Coronavirus (COVID-19) is too exciting for adults to discuss (CLOSED)

[heisman]

That article is talking about whether the ACA market (excludes most employer sold health insurance btw) can vary premium based on whether members have the vaccine. That’s a different situation than the original comment, whether insurers can reject claims for members that already paid their premium for coverage.

Thanks for the clarification.

No, that's not accurate. ACA is required compliance for all employers and insurers.

 

[ORD_Buckeye]

A bit of a misunderstanding possibly. Private insurers were covering ALL Covid related expenses. They have stopped doing that recently. So, they still are required to cover the insured, but the insured will now bear the cost of co-pays, deductibles, max-out-of-pocket costs, etc.

I agree with all that. What I'm talking about is will the insurers start denying any and all coverage, saying it was willful negligence on the part of the insured that landed them in that ICU bed. Lawyers can probably insert the official Latin legalese term for it. For instance, I'm pretty sure that my insurer could deny coverage for a cracked cranium if I cracked my cranium doing a "milk crate challenge."

At the very least, one has to wonder whether lack of vaccination might soon lead to a cancellation or rejection of coverage. That's how damned stupid these people are; they literally have me on the side of the American health insurance industry.

 

[BigJim]

No, that's not accurate. ACA is required compliance for all employers and insurers.

This is true for some elements of the ACA but not premium setting (or essential health benefits for that matter, which is what ORD’s initial comment would fall under), which is what the article was talking about. Employers with 50+ employees (the majority of insureds) can be rated with a lot more flexibility, most using their actual morbidity and/or experience.

 

[heisman]

This is true for some elements of the ACA but not premium setting (or essential health benefits for that matter, which is what ORD’s initial comment would fall under), which is what the article was talking about. Employers with 50+ employees (the majority of insureds) can be rated with a lot more flexibility, most using their actual morbidity and/or experience.

Well, no, his comment was that they could completely deny claims. I don't see that happening.

 

[heisman]

I agree with all that. What I'm talking about is will the insurers start denying any and all coverage, saying it was willful negligence on the part of the insured that landed them in that ICU bed. Lawyers can probably insert the official Latin legalese term for it. For instance, I'm pretty sure that my insurer could deny coverage for a cracked cranium if I cracked my cranium doing a "milk crate challenge."

At the very least, one has to wonder whether lack of vaccination might soon lead to a cancellation or rejection of coverage. That's how damned stupid these people are; they literally have me on the side of the American health insurance industry.

Maybe I just have good health insurance, but I've never been asked the nature of my injuries/illness by my health care provider. I've shattered my back, my pelvis, and my femur and had a pulmonary embolism and spent about 6 weeks total in a hospital bed, but I was never asked what happened by BCBS IL. Now, I've seen "The Rainmaker", but that was pre-ACA. My belief is that ACA would govern this behavior extensively.

 

[Herb Kirkstreit]

Maybe I just have good health insurance, but I've never been asked the nature of my injuries/illness by my health care provider. I've shattered my back, my pelvis, and my femur and had a pulmonary embolism and spent about 6 weeks total in a hospital bed, but I was never asked what happened by BCBS IL. Now, I've seen "The Rainmaker", but that was pre-ACA. My belief is that ACA would govern this behavior extensively.

Would your insurer, without asking the nature of the injuries, also cover the removal of a gerbil from someone's nether regions? Asking for a friend.

 

[BB73]

Maybe I just have good health insurance, but I've never been asked the nature of my injuries/illness by my health care provider. I've shattered my back, my pelvis, and my femur and had a pulmonary embolism and spent about 6 weeks total in a hospital bed, but I was never asked what happened by BCBS IL. Now, I've seen "The Rainmaker", but that was pre-ACA. My belief is that ACA would govern this behavior extensively.

Yeah, back in the day I had great coverage with BCBSIL. My wife and I paid a total of $5.00 to have two kids born in a hospital. They charged us $5.00 for thermometers the second time, I gladly paid it and didn’t ask why.

 

[BigJim]

Well, no, his comment was that they could completely deny claims. I don't see that happening.

Again, I was responding to the article.

Also, your other point you’re making, that it isn’t allowed or being considered, is incorrect. Part of my job is to go through these things.

 

[heisman]

Again, I was responding to the article.

Also, your other point you’re making, that it isn’t allowed or being considered, is incorrect. Part of my job is to go through these things.

I have zero knowledge on denials or approvals, as it pertains to claims. But, I am an expert on ACA, and the discrimination clauses would clearly protect the insured from any type of vaccination requirements.

 

[BigJim]

I have zero knowledge on denials or approvals, as it pertains to claims. But, I am an expert on ACA, and the discrimination clauses would clearly protect the insured from any type of vaccination requirements.

That only applies to business sold in the ACA market. There are tons of 50+ Employee groups today with riders that exclude coverage for any number of benefits (maternity, contraceptives, you name it). There are even individual policies in most states that carve out certain benefits. Stop acting like this applies universally to all health insurance, let alone the majority.

 

[heisman]

That only applies to business sold in the ACA market. There are tons of 50+ Employee groups today with riders that exclude coverage for any number of benefits (maternity, contraceptives, you name it). There are even individual policies in most states that carve out certain benefits. Stop acting like this applies universally to all health insurance, let alone the majority.

I have 300+ employees and it definitely applies to me. An insurance carve out requiring vaccination simply doesn't exist.

https://www.ncsl.org/documents/health/aca_requirements_for_employers.pdf

 

[BigJim]

I have 300+ employees and it definitely applies to me. An insurance carve out requiring vaccination simply doesn't exist.

https://www.ncsl.org/documents/health/aca_requirements_for_employers.pdf

The FDA literally just approved it. Insurance companies are figuring out options, talking to their regulators, determining whether they want to recommend industry standards vs flexibility, etc. It’s happening as I type this. No comment in this thread was remotely claiming it was already available.

 

[ORD_Buckeye]

Sounds like Johnson was just waiting for the FDA to give her cover so she could go full Marcus Hall at the statehouse.

 

[dragurd]

Sounds like Johnson was just waiting for the FDA to give her cover so she could go full Marcus Hall at the statehouse.

As stated in the other thread yep. OSU has been requiring shots for at least 20 years probably much longer than that. Which makes it a no brainer to add it to the list. Though it looks like it is the first one to be added in years so that'll probably cause a bit of grumpiness. While I never had to go through it I'm sure they account for medical/religious exceptions. What this won't allow is anymore well don't feel comfortable with it or don't tell me what to do excuses.

 

[ORD_Buckeye]

As stated in the other thread yep. OSU has been requiring shots for at least 20 years probably much longer than that. Which makes it a no brainer to add it to the list. Though it looks like it is the first one to be added in years so that'll probably cause a bit of grumpiness. While I never had to go through it I'm sure they account for medical/religious exceptions. What this won't allow is anymore well don't feel comfortable with it or don't tell me what to do excuses.

Don't want to get the shot? Great, let us know how that Bowling Green education works out for you. Though, I have a hunch that The Ohio State University making the move on this will give the cover for The Other State Universities to act similarly.