(Some) Fancy pants doctors won't accept PPO from the exchange

[flamingdem]

So I'm all happy thinking that I can get great care with Blue Shield or Anthem PPO in California on the Silver plan. I used to pay these companies so much money for large deductible policies that were just a step above catastrophic coverage.

However today I called an orthopedist who was recommended to me. The receptionist admits that none of the doctors in the group will accept ACA policies because the payments to are too low. They are "in negotiations" but have pretty much made this decision.

She advises me to use Kaiser's HMO program because her sister apparently finds it great but then I don't get to see my doctors! What's the point?

Then I realize that this may be true with other specialists or expensive doctors as well and it could cause major problems. Why isn't an Anthem PPO policy bought on the exchange as good as Anthem via a business plan from before? How can they use the same name for it? This will perpetuate a two tier, multi-tier treatment program that doesn't benefit those of us who want to access the best doctors. I'm pissed.

It seems like this was an oversight, not forseen?, greed driven and unexpected? or that it was always part of the plan to have expensive specialists bow out.

Opinions? Experiences?

[Paulie]

1. $100 > $0

There are plenty of others who like to make mortgage and medical school payments. More expensive doesn't mean better doc.

[flamingdem]

4. The problem is that some are known to be the best for

certain things. Others don't have a clue. So it's so important, to me anyway, to be able to go to a specialist that knows what I need them to know. A generic specialist will not do.

I'll make do but what a turn off to see doctors recoiling from the ACA payments as if they don't have to give anything on their part. I guess this is just typical but it makes a plan called PPO not really a PPO if doctors are cherry picking like that.

[Incitatus]

41. I'm a little confused. What do you mean by ACA payments?

Doesn't ACA cover all insurance policies? So if they won't accept ACA payments, wouldn't it mean they won't accept any insurance and only accept private payment from patients?

Excuse my ignorance, I have insurance but haven't seen a doctor in years.

[flamingdem]

42. This doctors office will only accept plans that are independent

from the ACA exchanges. That would mean Blue Shield or Anthem from a business or bought privately on the insurance market.

They also accept Medicare. If that's the case then the issue here is the amount of reimbursement. Maybe over time that amount will have to go up.

Lower in the thread the narrowness of the networks under ACA is discussed. That means I can only chose from a limited pool of doctors, in my case that is much more limited than before.

Trade off is that I get some subsidy so my payments and deductible are less than before

[tsuki]

46. The same thing happened with the roll out of Medicare. nt

[flamingdem]

48. Piratesmile posted something about that

I'll have to read up on the precedent for ACA. We really should have Medicare for all.

[OrwellwasRight]

52. There is no standard "ACA" payment.

Each private plan negotiates its own rates with providers. Some providers may not take certain policies just as before. I can tell you, as a former professional in the field, very few if any private plans pay less than Medicare. in general Medicare is the benchmark for low private payments. Elite plans pay more than the Medicare benchmark. ACA networks or no more nor less narrow than the range of insurance previously available in the private market for individual purchasers. Some plans always had limited choices -- some always had wide choices.

[NYC_SKP]

2. Also in California. I think it will work out.

My doctor is in the Anthem BCBS system and I've passed on Kaiser plans year after year to stay with him.

And I know he won't bail because he's been an advocate all along.

We are in a temporary mini-crisis right now, so don't expect many specialists of any stripe to be taking new patients.

If you can hang with your PCP, just hang and if you need an orthopod keep looking and if it's urgent you'll have to use emergency providers.

But this will all pass.

[flamingdem]

10. Do you think the mini-crisis is the confusion about ACA

plans and benefits or just that many more are getting into the system?

[NYC_SKP]

12. I think "many more in the system" is a red herring. I think non-PCPs are edgy about being paid.

I had an issue for which I needed elective services and cannot find a provider to save my life.

No excuses, actually one receptionist said something about insurance and then backpeddled that during a second call.

So I think they're in a "wait and see" mode.

Everybody is probably up to date on their boat and Porsche and vacation home payments.

[flamingdem]

14. Aha! Good and optimistic analysis

So it's more of a wait and see and there's still room, or we can hope there is still room to work things out and keep those Porsche payments up!

