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  • Well, the government is not going to streamline things or reduce red tape.

    As far as deductibles and approvals go, it's the employer who dictates what is covered for their employees.
    "The problem with quotes on the Internet is that it is sometimes hard to verify their authenticity." -Abraham Lincoln

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    • Not really AA. For some self funded plans yes, but there are very real limits even on those plans.
      To be a professional means that you don't die. - Takeru "the Tsunami" Kobayashi

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      • Trump may be good for the news divisions of TV but it has been bad for their bottom line because he isn't spending any money on TV ads. A lot of these stations set their budgets in anticipation of the easy money of fall political ads. It isn't happening this year.

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        • Yeah, AA. You don't know shit about healthcare. Heh.
          Dan Patrick: What was your reaction to [Urban Meyer being hired]?
          Brady Hoke: You know.....not....good.

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          • Originally posted by SeattleLionsFan View Post
            Not really AA. For some self funded plans yes, but there are very real limits even on those plans.

            No. Often a CFO, COO, or VPHR goes into BCBS, for example, and sets up how much coverage they want to buy for employees. Now, there are "canned" plans, but the employer absolutely sets limits of what they will pay and shops coverages and deductibles.

            Spoiler: I did this. It was one of my duties in a past life. It's one of the reasons that the BCBS plan a restaurant employee gets is so vastly different from the BCBS plan a utility worker, cop, or fireman (or most union workers) get.
            Last edited by AlabamAlum; August 16, 2016, 06:26 PM.
            "The problem with quotes on the Internet is that it is sometimes hard to verify their authenticity." -Abraham Lincoln

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            • Originally posted by iam416 View Post
              Yeah, AA. You don't know shit about healthcare. Heh.
              Heh. Shaddup.
              "The problem with quotes on the Internet is that it is sometimes hard to verify their authenticity." -Abraham Lincoln

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              • Miscellaneous And Off Topic Subjects

                AA is correct. We are self insured (mostly) from a healthcare perspective. Employers have options and a deductible is one way to manage costs.


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                Last edited by entropy; August 16, 2016, 08:07 PM.
                Grammar... The difference between feeling your nuts and feeling you're nuts.

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                • Brazil synchronized divers split after one kicks the other out to have sex all night.... Prior to their competition.


                  Sent from my iPad using Tapatalk
                  Grammar... The difference between feeling your nuts and feeling you're nuts.

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                  • Originally posted by AlabamAlum View Post
                    Well, the government is not going to streamline things or reduce red tape.

                    As far as deductibles and approvals go, it's the employer who dictates what is covered for their employees.
                    Of course a company can pick a plan with a specific deductible. I was referring more to approvals. A company cannot generally say that a claim (or necessarily even a benefit) should be granted. That is governed by the law and the plan documents.

                    Source: was health insurance sales and customer service for 7-8 years.
                    To be a professional means that you don't die. - Takeru "the Tsunami" Kobayashi

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                    • Originally posted by SeattleLionsFan View Post
                      Of course a company can pick a plan with a specific deductible. I was referring more to approvals. A company cannot generally say that a claim (or necessarily even a benefit) should be granted. That is governed by the law and the plan documents.

                      Source: was health insurance sales and customer service for 7-8 years.
                      Co-pays, deductibles, percentage covered, and (before the PPACA) you could set a plan dollar limit on a policy. These are the big money variables decided by companies. The big dollars on approvals are RX. Generally, fertility and PDE5's and to a lesser degree generics. Techinically now, even with PPACA compliant plans, a company can set a procedure limit on a plan (most usually don't).

                      But no, of course, companies can't exclude psych or other federally mandated things, but the plans are indeed customized. For example, if an employee needs bariatric surgery, we could approve with any medical cert, or make them diet for YEARS under the care of a physician to get the cert. The former cost more.

                      I met with a VP of marketing and we decided what the plan would be. When things were stable, this was only done every four years or so. Much more often now.
                      Last edited by AlabamAlum; August 17, 2016, 12:47 AM.
                      "The problem with quotes on the Internet is that it is sometimes hard to verify their authenticity." -Abraham Lincoln

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                      • Hell, on RX some companies sign off on plans that will only approve the cheaper statins (and other drug classes). For example, if the MD wrires for Crestor, he's gonna have to justify why he didn't write for generic lipitor.
                        "The problem with quotes on the Internet is that it is sometimes hard to verify their authenticity." -Abraham Lincoln

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                        • And even with federally mandated reqs, companies have sued and won (Hobby Lobby and birth control, for example)

                          But enough about this...it won't change anything.
                          Last edited by AlabamAlum; August 17, 2016, 01:01 AM.
                          "The problem with quotes on the Internet is that it is sometimes hard to verify their authenticity." -Abraham Lincoln

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                          • Any Elvis fans in the building?

                            BLM new target this week is Graceland

                            Black Lives Matter aim to 'shut down Graceland' during Elvis Week

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                            • Matt Taibbi on why campaign 2016 won't just have lasting implications for American politics. It's obliterated what was left of our news media.


                              A bit repetitive but some well-formed sentences here about media polarization. Excerpts:




                              In the same way that Fox used to (and probably still does) save on reporting and research costs by simply regurgitating talking points from the RNC, blue-leaning cable channels are running segments and online reports that are increasingly indistinguishable from Democratic Party messaging.

                              But Fox's coverage has been so overwhelmingly one-sided that it has lost forever the ability to convince non-conservatives of anything. Rupert Murdoch has turned into the Slime Who Cried Wolf. Even when Murdoch gets hold of a real story, he usually can't reach more than an inch outside his own dumbed-down audience.

                              This is a problem because if there ever comes a time when you want to convince your own audience of hard truths, you'll suddenly find them not nearly as trusting and loyal as you’d thought. Deep down, they'll have known all along you were full of it.

                              ...

                              The public hates us reporters in the best of times, when we’re doing our jobs correctly, merely being conniving, prying little busybodies forever getting up into peoples’ business.

                              But the summer of Trump could easily turn into an Alamo moment for the press. There are reporters who are quietly promising themselves they'll go back to being independent and above the fray in November, after we're past the threat of a Trump presidency.

                              But just ask the National Review: Once you jump in the politicians’ side of the pool, it's not so easy to get out again. And what will they think of us then? Is there a word for "lower than scum?"

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                              • Is there a word for "lower than scum?"

                                Buckeyes.
                                “Outside of a dog, a book is a man's best friend. Inside of a dog, it's too dark to read.” - Groucho Marx

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