JJ Husker

I'm not sure there is a good option for dental anywhere. Every plan I've seen, it seems you would be lucky to get back in benefits what you pay in for premiums. If you have a lot of work that needs to be done, you can make the insurance pay off but, it also requires you to spend a lot on your share of costs. Sort of a double edged sword. Have you looked into your options for health insurance on the exchange? I bet there are packages you could afford, especially if your income is lower. Guessing you are near half my age, your plans would be rated much lower to start with, then with the subsidies that are available, I would really think it would be affordable. Problem is, when you are younger and relatively healthy, any cost for health insurance probably seems unaffordable when you feel you can get by without it. I might be wrong about that but it does seem like the part of the ACA that actually does sort of work (maybe the only part) is particularly in the area of helping lower income people afford coverage. I researched individual plans for my son and his would've been around $200-$250 full load, before subsidy. He probably would qualify for virtually free care through medicaid if we actually chose to go that route. But for sure he would qualify for a large subsidy that would make it affordable if he needed to.

Also, KP told me something today that I was not aware of. People like me who are not receiving a subsidy or assistance with their premium get cancelled/terminated within 30 days of non-payment of premium. However, if you receive a subsidy, they give you a longer time period before cancelling. Not sure if this is KP policy or the law. Of course they made it sound like it was the law. The more I think about all of this stuff the more I realize just how absolutely jacked up and corrupt the whole system is. Why should policy cancellation depend on receiving a subsidy or not? How can a bill for an infusion be $25k but instantly be reduced by $11k as a negotiated insurance company discount? Why is a drug manufacturers cost assistance program not available to those without insurance or those who are on Medicare or Medicaid? How can the people in charge of determining if they'll reinstate your coverage or not also have access to your pending care costs? Does anyone think they will freely choose to have to pay out $12k instead of collecting a $1450 premium? KP had every incentive to want to cancel my policy at this point in time. They had every incentive to make sure I did not receive that notice. Everyone I have talked to, even at KP, started out understanding and saying how I couldn't see this coming. Then they go review it a bit and all of a sudden doors start getting slammed shut and I'm told no way José. The way the whole system operates is criminal IMO.

Yeah, somebody actually mentioned that earlier in the thread. It could very well be effective but it seems sort of like a last resort option to me. I've only got a couple avenues left, CO division of Insurance and the AG. Hoping one of those will force the right thing before I decide to go all scorched earth on 'em. Just don't want anyone feeling like it's out of their control before then. Thanks for the suggestion.

I fire employees who don't use Huskerboard, but that's me

With fans like you, who needs enemas........or something like that.

Thanks you naughty picture posting environment hater

I am and I did. Don't think I'll be talking to KP anymore. This morning was the 2nd time I lost it on one of their phone personnel. Guessing she'd never heard some of the words I used before. Heck I'm not sure I've ever used some of them before. I was making them up like I was speaking in tongues I was so hot. That's what she gets for having an attitude. I kind of snapped....

Update; Kaiser Permanente is a bunch of weasel c#ksuckers. That is all.

I will be contacting the Division of Insurance first today and I am supposed be hearing from KP....their final determination from my complaint. If that isn't satisfactory, I will contact the AG. Thanks for that advice.

Got a little bit of good news to share. I discovered tonight that what my wife told me was a bill from the hospital was actually a details of benefits from KP. The total was almost $25,000 for the one infusion but KP's plan discount was about $11,000 off of that. Then they pay their share and bill me the rest. So, I am more hopeful now that should I get stuck with that the cost of that infusion, with no insurance, maybe the hospital will at least offer me the same discount. So hoping worst case just went from $25k to $14k. Maybe I'm dreaming but seems somewhat logical to me or am I just grasping at straws? Also, this makes me a little more hopeful that KP may do the right thing. They wouldn't be on the hook for as much $$ as I previously thought so that might help allow them to step up and make it right.

Ha, beat me to it.

Wait......that isn't what the WNBA is? I'm confused.