[Hoyt]

3. Docs want to get their share just like other greedy participants in health care system.

Personally, I like going to doctors who take Medicaid because you know their heart is in the right place. A good number of the others are in it for more than just a decent living.

[flamingdem]

6. Here's the crazy thing - these fancy doctors DO take Medicare

so I guess that implies that ACA is paying less than that.

I really hope they can resolve this because that should not be happening.

Does point to Medicare for all as a better solution.

[Nye Bevan]

17. Lots of doctors take Medicare, but not Medicaid.

Medicare reimbursement rates are significantly higher.

[Hoyt]

30. A lot higher in some states.

[dlwickham]

35. what you just said

and that's one of the problems that the poor face in this country-those lucky enough to have medicaid have problems finding someone that will accept it in a lot of areas

you might have one or two providers in a geographical area accepting patients with medicaid and it's two buses, walk 3 blocks, etc to get to those providers

[notadmblnd]

5. Well I guess if they think the 1% will take care of them, then I say go for it Doc.

personally, if I were a Dr. I think I would want a piece of the pie that 40 million+ newly insured people are going to bring to the table. Hell with the lower payments, I'll make it up in volume.

[flamingdem]

8. The fancy doctors will stellar reputations are often fully booked

due to reputation. But that's where ACA has to pay competitive rates based on a scheme that works -- as I noted below these doctors do accept Medicare.

That implies that Medicare pays more than ACA? I hope it gets worked out.

[notadmblnd]

16. Well then I guess you wouldn't have a chance of seeing one anyway, no?

[flamingdem]

19. With my previous PPO that wouldn't be a problem

My point is that many of the better doctors don't need more patients so they lack that incentive.

[notadmblnd]

23. Then it's not an ACA thing and the ACA is not to blame

If Drs are fully booked and not seeing new patients, then no insurance and no amount of money is going to incentive-ize them.

However, I do think that there will be perfectly competent Drs. who will be motivated to grow their practices and eventually become one of those "designer Dr.s of which you speak.

[flamingdem]

24. I'm more pissed at the doctors than ACA

but I think there are many issues cropping up here.

I used to be able to see any doctor that took PPO -- almost all doctors do.
Now I'm limited to a narrower group of doctors. Not every doctor fits the
bill.

Speaking of bills, that IS the point. Why waste money on a doctor who is
NOT up on my issue when I've gotten a clear recommendation for one who
IS up on it - but I can't see him now. THUS it will cost me more CASH so
what's the point of saving money via ACA when I'll end up spending as much
because I only want to see certain specialists, not an up and coming specialist
because I know from experience that is a waste of time and money.

This is not a good thing for patients in my opinion. We'll see how it shakes out.

[notadmblnd]

27. Seems to me that the most up to date Drs will be the ones who've recently gone into practice

Do I want one that knows the latest and greatest? Or, do I want one that has rested on his fancy-ness for the last 20 or 30 years?

[flamingdem]

39. Certain doctors deal with the same issues over and over

when there's a "sports medicine" aspect they can work with athletes for example. My experience is that I save time and money going to the Doctor known for exactly what I need.

I've wasted too much money taking chances, in this case I'll probably pay cash.

[onyourleft]

68. Not necessarily.

Give me a doctor at a teaching institution any time. If they teach those new doctors, the physicians in a teaching institution have to keep up.

What is with the disparaging term "fancy" being applied to physicians? I've seen that in this whole thread. In other words, this question is not just directed at you personally.

[Lex]

7. It is NOT an "ACA policy." It's a regular insurance company policy.

I don't think the doctors can even tell on their end by looking at the med card.

[flamingdem]

9. I hope you're right. This is a question to ask one of the reps

will do so tomorrow.

[Viking12]

11. Exactly.

Insurers negotiate/dictate the same payment for a given treatment for all policies. A provider would never be able to discern whether a policy was purchased through an exchange, through a broker, or directly from the insurer.

[Nye Bevan]

15. Sorry, that is incorrect.

An Anthem exchange plan, for example, will probably have a lower reimbursement for the doctor (and a narrower network) than an Anthem employer group plan.

[Viking12]

20. Source?

While a group plan may offer broader network due to need for access for larger population, I've never heard of differnt reimbursement rates.

