dcdave3605

dcdave3605 t1_iui9paa wrote

Realistically, he can stay put in south Carolina and work with the hospital and pay a ton of money for the surgery,etc.

Or, he can move to a state and live with someone for a few months while he recovers. That state should be one that does allow adults with no dependents to apply for Medicaid. If he has a period of time where he will earn no or very low income and/or has proof that income has ended (termination letter from employer for example) he can apply for Medicaid based on that income. He could apply and during that pending period (waiting for approval) go to the hospital and get treatment and surgery arranged. He would need to do a change of address and provide proof to show he is a resident, but most states don't have more than a day wait for establishing for Medicaid purposes.

Once approved and the bills are paid by Medicaid (could take a few months), he can end Medicaid and move back to south Carolina.

I live in Maryland and had friends do this.

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dcdave3605 t1_itxxvj4 wrote

In my experience when Carefirst is specifically providing insurance coverage and Not just Administration of claims for a benefit program , it pays more.

Cigna, Aetna have been significantly lower payer amounts.
Personally I've had jobs with various insurers and have found carefirst the most expensive, biggest network, that paid the most for claims. Aetna has been the narrowest network, cheapest premium and decent payment to providers. Cigna was expensive and they didn't pay much out. But alot of this is dependent on what the company benefit plan rules are, so there is too much variation.

My prior career, the doctors I worked for and the billing I saw showed a higher payment consistently from carefirst of Maryland and most of the carefirst bluecross blue shield PPOs out there. The exception being Anthem...which paid very little.

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dcdave3605 t1_itvt544 wrote

Would love to see the actual agreement reached. If it's just a simple agreement for additional payment to JHH an overall increase will be passed onto the consumer through Premium increases during next year. Carefirst already pays higher reimbursements overall, when compared to the other large insurers in the state.

Hopefully there are some cost controls built in to mitigate passing it on.

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dcdave3605 t1_iqw7z8i wrote

COLAs are given. Merit increases would apply to university, but that's decided by university systems. The step system is for all other state entities.

There have been little to no step increases for a very long time. Cola's happen routinely and multiple times this year. Merit increases don't happen often, but there was one this year, usually budget requirements are tied to it.

So besides cola's you'd have to move to a different role to get a bump.

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