This is correct. It is a CC company problem, not an ACA problem. They are the ones that f'd you. Raise holy hell with them about it. Don't take "no" from anyone there. KP is just following their rules, although they should have some appeals process that you can go through. There is a reason that people can't jump on/off health insurance whenever they please. If you allow that, then its not really "insurance". And if people think costs are high now, you don't want to see what would happen if people could come and go as they please. I somewhat agree with this but I just don't see what the CC provider can or would do to really fix this for me. They can't get my insurance reinstated. They can't get me into a new plan for the rest of the year. They could pay my medical bills but I'm sure they won't. If I lawyer up, they will really become hard to deal with, and they have much deeper pockets than I do. I just don't see what the CC company can do, or would be willing to do, at this point in time. Same goes for KP except that they could and hopefully might still agree to reinstate my insurance. Problem is that is obviously a money losing proposition for them. Hopefully they do the right thing or somebody forces them to do the right thing.

Uh, that is not an opinion. That is a fact. Some of the drugs I've recently been prescribed are out of this world ridiculous. I started with Lialda/Mesalamine. I was on a generic only plan at the time and it is not available in the US as a generic. My cost with BCBS insurance was $770 for a 30 day supply. Anthem BCBS wouldn't pay a dime of it. I never did pay that for it however. I got free samples from my doctors and ended up ordering it out of a Canadian pharmacy when I did need to purchase it. The generic from Canad was about $200 for a 90 day supply. Weird but true- it shipped out of India though Singapore and then directly to me. Canada never saw it. When I got on the KP plan it was covered and only cost me $30 for a 30 day supply. Of course only 2 months of that and then my doctor put me on something else. Humira- You've all seen it advertised on TV It worked relatively well for me but would not get me to where I needed to be with my condition. When I would pick up my prescription, my share was $5 for the month. Great, right? Well the receipt stated that my insurance had saved me $4,800.....for a 1 month supply, 2 or 4 self injectable pens. I'm sure KP had some lower negotiated rate and they paid it down I'm guessing to about $200-$300. The manufacture offered a cost support program and they would pay it down the rest of the way to where my cost was only the $5. Great deal for me and anybody with health insurance. But they do not offer that cost support program to anyone without health insurance or who was on Medicare, Medicaid, or any state run government program. Entyvio- Sort of the same thing as Humira but requires IV infusion and is a biological more directly targeted to my condition. I am also supposed to be in a manufacturers cost support program for it. I think my cost is supposed to be capped at $50 or $200 per infusion. I haven't determined yet if they ran it through that coverage and the additional charges are for the infusion center charges or what. But $25,000 for one bag of fluid that takes about 1 hour to drain into me......I don't care how you spread that out, it's ridiculous. I needed to stop that one anyway. It hasn't appeared to work any better than the Humira and probably wasn't working as well. If I lose my coverage, I will have to go back to the Mesalamine from Canada and hope my condition does not worsen in the next 8 months. The cure is surgery but it is also a last resort type of thing. I have been relatively lucky in that everything I am on severely suppresses my immune system. Unbelievabley I have not been sick once since starting these drugs. *knocks on wood

Once again, thanks to everybody for the advice and suggestions. I do want to clarify that the new CC WASN'T sent pre-activated. I believe they (Chase bank) told me that they activate automatically after 30 days. I still think that is jacked up because they have no idea if that card is in our possession or not. 84HuskerLaw- I said it was a reasonable plan only in that it is a lower premium and better coverage than my prior non ACA plan. I agree that the premium is high and that my cost shares are still too high but that is not necessarily a result of Obamacare. It is because of the main problem in our healthcare system; rapidly escalating and ridiculous care costs and runaway premiums. Yes, the ACA did not address the most critical problem but it also is not a direct fault of the ACA. My deductible is $1000 or $1500 per person, max about $3000 per family. That is reasonable. I'm not sure what our co-insurance is, I think it is probably 20% until we reach our max out of pocket around 20k. Based on plans I have seen, those are also reasonable limits considering the current CF that is our healthcare system.