Moreover, individual plans, whether purchased through an exchange or directly from the insurer, the policies and coverage must be identical by law.

in general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and can’t deny you coverage if you’re already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.

Of course, the main attraction of the exchange is that plans sold there may come with subsidies that can substantially lower your monthly premiums. (Premium credits are for people making up to $46,000 for an individual and up to $94,000 for a family of four.)

http://www.nytimes.com/2013/10/26/your-money/health-insurance-options-arent-limited-to-obamacare-exchanges.html?_r=0

[Nye Bevan]

22. The policies and coverage must be identical. But not the networks.

And when I say "reimbursements" I am referring to what the insurance companies pay to the doctors in exchange for providing care.

Many of the health plans that will be sold on the new state insurance exchanges in January will offer substantially smaller networks of hospitals and physicians than current health plans generally offer.

Nearly half the exchange plans in 13 states with early filings will be of the narrow-network type, according to an unpublished McKinsey & Co. analysis of 955 plan offerings. Enrollees in such plans will have limited or no coverage if they seek care outside their plan network. In exchange, subscribers will enjoy lower premiums than they would pay for plans with broader networks, insurers say.

....

Insurers including Aetna and Health Net say narrower networks, made up of hospitals and physicians selected using cost and patient-outcomes criteria, are necessary to keep their exchange plan premiums affordable while still meeting the requirements of the Patient Protection and Affordable Care Act. They increasingly have offered such plans to employer groups over the past few years, touting annual cost savings of 10% to 25%. In the large-employer market, Aetna's narrow panels are 15% to 35% smaller than its standard preferred provider panels. Blue Cross and Blue Shield of Illinois says its exchange plans using narrow networks will cost 20% to 30% less than its exchange plans with bigger networks.

Insurers say they are able to charge lower premiums for narrow-network plans because they can select more cost-effective providers, and in some cases they are able to pay them lower reimbursement rates in exchange for funneling more patients to them.

http://www.modernhealthcare.com/article/20130817/MAGAZINE/308179921

[Hoyt]

43. There can be very different payment rates depending on plan and network.

[Yo_Mama]

36. No - that's not true.

I don't live in CA, but I read a long article within the last two months about CA insurance and the new plans, and a consumer advocacy group was saying many of them were too narrow. There is a much smaller network of providers for a lot of these plans.

This isn't it, but it does provide some info:
http://hl-isy.com/Healthcare-Reform-Blog/June-2013/Exchange-ACA-060313

The health care providers in these networks get lower reimbursements in exchange for a larger slice of the pie, and more established doctors are probably not that interested in the deal. Younger doctors or doctors trying to establish a practice might find it a worthwhile deal.

Also an NYTimes article discussing this:
http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html?_r=0

[Nye Bevan]

13. Most of the policies on the exchange have much narrower networks

than group policies, or individual off-exchange policies, issued by the same company. And yes, the doctors office will know immediately from the group information on the insurance card.

The reason is that the coverage is standardized, so the only way the premiums could be reduced to the desired levels was to reduce the doctor reimbursements, which would obviously cause some doctors to decide not to participate.

[flamingdem]

18. This could prove to be problematic

in terms of getting care from the best places.

Plus it sounds like it's not clear who will accept what so it's hard to pick a plan if it's based on accessing certain doctors.

[Nye Bevan]

21. You have to do a lot of homework before choosing a plan.

You need to go to the insurance company's website to check whether the doctors you like participate.

This has already caused lots of angst. In NH, for example, Anthem is the only insurance company offering policies on the exchange, and their network includes only 16 out of the 26 hospitals in the state.

http://www.seacoastonline.com/articles/20130915-LIFE-309150315

[flamingdem]

25. I agree. I've already logged a number of hours on this

and I have a question in to a "Lead" and a promise of a return answer but that never happened, they allowed 3 days to get an answer.

I think it will be tough to get real answers if doctors are still negotiating, but I'll get a better idea by calling around.

In the end I think that I will end up as before, paying cash for the doctors I need. That will be the same as having a large deductible.

There are gains in other areas to offset some of the cash payments.

