Under Obamacare, some top cancer centers off-limits

[magical thyme]

Another way health insurance companies are evading the intent of the law...


"...An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state's insurance exchange. MD Anderson Cancer Center says it's in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.

Doctors and administrators say they're concerned. So are some state insurance regulators....

...Before President Barack Obama's health care law, a cancer diagnosis could make you uninsurable. Now, insurers can't turn away people with health problems or charge them more. Lifetime dollar limits on policies, once a financial trapdoor for cancer patients, are also banned....

The new obstacles are more subtle."

http://www.cbsnews.com/news/under-obamacare-some-top-cancer-centers-off-limits/

[hobbit709]

1. Once again, the ACA gives us INSURANCE not CARE!

[idendoit]

19. What a great way to put it. Thank you.

[PumpkinAle]

28. Well said. (n/t)

[Hoyt]

2. The cancer centers might be holding out for more money. There's a lot of greed

in the system.

[denverbill]

3. Doctors and administrators say they're 'concerned'. Why weren't they concerned before?

This is nothing new. I can't go to any doctor I choose and never have been able to with any insurance I've ever had. Or, I can go to a doctor not on my list and pay twice as much or more in coinsurance.

I'm sure they are 'concerned' Obamacare won't pay for boob jobs and facelifts either.

[Hoyt]

5. Exactly, if that concerned, they can take you at the plan's rate,

But they won't. They'll charge their normal inflated fee and come after you for whatever the plan does not pay. Then, they'll blame their greed on Obama and the insurer.

[Mojorabbit]

10. For many people this will not be an issue until a loved one is not able to obtain treatment

within a reasonable distance. Only then will they stop defending the actions of the insurance companies. I read that California has plans so narrowed by insurers that it will be difficult at best to obtain care. I imagine there will be many areas with the same. I can't see what is wrong with not being happy about it.

[uppityperson]

4. Seems that is done by insurance companies wanting to maximize their profits. There need to be

laws prohibiting them from denying coverage like that. There needs to be major insurance reform.

Doctors and facilities have always done this and it really really sucks. I lost my best endocrinologist because they quit taking my insurance and I could not afford to pay cash. I found another in-network who is better, finally.

[Ms. Toad]

6. Scary headline...

insurance plans under the ACA act just like insurance plans not under the ACA. Each plan has contracts with certain facilities and doctors. Those doctors and facilities are covered (or are covered at preferred rates) and others aren't.

[magical thyme]

8. I used the article headline which, I agree, is scary

and not exactly. The ACA contracts have more limited coverage than non-ACA contracts.

Per the very last 2 sentences in the article:

The Obama administration says it has notified insurers that their networks will get closer scrutiny for next year in the 36 states served by the federal exchange. Cancer care will be a priority, it says.

[Ms. Toad]

12. It depends on which plans outside of the exchanges you are comparing them to. n/t

[stevenleser]

16. That is my take as well. I can't go to any hospital on my non-ACA plan and get full coverage.

The way to deal with this issue is to determine what percentage of plans of various costs include these hospitals in their networks and then compare to the percentage of ACA plans that cover them.

That would be the honest way to deal with this issue. It does not seem like the article referred to here did that.

[Xithras]

22. A lot of people are just learning how insurance works for the first time.

The previously uninsured, or those who only had catastrophic coverage, never learned about things like "provider networks" because they never needed to learn those things. I was talking to one young woman last week about the need for her to enroll before open enrollment ends, and she gave me a blank look. She'd never had insurance before, and had no clue what "open enrollment" meant. She thought that she could just sign up any time, and actually thought I was pulling her leg when I told her that you can only buy insurance during certain time periods (her exact quote when she realized that I was serious was: "What kind of company stays in business only selling their products a few months a year? Are they selling insurance or Girl Scout cookies?!&quot She'd never dealt with them before, and had no clue.

The poor and uninsured are often clueless about provider networks, and mistakenly think that the only difference between the plans are the costs of the deductibles. Cheap plans get you limited coverage and high deductibles but protect against catastrophic health emergencies. Cadillac plans get you awesome coverage and low deductibles, in exchange for high premiums. The price of your plan determines the quality of your provider network.

The ACA did nothing to change the existing insurance model. Cheap ACA plans get more limited coverage than expensive private plans. Even the most expensive ACA plans lack a lot of the coverage available in comprehensive private plans (my current $19,000 per year family PPO covers ACUPUNCTURE for chrissakes). Basically, the insurance companies shave premiums by eliminating access to more expensive services and coverage. If they didn't do this, nobody would buy the more expensive plans.

[Ms. Toad]

24. Definitely true -

And even among people who have had insurance all along, most people never delve into the details because they don't need to. Whatever is covered, they are grateful for - and they don't even check to see if it covered all they are entitled to have covered.

I check every statement, and frequently find out they have not properly paid it, or the doctor has not properly credited it.