Thanks guys for the suggestions. I am still just getting into this so I'm not sure where it will lead. I can't get over the feeling that somebody along the way will do the right thing but it sure isn't looking like that will happen yet. Knapp- as far as your question "how is this an ACA issue?" KP has repeatedly told me that due to how the ACA law is written, once a policy goes 30 days without being paid, they have to cancel and cannot reinstate, unless it is their fault. All parties can be blamed to some extent IMO. I guess even I have some culpability for not knowing that the online payment confirmation didn't mean squat. Maybe I should have checked a few days later to make sure our balance had been reduced to zero? Logic tells me that shouldn't be required but in a critical situation like this, maybe it would be wise. I blame KP first and foremost for providing a payment confirmation and then reneging on it. I also blame them for cancelling our policy while prior only supposedly providing one mailed notice. Seems like a fairly significant action to take without maybe a call first to the insured and notify them more positively. They cannot provide proof they mailed that notice. They think their word that they mailed it is sufficient proof. Who really knows if they did? And yes, I blame the CC provider. Seems to me they should never automatically activate a new card. What if the reason I hadn't activated was because I didn't receive it or it got stolen or delivered in error? They activated a card that may not have been in my control and they cancelled a card that for all I knew was still good. Yeah, they're to blame also. The problem with insurance outside the ACA is that they can specify waiting periods, exclude certain things, etc. Hell, if they're going to exclude my medical conditions, I may as well save the money and hope something unrelated or serious doesn't occur in the next 8 months. Right now it looks like I'm going to need that premium money to help pay the hospital bill.

If that is case, the only question is how do we release way more balloons, way more often. I propose we expand the season to 24 home games and incude 2 balloons with each seat per game. Take that Iowa.

I actually tried a couple different converters like that and they didn't work. Got both from Amazon and returned them. I should've updated this a long time ago. I went with a Zvox system (can't think of which one specifically off the top of my head). It works fine sound wise. Way better than the TV speakers. Still prefer my receiver and Bose surround system for movies but I use the soundbase about 95% of the time. The one downfall is I went into settings on my TV and disabled the TV speakers and I set the remotes to control the soundbar. Problem? The TV still senses the volume adjustment signal and everytime the volume gets adjusted in either direction I get a big ole notice that pops up in middle of my screen saying that the speakers have been disabled. No sh#t Sherlock. That notice has become extremely annoying. It lasts for about 5-7 seconds. I can get it to go away by clicking the "enter" button on my TV remote but I am usually using my cable remote and it doesn't have that. So I have to keep both remotes handy if I don't want that notice blocking the picture. #thirdworldproblems

Oh, and to top it off, I will get hit with the penalty on my taxes for not having sufficient coverage for 9 months of the year. And they wonder why we drink.

BTW, if anyone has any suggestone on what I can possibly do, please share. As far as I know, my only recourse at this point is to file a complaint with KP (which likely won't do any good). I'm pretty sure those bastards were looking at my outstanding bill and comparing it to my premium and they decided no frikken way we're going to reinstate. I can and will be filing a complaint with the the state Insurance Commisioner. Probably pissing up a rope. And I will attempt to explain my situation to the hospital, hopefully get my bill reduced and hopefully they are willing to wait a long time for it to get paid off. I'm guessing I will end up engaging the services of a lawyer but I really have no idea what they will be able to do to help other than help me out of even more money. So anyway, any suggestions would be greatly appreciated.

Sorry (it was supper time and I was hungry) I've got a couple more lessons to incude. 5- If you don't want any surprises on your hospital bills, insist that someone provide you with what your share of the costs may be. I received 2 of these infusions in March and 1 in April. Of course the April one is the seriously ugly one but I did not receive any of the hospital bills until May. My share of the infusions in March, when I had insurance, was about $1500 each. I asked my doctor before, they didn't know. I asked the first 2 times at the hospital, they said they didn't know "wait for us to bill you" Had I known my share was even the paltry (ha) $1500 I would not have consented to this treatment. Summary I and my family have had continuous healthcare coverage forever. Always. Period. One of the driving forces behind Obamacare ACA was so that everyone would and could get coverage. You doubt the law of unintended consequences? Because of the way they wrote the law, I now for the first time in my life , when I really need it, cannot get healthcare coverage for a period of about 9 months. Thanks Obama. And f#*k you Kaiser Permanente. And f#*k you US Postal service. And a big f#*k you to Chase bank Visa provider.