[Nye Bevan]

26. Your other option is to buy a policy off the exchange.

You will give up your ACA subsidy, but you should be able to get a much better network. You then need to do an analysis to check whether losing the subsidy is worse than paying cash for the doctors you need who are out of network on the exchange plans.

[PoliticAverse]

28. One of the ways that the Insurance organizations are keeping prices low on the exchanges...

is to reduce the doctors and hospitals in their network for the plans offered via the exchanges
to those that are willing to accept lower reimbursements, resulting in less doctors and hospitals
participating than do for the regular health plans.

This is the same type of problem that Medicare and Medicaid recipients have.

[Nye Bevan]

31. Much more of a problem for Medicaid then Medicare.

Medicaid reimbursement rates are much lower than Medicare, and so far fewer doctors will accept Medicaid.

[PoliticAverse]

34. One of the things the ACA did was to boost Medicaid reimbursement to be comparable to Medicare

for certain primary care services....

See: http://www.acponline.org/advocacy/where_we_stand/assets/v1-enhanced-medicaid-reimbursement-rates.pdf

[flamingdem]

49. This article is a good find

I am almost glad I didn't know that it's not going to be a picnic to get care under these narrow plans.

[frazzled]

29. Sez who?

Some receptionist? Sorry, you'll have to do better than that.

[Nye Bevan]

32. How about a few thousand Google hits?

https://www.google.com/search?hl=&q=%22exchange+plans%22+narrow+networks&sourceid=navclient-ff&rlz=1B3GGLL_enUS399US400&ie=UTF-8

[frazzled]

37. Yeah, but the first hit is a total fail

First, it was written before what it admits were the release of any official plans. And if you read down:

Dr. Jeff Rideout, senior medical adviser for the Covered California state exchange, said some insurers have built networks that are “wholly new and created for the exchange” while others are using networks identical to their current products. He stressed that all plans included in the exchange had to get state and federal regulatory approval for network adequacy. Covered California says the 12 plans approved for its exchanges include 80% of the state's doctors and hospitals.

http://www.modernhealthcare.com/article/20130817/MAGAZINE/308179921

Gosh, 80% of the states' doctors and hospitals too small a network for you?

[flamingdem]

51. Anthem's seems to be closer to 50%

Not great

[frazzled]

58. 50% not good?

That's better than the network on my excellent employer based insurance. If 50% of all the doctors in the city of millions in which I live were on my network, I wouldn't be able to make it through the list. As it is, we've never NOT had access to a top-rate specialist or surgeon.

Look, the ACA has certain standards that the exchange policies have to adhere to. It's up to the states (as in Medicare) to implement that, which means some states are going to do better than others:

The ACA provides consumers, particularly those in the individual market, with access to a wider range of health insurance benefits than has ever before been available. Whether or not consumers will be able to easily access those benefits depends on how closely states adhere to, or build upon, the network adequacy standards set out in the ACA’s implementing regulations.

The ACA requires that Qualified Health Plan (QHP) networks be sufficient in numbers and types of providers, including providers that specialize in mental health and substance abuse services, to ensure that all services covered under the QHP will be accessible without unreasonable delay. While the ACA provides a general framework to address the adequacy of QHP networks, the law and its implementing rule and guidance make the states responsible for assuring that network adequacy is achieved for the benefit of consumers. States, in turn, take different approaches in regulating the adequacy of health plan networks, at least in part due to the need for states to maintain robust health insurance markets by balancing access needs with the goals of controlling costs and attracting a healthy number of insurers.

http://chirblog.org/new-report-on-aca-implications-for-state-network-adequacy-standards/

Lastly, narrower networks as opposed to WHAT on the previous individual insurance market? Which as we all know, was hardly a beacon of generous benefits.

[Yo_Mama]

38. This issue has been widely discussed.

It's not just CA, but it has some of the tightest networks for ACA plans.
http://pnhp.org/blog/2013/09/16/exchange-plans-have-sharply-limited-networks/

[flamingdem]

40. I'm beginning to wonder if this is more of the same

Another scam run by the insurers so they make top dollar at the consumers expense.

I should add "duh"! but I still hold out hope..

[Yo_Mama]

66. I wish I could find that article, because it discussed all the ins and outs

It's not necessarily a scam, but there was concern about affordability, and this was one of the tradeoffs.

