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by Bubbadoo
2111 days ago
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The 'ACA' is not one plan and it certainly does not require health insurance carriers to pay for 'ALL' healthcare expenses after you reach your deductible. Coverage varies by state and by level (ie., gold or platinum). Many plans do not cover out-of-network doctor visits for example. On top of this, you need to get prior approval for every medical procedure because not ALL are covered. In some cases, the insurance company will recommend a different treatment, instead of the prescribed treatment. I speak from experience. AHCA coverage is superior to what we had before, but it isn't enough. It was drafted with the Health Insurance lobby in the room, so do the arithmetic. |
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And health insurance does recommend different treatment depending on what the insurance’s doctors think. That’s the entity with the knowledge to be able to challenge a doctor, since the patient rarely has sufficient knowledge to do so.
The alternative system of a check and balance is if the government pays for healthcare and a government employed doctor approves or suggests alternative treatment. That’s what the UK does.
Either way, you have to have a second opinion to avoid mistreatment or overcharging by the healthcare provider. This isn’t an issue specific to healthcare, it’s present in any sufficiently complicated field.