I am going to share this true story, not really to complain about the ACA but in the hopes that it may prevent even one other person from having anything like this happen to them. Prelude- As some of you are aware, I am not an Obama fan or necessarily a fan of Obamacare, especially the way it was rammed through congress. I also still believe they failed to address the single biggest problem with healthcare; runaway premium and care costs. I have not been proven wrong on that concern yet. I am in Kaiser Permanente Gold plan for myself and my family. The premiums have been relatively reasonable (currently $1450ish per month for myself, wife and 2 kids). The plan coverage also has not been bad. I purchased this plan through the exchange in Colorado. I have been on this plan since January 2015. It has been better than the small group plan I left behind. My Nightmare On March 31, 2016 I went online to pay my April premium. I charged it to Visa card, as we always do, to get the perks from using the credit card. We keep our credit cards paid off. I got a payment confirmation from KP's online payment system. I assumed the premium had been paid. So, I went back online in early May to pay my May premium. It was a few days late but we'll within the 30 day grace period to pay it. Problem is, I could not pay because the system said my policy had been terminated. So I call KP to see WTH. They inform me that my CC PROVIDER had declined payment of the charges and they said they mailed us a letter informing us of that. Bigger problem- we never received the letter. They terminated our policy and refuse to reinstate it. We cannot get back into any exchange policy until the open enrollment period at the end of the year. So myself and 3 family do not currently have health insurance. I called my Visa provider to see if and why yhey decline ed payment. They informed me that they had recently sent us new chip cards. We knew that but we had not activated them yet. The CC provider took it upon themselves to provide these cards and to activate them with a new expiration date. So they declined payment based on the exporation date not matching (even though I got an online payment confirmation at the time). The Ugly part, I have been receiving some Entyvio infusions at the hospital. I received one in late April, when I thought I had insurance but didn't. The bill arrived from the hospital last Friday..... $25,000 for one infusion. I have little recourse on anyone on this. KP's policy is, if it's not their fault, they will not reinstate. The ACA law is written so that people cannot hop on and off plans and avoid paying premiums. I understand that but it is so black and white that situations like ours don't trigger any common sense loophole. We didn't know our premium had not really been paid and we did not know KP was going to cancel the policy or that they in fact did. Lessons for you 1- Don't assume a payment confirmation means jack sh#t. It doesn't, at least to Kaiser Permanente, even their payment system generated. 2- Don't a assume that anyone will provide you more positive notice than saying they put a letter in the US mail. We all know they have a 100% delivery rate, right? 3- If you get a new credit card you better activate yourself immediately. I always figured the old one was good through the expiration date or until you activated your new card. 4- Everytime you receive healthcare, you may want to double and triple check that your insurance is in force before receiving the care. I'm guessing the hospital is under the delusion that I have some intention of paying that 25k bill. I dont, and won't. I just hope, with my medical condition, that I can make it to the open enrollment period without incurring any more high dollar care bills. Anyway......

This is the perfect space filler topic for the off season. It's just pure speculation and opinion with very little in the way of supporting facts or figures. People can simply go back and forth to their hearts content as they wish. Anyway, carry on.

I think that toxic culture and buy in have been greatly over blown. It may have been of limited concern last year with a very small handful of players but I think any of those types of concerns are pretty much behind this staff now. If any players are still harboring any conflicting feelings, I'm sure it will affect their play time and/or retention on the team. Not so sure that isn't what caused a few of our recent seemingly premature departures. If some fans think they can see it from the outside, if it is a real thing, think how obvious it would be to the the coaches and fellow players who are much more intimate with the situation. That issue doesn't concern me.