We had a 100% reimbursement HRA at my last place of employment - I am pretty sure I am the only one who actually collected on it. I know my boss (who bought the plan) routinely ignored the steps she had to do to get fairly significant work covered.

[ProSense]

7. Seriously,

"Under Obamacare, some top cancer centers off-limits"

...why exactly are people pretending that Obamacare is structuring health insurance plans? There are mandated benefits, but the law does not determine the providers. Obama is not the head of every insurance company in the country.

"...An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state's insurance exchange. MD Anderson Cancer Center says it's in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.

That is not new, and three insurer do include the first center so the headline that these centers are "off-limits" because of Obamacare is completely false.

[magical thyme]

9. I guess that's why the administration has advised the insurers they'll be given them more scrutiny

with a priority on cancer care.

"To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans.

By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere....

"...The Obama administration says it has notified insurers that their networks will get closer scrutiny for next year in the 36 states served by the federal exchange. Cancer care will be a priority, it says."

really, people should consider reading linked articles before shooting from the hip. We are limited to a couple paragraphs (and rightly so) which makes it impossible to tell the whole story in the OP. Just some critical stuff to get those who are interested to read on...

[ProSense]

11. That has nothing to

"The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans. "

...to do with the claim that the centers are "off-limits." Also, that claim is unsubstantiated.

In fact, people have more choices of plans than an employer package offers.

[magical thyme]

13. they're off limits in more than 50% of the ACA plans

which makes them off-limits to everybody in those plans. Except the 1%, of course.

More choices among ACA plans that consistently offer less than fewer choices among employer-based plans which consistently offer more.

The fact that the administration plans to scrutinize them suggests they consider it a potential problem, along with state regulators.

But you, of course, are welcome to consider it not a problem.

Personally, I think its good to bring attention to potential problems so they can be fixed.

But hey, I'm glad everything in ACA is all rainbows for you.

[ProSense]

15. Obamacare has nothing to do with determining providers, and it's a bogus mischaracterization. n/t

[magical thyme]

25. I guess that's why the administration plans to scrutinize the ACA insurers more closely next year.nt

[ProSense]

26. Insurers can

"I guess that's why the administration plans to scrutinize the ACA insurers more closely next year."

...be dropped from the exchange if they don't follow the rules, and they pay a fee to participate.

Health Insurers Will Be Charged to Use New Exchanges
http://www.nytimes.com/2012/12/01/health/health-insurers-will-be-charged-to-use-new-exchanges.html

[Rosa Luxemburg]

20. yes

[DesMoinesDem]

14. Obamacare provides an incentive to provide poor care to expensive patients.

Anyone that had a basic understanding of this law saw this coming years ago. Insurance companies don't want these expensive patients so they give them poor service hoping they'll leave.

[gulliver]

17. People who don't vote Democratic are squarely to blame for any flaws...

...in Obamacare. We got as much as we could get, and tens of millions of people are better off. We could have gotten more. The fact that we didn't is on Republicans and folks who failed to vote Democratic steadily and at full force.

[mucifer]

23. Don't forget the blue dog dems and Max Baucus in the senate

We had a majority in the house. But, some of the dems were huge roadblocks to a much better law.

[gulliver]

30. That's true.

To get a better law, we would have needed enough Democrats to get by without the blue dog votes. Also, since seats were on the line and health care is not the only issue of importance, we needed the 2010 Democratic-leaning demographic voters to be reliable, determined, and unshakeable.

But they were, instead, typical human beings. Moody, bored, self-absorbed, disgruntled, misguided... Our thin Democratic majority had to face a 2010 election with that type of voter as their backup. It is a wonder we got a health care bill at all. It was a bit of a miracle.

The ACA is a huge win, undeserved or not. The voters? They got a vastly better bill than they deserved. Most of the the perceived flaws in the bill are their fault or simple misperceptions or both.

[Bluenorthwest]

27. Except the ACA had no Republican votes, so it was not a product of compromise with

Republicans. Not one of them voted for it.

[gulliver]

29. How is that relevant?

Republicans didn't vote for the ACA, so Democratic non-voters aren't responsible for the bill's flaws?

I don't think your argument's toe bone ends up connected to the head bone. There is some hand waving and emoting in there where the linkage should be.

[ScreamingMeemie]

18. I was just at MD Anderson in Houston last

week with Humana. FTR Humana has over 100 doctors available to me within a ten mile radius. They took my card which looks just like any other Humana card.

[mucifer]

21. You also have to have fancy insurance to use "Cancer Centers Of America"

Which is owned by right wingers.

For a while now here in Illinois less and less hospitals are taking public aid. It's very sad.

But, Stroger Hospital which is the county hospital is getting lots of ACA money and finally getting reimbursed for some of the indigent patients who are not eligible for public aid.

There are some things Stroger does better than some of the fancy hospitals in Chicago.

[WinkyDink]

31. Aren't these decisions made solely by the excluded entities themselves and not by the ACA?