betty Cracker: That’s not too dissimilar from the legacy PPO coverage we had at HerrDoktor’s former employer.
Oddly enough, we have an HMO plan now, same carrier, same broad network, for about a third of the cost. Obamacare improved the plan designs enormously over Romneycare — and small businesses wised up and joined groups instead of continuing to go it alone.
StringOnAStick
@Jerzy Russian: “European” means the European weather model that they use. NOAA and the NWS use a suite of computer models to do their predictions because the different models will return slightly to obviously different predicted results with the same input data. They will tend to use the results of the model that has been doing the best predictions recently. If you read the text under “Scientific Discussion” tab on a NWS page or an app that links to that, they will sometimes mention the different models by name and why they are going with the results of one over the others. (I’m a long time weather nerd).
My fellow weather nerds, do you have the sense that the models have lost a bit of their predictive accuracy over the last few years? We live on the west side of Denver and weather here is nuts anyway thanks to being on the east side of the Rockies, but the amount of active events that seem to come out of nowhere and unpredicted seems to be up in my view.
StringOnAStick
@TriassicSands: My boss’s youngest son broke his neck in Mexico over a year ago and is now paralyzed from the high chest down with some use of his arms but not his hands. Between the surgeries and therapy, his first year of care cost over $2 million. The only lucky part of any of this was his wife had been able to go back to work full time as their sons got older, and the insurance they could get through her job was much better coverage for less than what he could buy for his family and our small dental office. Hers is through a nationally recognized rehab hospital that strongly believes people need to be covered for these rare events because they are so physically and financially devastating. Without it I am sure he would have sold his practice and spent themselves into poverty to try to help their 18 year old son get some muscle control back. He got a little, but not much at all and you don’t know when rehab starts how much a person will regain so you keep spending to chase the hope of more.
Ohio Mom
@TriassicSands: Sorry, but when I felt that lump in my breast, my concern wasn’t what things would cost, a sample of my concerns were:
Is this what I think it is?
Is this biopsy going to hurt?
Is this MRI almost over, please?
Why do I have to wait two more weeks until I can have surgery?
And so on.
I don’t know how knowing how much each test and procedure along the way cost would have changed anything. Most of the decisions were not mine to make, they were determined by the specifics of my cancer, and they mainly in the hands of people who went to medical school. I was not, and continue to be not in anyway qualified to steer my medical treatment, except in the most superficial ways.