Really ... I just got a check for Medical Loss Ratio ... ACA

[vacationhopeful]

Really ... I pay $996.59 per month for my single person policy under the Affordable Care Act.

I got my "Medical Loss Ratio" check in the mail today. If the insurance company does NOT pay out 80% of the MLR (your premiums) required by the ACH ... they have to refund it to the to the individual customer(me)(the amount UNDER the 80% required from the way I read it.) This is for all the members COMBINED premiums and expenses of my ACH policy ... not just my payments and claims. "For example, an MLR of 80 percent means that an insurer spent 80 cents of every adjusted premium dollar to pay claims, clinical services and activities that improve the quality of health care from members"

So my health insurer for all members of my class with premiums paid of $306,573,780 spent only 79.4% on health care and activities to improve health care quality.

My check from my Health Insurance company is for (really it must have cost $75 to produce and mail said check) ...... wait...... drum roll ...... longer drum roll ..... $12.12.

I could make a political statement ... but I guess the insurance company gets to keep 20% of the premiums for management costs and overhead...in this plan amounts to $61,314,756 ... 20% of the premiums paid.

I do NOT believe this is the ONLY PLAN "the Blues" have .... just one little old plan in my state.

 

[Fern Modena]

You talk about how much it took to bill and process your rebate...I just got a bill from a doctor for $2.24

 

[SMHarman]

You talk about how much it took to bill and process your rebate...I just got a bill from a doctor for $2.24

I'll see your 2.24 and raise you 36c from quest on some blood work.

 

[Conan]

If the insurance company does NOT pay out 80% of the MLR (your premiums) required by the Affordable Care Act ... they have to refund it to the to the individual customer....

Before the ADA, many states had no MLR rule for insurers. Democratic Senator Jay Rockefeller’s staff found 32 states with an MLR provision on the books. In Pennsylvania, the threshold was 50 percent. Five states had provisions for the small-group market ranging from 60 to 82 percent. The California Legislature had tried to enact an MLR measure, but Republican Governor Schwarzenegger vetoed it.

The New York insurance department was one of the most aggressive in enforcing the MLR. In early 2008, it forced Oxford Health Insurance — a subsidiary of UnitedHealth Group — to pay back $50 million in premiums to small-business customers after investigators determined that the insurer hadn’t met New York’s 75 percent minimum.
Plans Scramble to Defend Their Medical Loss Ratios

http://www.managedcaremag.com/archives/1001/1001.regulation.html


So even if your refund is 2 cents the good news is your insurer at least had to abide by the ACA's 80% rule that now applies in all 50 states.

 

[vacationhopeful]

<snip> So even if your refund is 2 cents the good news is your insurer at least had to abide by the ACA's 80% rule that now applies in all 50 states.

Conan ... thank you for the back story.

I used to pay $732 monthly for Health Insurance .. but that policy did not meet the new ACA's rules and I got all of 3 months to find a new individual policy. Almost $268 MORE per month. And was dumped into the land of co-insurance while my doctor's office closed up due to the changing (medical insurance) tide.

And I count the months til I age out into Medicare.

 

[Icc5]

.52 from Quest

I'll see your 2.24 and raise you 36c from quest on some blood work.

I also had a bill from Quest for .52 and contacted them because I shouldn't be paying anything for what I had done. They told me to wait because my plan should have covered it. Then I got a check in the mail for $32.35 from Quest with a letter saying they found they owed this to me when they did an audit.
This was from 2 years ago and I argued with them back then to no avail. Well, guess what Quest. I was right.

 

[Talent312]

I recently charged _$1.12_ on VISA for for a mail-order Rx.
The actual cost was /mostly/ paid by my plan's drug coverage.

 

[Conan]

I count the months til I age out into Medicare.

A single payer plan!
https://en.wikipedia.org/wiki/Single-payer_health_care#National_policies_and_proposals

 

[Don]

Not medical, but I had to share. I just received a refund for unused time on my SiriusXM account. It was a FREE trial period and I refused to give them a credit card number. The check was for 12 cents.