The article I read said the insurance regulators would monitor it, and if there was evidence that the tighter networks were impeding access, they would intervene.

There really is an affordability bonus. In more rural areas, like mine in GA, we all of course use the same doctors and hospitals. There is no choice. But our ACA rates without the subsidies are very high indeed, and some people who were insured are now not going to be insured because of that.

The last part of this is that some hospitals that care for a lot of the poor/uninsured are being cut out of these networks because their rates are relatively expensive (the insured pay for the un/underinsured, including some government insurance), and so there are concerns about whether the community hospitals will now be in trouble.

This all seems a balancing act that will have to be dealt with as everyone sees how this develops.

[Pirate Smile]

33. I think people underestimate the issues Medicare had to deal with but there was no cable news or

Twitter. Hopefully, all these issues get resolved quickly.

Medicare survived its early missteps

......
Because Medicare involved federal aid to the states, participating institutions had to comply with Title VI of the Civil Rights Act of 1964, which banned racial discrimination. Hospitals in the South, which segregated patients by race, initially refused to comply with the law. As conflicts between hospital administrators and the federal government intensified, the president of the Louisiana Hospital Association put the matter bluntly: “It’s the requirement that Negroes and whites be permitted to share the same hospital room,” he warned. “I don’t know what the hospitals will do but I hear that some of them don’t see how they can comply.”
Some hospitals didn’t: When Medicare began on July 1, 1966, large swaths of the hospital system in the South remained segregated. Despite appeals by President Lyndon Johnson on television and radio, three-fourths of the hospitals in Mississippi couldn’t accept Medicare patients when the program went into effect. Entire cities in the region — Selma, Ala., and Macon, Ga. — had no hospitals eligible for Medicare.

.....
Predictions of doom soon filled the nation’s papers, with eminent voices from both sides of the political spectrum warning of the coming disaster. Sen. Edward Kennedy ominously predicted that the nation would need a half-million more nursing home beds; the Wall Street Journal warned of a “patient pileup” at hospitals. Hospital administrators grumbled, complaining of delays processing patients, overcrowding and a host of related ills.

In the end, the nation’s health care system weathered these crises, even as new ones materialized. Under Medicare, doctors could either bill participating insurance providers or patients, who would then need to submit receipts for reimbursement.

In the first years of the program, the majority of doctors billed their patients. When these patients — many of them on fixed incomes, with little cushion of savings — submitted their bills, it took them an average of two months to receive reimbursement. Stories of much longer waits became commonplace in the media.
Eventually, the government and the private insurers worked out most of the kinks, and by the late 1960s the system was working reasonably well. Almost all hospitals had desegregated, doctors dropped their opposition and claims processing improved.

http://www.courier-journal.com/article/20131020/OPINION04/310200006/

[slipslidingaway]

45. So if someone goes out of network their bill will be resolved in a couple of months ...

and they will not be held personally liable?

I'm not sure one can equate the two systems, but it sounds good.

[slipslidingaway]

44. People need to look beyond the premiums to who is in your network ...

and the hospital may be more important than the doctor!

It is NOT just about the monthly premium, it is about where can you go in network when something serious happens to someone in your family. Many of the large hospitals work in teams for a specialty, so a particular doctor might not be the most important ... things to think about!

[flamingdem]

47. This is upsetting to me

I have shopped multiple hospitals and specialists before and was very glad I did!!!

That's because some of these doctors weren't qualified.

I like to research and be in the know, talk to people and get names. That is really and truly how one gets good care. Now it will be a matter of being lucky as to whether the doctor I need is accessible. I do not like this at all.

One thing I wonder is the ease with which we can change programs. Can I up my coverage to the Platinum higher coverage plan, presumably with more choices with no penalty....

[Nye Bevan]

56. "Gold" and "Platinum" do NOT mean better networks. Don't be misled.

A given carrier's Platinum exchange plan will have lower deductibles and copays than the same carrier's Bronze exchange plan, but most likely the exact same provider network. If access to your preferred doctors is your main priority, you may well need to buy a plan that is not on the exchange (which means that you will give up your right to a subsidy).

Also, once open enrollment is over, you cannot switch plans unless you have a significant life event (give birth, get married, get divorced, etc.). And doctors leaving your network is not considered to be a qualifying event.

