How Obamacare Leaves Some People Without Doctors

[antigop]

http://www.huffingtonpost.com/2014/04/10/obamacare-patients-without-doctors_n_5044270.html

In January, a doctor told Noam Friedlander, who was suffering from excruciating lower back pain, that she needed surgery to remove part of a severely herniated disc. Friedlander had Blue Shield insurance through Covered California, California's version of Obamacare, and planned to use it to cover the costs of the operation.

But when she started to call surgeons covered by Blue Shield, she ran into a roadblock. Surgeons who were covered by her insurance operated out of hospitals no longer covered by her insurance -- or vice versa. Friedlander spent days on the phone, hours on hold, making dozens of calls across Southern California, trying to match a surgeon with a hospital that would both be covered. In total, she reached out to 20 surgeons and five hospitals.

"No one could help me. Some expressed sympathy," Friedlander, 40, told The Huffington Post in an email. "They told me, 'I'm so sorry -- it's all just so new. You're a victim of the changes. No one knows what they're doing.'"

Unable to match a hospital and a surgeon that were both covered, Friedlander started haggling between doctors for a cash price for the surgery. She chose a surgeon who wasn't covered by her insurance but who operated in a hospital that was covered. She expects her insurance to pay the hospital bill, but she had to pay for her surgeon's bill herself. In the end, she had to take out two credit cards so she could pay $16,000 out of pocket.

Limit the networks...force people to go out of network. Out of pocket expenses can be unlimited if you are forced out of network.

[CurtEastPoint]

1. Another good reason for single payer.

[OhioChick]

14. +1000 n/t

[Ms. Toad]

2. Anyone lucky enough to have had insurance

has wrestled with this issue all along. It is not an ACA problem, it is an insurance problem - insurance plans have always had limited networks. Some better than others. That's the reason the last place I worked dropped Kaiser - they had a community based plan and decided to abruptly drop all community providers because many of us were seeing doctors (or going to hospitals) that would no longer be covered.

Bottom line - it is still better to have insurance than not. If we could not have found a better plan at work - it would have been better to have Kaiser than nothing. But - again - that is a longstancing insurance issue, not an ACA generated issue.

[antigop]

3. go back and read the article. nt

[Ms. Toad]

5. The general problem is not new.

More people are experiencing it because more people have insurance - particularly people who did not have insurance before and did not understand how carefully they needed to review the provider lists. That is supported by this - an article on which the HP article is based:

Our analyses show, however, that products comprising narrower hospital networks correlate with a lower premium. Indeed, across the markets we analyzed, the median increase in the premium for the same product type (e.g. HMO, PPO), offered by the same carrier, in the same metal tier, but utilizing a broad versus narrow hospital network is 26 percent. Thus, the trade-off between price and choice of hospital breadth in a network in the exchanges has been established for the consumer. The consumer will now need to evaluate this price/breadth trade-off and choose a product accordingly.

And - FWIW - I have gotten hit (as long ago as 25 years) with out of network bills from specialists who I could not avoid because they practiced where I needed to have surgery and I had no choice but to use an anesthesiologist - a group notorious for being out of network because they refuse to accept what insurance companies are willing to pay.

So just because a news article ties something to the ACA, or because there is a correlation, doesn't mean they are inherently connected Other factors (like the factors that created the same challenges with Kaiser a few years ago, or the ones which historically keeps anesthesiologists out of network) can also explain what we are seeing.

For example - from one of the articles referenced:

Network breadth and product type (e.g., HMO, PPO) are correlated: the majority (76 percent) of ultra-narrow networks is coupled with HMO designs, and the majority of HMOs (58 percent) is coupled with ultra-narrow networks

Guess what Kaiser is - and guess why our network narrowed dramatically a few years ago (completely disconnected from the ACA): It was shutting off the PPO option (traditionally a broader network).

