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by lotsofpulp 1903 days ago
Great write up! Only caveat is the limits only apply to in network providers (providers that have made a deal with the insurance company), so if you're on a trip and an emergency happens and you end up in a hospital that's not in network, then you're on your own.

But I assume a company like Amazon is dealing with a large insurer part of nationwide networks like BCBS.

Also, insurance companies have their own doctors and pharmacists that might disagree with the patient's doctor's treatment plans, and will not cover the healthcare costs for those items without a "prior authorization" from the insurer. There's an appeal system in place for this too. Although, this type of thing exists without health insurers too, it's just employees of the government deciding what to approve and not approve.

1 comments

> Only caveat is the limits only apply to in network providers (providers that have made a deal with the insurance company), so if you're on a trip and an emergency happens and you end up in a hospital that's not in network, then you're on your own.

Actually, out-of-network emergency care is an 'essential benefit' under the ACA, so most plans do cover this scenario.

I actually just screwed myself with this recently. I went to an urgent care while traveling (because that is usually cheaper when I'm at home) and it wasn't covered. An urgent care apparently doesn't count as emergency care. It turns out that I should have gone to the (typically very expensive) ER instead -- it would have been covered 100% because of the ACA!

Thanks for the correction, I did not know that!

Every time I dig into ACA, I find that it’s a pretty decent framework for a non taxpayer funded healthcare system.