[slipslidingaway]

57. Not sure how to answer your question ...

about the ease of changing policies.

Personal referrals from trusted sources are always a great source, that is why having the widest network of providers helps considerably. Of course one pays for that convenience and sometimes it can literally be a matter of life and death.

If you are happy with what you have and can afford the current costs I would suggest staying with the policy until the dust settles. If this is your first chance for affordable premiums, not necessarily HC, then do the best you can to research all aspects ... monthly premiums, in/out of network providers/out of pocket annual maximums etc.

You bring up valid points for people to consider, thanks.

[Rosa Luxemburg]

50. THere should be no fancy doctors in a healthcare system for all

I am so sick of greed in the health system. It makes me angry that this country allows doctors to behave like business people. Health is not a business!

[Nye Bevan]

59. Say a successful doctor is netting $90,000 per year from his practice.

Is it "greed" if, when asks, he declines to participate in a new exchange network that would cut his reimbursement significantly and reduce his net to $55,000 per year?

[Lex]

61. I've yet to see a doctor net $55,000 from their practice.

More like $250,000 down to $210,000.

[Hoyt]

70. That would not be "greed." But, there are not many hardworking docs making just $90K.

Maybe some pediatricians or some guy in the backwoods who doesn't have a lot of patients.

I would be surprised if the ACA rates offered are less than Medicare rates. If they are, then the docs have justification for holding out. Unfortunately, that is likely to increase premiums if the rates we are seeing a sub-Medicare Fee Schedule.

[Beausoir]

60. Ignorant assumptions.

You do realize that physicians are reimbursed according to what the government dictates, right?


I don't think I'd want to visit a physician who didn't behave like a "business person". These people have staff to hire, equipment to constantly upgrade, a myriad of governmental regulations to sift through constantly, constant changes in health care laws to keep abreast of.

If you are looking for a physician who doesn't take a monetary fee, I suggest Theodoric of York.

[flamingdem]

62. I can only imagine that Theodoric used trepaning

or the ole cut a 'ole in the 'ead to release teh vapors kind of medicine

[Rosa Luxemburg]

78. Staff should be hired by the state government including doctors

I would have a completely different system where doctors get a salary from the healthcare system and they don't need to make a profit they just treat sick people!

[Beausoir]

80. How dumb. Trust me when I say that if you ever get sick, you do NOT want government trained

physicians to try and heal you.

It's all fun and games to promote socialist medicine...until YOU get gravely ill.
Then, my friend, you will be screaming a different tune indeed.

[Rosa Luxemburg]

81. I hope you hit the sarcasm button

[hughee99]

53. I don't think it was "part of the plan" but rather something not fully addressed by the plan.

I'm not sure anyone can honestly say it was unforeseen either. This issue goes back at least until First Lady Clinton's health care task force from the mid-1990's where then did have some ideas about how to address it.

[OrwellwasRight]

54. Besides, Kaiser is great!

Don't pooh pooh it! You'll never know how convenient it is to be guaranteed same day appointments and after hours and weekend appointments that cost the same -- not emergency room prices!

[Hoyt]

65. I've been using Kaiser for a couple of years. I like it. Problem is

Most people don't like HMOs, even if it saves them money, is convenient, and has high quality ratings.

[OrwellwasRight]

79. Anyone who supports universal health care

better get with the program -- this is how you make care affordable. And it works!

[lostincalifornia]

55. I can tell you UCLA, UCSF, and a lot of fine medical facilities in Ca

accept the ACA

John Hopkins, Cleveland clinic, Mayo clinic outside California not only accept it but are strong advocates of it

In other words, there are some very fine Doctors who accept it

[flamingdem]

63. Thanks! I was planning on calling various departments at UCLA tomorrow

That's my go to place and I believe they've worked out some of their problems with Blue Shield too. If I can go there that solves about half to 2/3 rds of my issues with ACA.