[antigop]

6. well, I'm sorry if you didn't understand what the article said. nt

[Ms. Toad]

8. I understand very clearly what the article says.

I also know that articles - and particularly articles about the ACA - are notoriously bad at accurately distinguishing between things caused by the ACA. I go to the source materials when possible - and they often tell a very different story. As do the source materials for this article.

[antigop]

10. Sorry if you didn't understand the article., but thanks for the kick anyway. nt

[antigop]

7. but, hey, thanks for the kick. nt

[Doctor_J]

11. You need to look past your knee-jerk defense

It is not an ACA problem, it is an insurance problem

The ACA locked insurance companies into the system, and guaranteed them a half trillion dollars in profit every single year. Insurance companies have been the problem all along, which is why Candidate Obama promised to take them out of the loop. Unfortunately that turned out to be a lie. So the woman in the OP is stuck without a surgeon, and my annual out-of-pocket through my employer plan went from 500 to 8500.

Like every "solution" cooked up by the turd way and other repukes, it provides some relief to the needy, locks in huge profits for the 1%, and clobbers working stiffs and the rest of the middle class.

[Ms. Toad]

13. It is not a knee-jerk defense.

I am responding to the knee-jerk reaction that every problem people are now encountering must have been created by the ACA.

Single payer would be far better - but it was not an option which had any chance of succeeding. The change we have is far better than living with the system pre ACA. And there are plenty of working stiffs and others in the middle class with pre-existing conditions that this law rescues from medically induced bankruptcy, or frees up to explore options beyond staying in a job they hate because the insurance provided by their employer is the only means they have to obtain the health care which keeps them alive.

A large portion of what is happening now is that people who have never had insurance before chose plans they did not understand, and are encountering formularies for the first time, limited networks, and so on.

Specifically, the playing field shifts all the time between HMO v. PPO v. POS. Certain plans give you broader or narrower ranges of service providers you can see and still stay in network. That is not a problem created by the ACA. It is a problem associated with insurance - generally. I have had challenges seeing the physicians I wanted to see (or any at all within a reasonable driving distance) since at least 1978. Unless my memory is seriously off, the ACA was not around in 1978. During the periods when HMOs were pushed, it was hardest to find a plan which gave me access to the doctors I needed to see - because HMO plans limit service providers more than other kinds of plans. During periods when those were out of favor (most of the time in recent years), I had a much broader range of service providers. From the research on which the HP article relies - that is a significant factor in the problem it complains about. Many of the plans created to meet the ACA demand are HMO plans. Those will have narrower groups of service providers.

I am not saying the ACA is a perfect solution - I just get tired of all the crap posted that blames every bump in the road on the ACA, as if it was something new created by the law, rather than something that has existed forever in the tool the ACA uses to provide access to health care to more people than have had it in recent memory - perhaps ever.

[antigop]

4. Obamacare: Fewer options for many (limited networks)

http://www.cnn.com/2013/10/29/health/obamacare-doctors-limited/

Nationally the marketplaces offer tens of thousands of different policies with a wide variety of coverage, but Harte has noticed many have one thing in common: They cover a narrow network of doctors and hospitals.

Obamacare sign-up more than a phone call away

That narrower network comes as particularly bad news for the residents of Concord, New Hampshire.

Concord's one hospital won't accept any policies offered by the marketplaces. To see a doctor, specialist or primary care provider affiliated with the hospital, patients on these Obamacare plans will have to pay out of their own pocket. The closest in-network hospital is in Manchester.

"Can you imagine having to go 25 miles away to Manchester to get access to a health care provider that is covered by your insurance?" Harte asked. "Right now, Concord is one big black hole of health care for people buying these plans."

And it's not just Concord. Nationally, consumers are learning a number of well-known hospitals won't accept insurance offered through the marketplaces.

[Scruffy Rumbler]

9. That is a result of the ACA being about insurance and not single payer.

As Ms. Toad said above, this is nothing new to people that have had to deal with insurance companies before.

[quadrature]

12. look on the plus side of this... pregnant men now have insurance coverage...nt