[lostincalifornia]

64. I may have misread some of the information. It is confusing. It implies only some of the plans

may be accepted. Here are the links I was using

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/which-top-hospitals-take-your-health-insurance-under-obamacare



http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/which-top-hospitals-take-your-health-insurance-under-obamacare

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

[flamingdem]

69. This UCLA bulletin lists a lot more plans - I'll call to be sure

http://www.uclahealth.org/body.cfm?id=85

[lostincalifornia]

74. Good, thanks

[flamingdem]

72. It was unfair to lock your thread

DU can get crazy when people assume the worst.

I can see why considering the right wing attacks on ACA but I think your post came out of genuine concern that people don't realize what they'll be getting. There is still time to research and select accordingly. So you were attempting a public service!

This too will pass. Thanks anyway.

[lostincalifornia]

73. It was. I was concerned I gave incorrect information out in this thread, and was just to make

sure people check. I guess I lost my cool also, but the implication I was trolling got to me, so I locked it. I didn't want the thread to become flame bait, that wasn't the intention. In fact if I was wrong, then I want folks to correct me.

Thanks

[geek tragedy]

67. There have always been doctors who operate on a cash-only, no insurance basis.

Saves them a ton of overhead and headaches.

[csziggy]

71. What's different - my "fancy pants" doctors won't accept my insurance company

Which is NOT ACA - at least they do not accept the amount the insurance company will pay as full payment. The orthopedic clinic I go to, one of the best in the country, is not in network for my insurance company, CIGNA. I prefer using this clinic rather than the mediocre doctors CIGNA recommends because of the quality of the service and because I have been going to them for twenty years and eight major operations.

Every time I go to the clinic, I get reminded that they are not in network, and charged more for each visit and service than my 20% copay would cost. I made the expensive choice to continue going to that clinic because of the quality of care, but I wish they were in network. I just found out that the carpal tunnel surgery I had last year still has a $1300 balance with my doctor. I paid well over $10,000 out of pocket last year for two total knee replacements because of this policy.

I'm not surprised that some doctors are placing themselves "out of network" for ACA policies. As more and more Americans get shuffled into ACA policies because of employer choices and because of cost, I suspect many of these doctors will change their minds. My primary physician was out of network - last year I paid over $500 for the annual check up that should have been free under ACA. My doctor was shocked when I told him, but he had good news - his group has just signed on with CIGNA so my next check up WILL be free. Without ACA we would not have complained to the doctor about the check up costs and he would not have made the move to get in network.

ACA has good and bad points. But insurance policies prior to ACA also had good and bad points. Nothing new here.

[PoliticAverse]

75. Related article: "Doctors are concerned about pay scales under health care law"

http://www.democraticunderground.com/114210621

[GladRagDahl]

76. Here's why

These services are going to be run like Medicare and Medicaid when it comes to government payments. Medicaid determines just how much they will pay for each of the services that you receive when you to a doctor. In order for that doctor to bill for your services, they have to hire a Medicaid insurance expert to handle the filing of those claims. Medicaid is notoriously slow in paying claims in many states. What’s more, they are known for changing billing codes or requiring billing code changes time and again because they don’t feel like a service should be billed under the code that it was originally assigned.

What’s more, Medicaid is cheap; it’s that simple. If you were to go to a doctor’s office and have a check up, it would cost you about $90. This covers the cost of the doctor’s time, the nurse or nurses that helped you as well as the office staff that checked you in, the rental of the office, etc. etc. Medicaid, however, might pay $30 for that same visit, which doesn’t come close to covering the necessary fees.

That is why you will often find offices that accept Medicaid often book their appointments at 10-minute intervals and they are often backed up. They want to make some money, while providing treatment for their patients but they have to book 3 times as many patients a day in order to accomplish this.

If you live in a state where you get excellent care while on Medicaid, then you probably live in a state where the payment for services is higher than normal. In these states you will find that a majority of doctors accept Medicaid. The truth is that, in any state, if every doctor accepted Medicaid, then the cost would balance out and the doctors that do accept Medicaid wouldn’t be hit as hard when they receive their payment from Medicaid.

[salin]

77. sometime in the 90s... went from nonprofit state level bc/bs

and became the for profit anthem.

The greed in health care started 15-20 years ago. Go back to your description of the plan's demise per higher costs and steeply declining coverage. This issue is why there is an ACA attempted fix. It is not the cause of the problem (and a glorification of greed is certainly a major contributing cause.)