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Old 11-15-2014, 07:39 PM   #61
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Seems like these problems wouldn't exist with Kaiser at all would they? Assuming ur there already or wanted to go that way, the old pre Obamacare Kaiser would be the same as the post Obamacare Kaiser.

Blue Shield in CA now has an EPO instead of a PPO is many counties. The PPO has many more doctors etc., You can't get the PPO under Obamacare, just the EPO.


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Old 11-15-2014, 08:01 PM   #62
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I noticed some 3 tier network plans. Preferred in network, in network, and out of network. Copays are near zero for preferred network, much higher (basically full freight) at non-preferred in network.
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Old 11-15-2014, 08:27 PM   #63
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Blue Shield in CA now has an EPO instead of a PPO is many counties. The PPO has many more doctors etc., You can't get the PPO under Obamacare, just the EPO.
I have blue shield PPO purchased on the exchange in CA. We specifically picked this over the EPO.
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Old 11-16-2014, 10:21 AM   #64
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Thanks for the link ERhoosier. Confirms what I thought, despite limited competition, I'm fortunate to have very good options.
Glad you're feeling fortunate, but I'm not vouching for this survey supporting any specific HI options as being good or bad. I only posted the link because there is so little 'real-world' HI-related consumer info available. IMHO- Its pretty rough 'data' on HI service. For example, this survey was NOT plan-specific in its data collection. It is very possible that, for similar HI premiums costs, an individual might be better off with the top plan from a lower-rated company than a better-rated company's lower-end plan. Folks still need to shop around to see what plan is best for them.
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Old 11-16-2014, 11:09 AM   #65
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I agree it's just a small set of data. I only have a small set of data to compare with so I may be scewed.

One important factor in HI(and many businesses) is the call center, not how long your on hold, but are there competent people you deal with. I've been inside many call centers, the good ones are most always good, the poor ones just always stink. Doesn't matter what product you buy the call center can determine much of your experience.

I only had 2 HI companys to choose from, one at the top and one at the bottom of the attached. My experience with them while shoping was educational. One could answer questions, the other, well they didn't know what cost sharing was, who was in network, or........ This was reenforced during the year when I had questions or issues. I received excellent customer service.

Yes you have to shop, very carefully. I did pay up for a better network. I knew that was important (for me), through the course of the year I discovered pleasantly how important.

Again thanks for the post it's the first data I've seen. I agree more "grain" would be great but it's a start.

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Old 11-16-2014, 01:43 PM   #66
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I have blue shield PPO purchased on the exchange in CA. We specifically picked this over the EPO.

When I go to covered ca there is only one choice for my zip code, that's EPO. I just checked a different zip and the PPO is available there. So it's zip code related I guess.


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Old 11-16-2014, 01:47 PM   #67
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Auh, my grandfathered plan for the next year and a half, can take 50K in LTCG every year, SS, convert to Roths, and fer get about the ACA.
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Old 11-16-2014, 04:04 PM   #68
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Seems like these problems wouldn't exist with Kaiser at all would they? Assuming ur there already or wanted to go that way, the old pre Obamacare Kaiser would be the same as the post Obamacare Kaiser.
Correct. I had Kaiser with my employer and on COBRA. I qualified for individual coverage with them after a few tries (pre-ACA), and am currently covered under an ACA Bronze HSA-eligible plan with them.

Over all this time, with three different policies, I have the same doctors, same MRN (medical record number, the Kaiser ID card number), same labs and pharmacy, and same hospitals. All that's changes over time are insurance-side details, like payments, copays, and deductible amounts.
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Old 11-17-2014, 11:30 AM   #69
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When I go to covered ca there is only one choice for my zip code, that's EPO. I just checked a different zip and the PPO is available there. So it's zip code related I guess.
Interesting. I wonder why they are dropping for some zip codes and not others (I would have expected them to make a california wide decision). Do you know if they offer the PPO in your zipcode off exchange?

Also we when signed up I think the difference between the EPO and PPO was only in the out-of-network coverage. I.e. they have the same in-network providers but the PPO plans had explicit max OOP for out-of-network.
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Old 11-17-2014, 08:31 PM   #70
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Interesting. I wonder why they are dropping for some zip codes and not others (I would have expected them to make a california wide decision). Do you know if they offer the PPO in your zipcode off exchange?

Also we when signed up I think the difference between the EPO and PPO was only in the out-of-network coverage. I.e. they have the same in-network providers but the PPO plans had explicit max OOP for out-of-network.
Being spotty by geography seems like it might have arisen from spotty provider signup in that geography. In other words if none of the doctors in Richville sign up for the crummy reimbursement plan, that town doesn't have the plan offered.
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Old 11-17-2014, 10:07 PM   #71
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When we signed up for our BCBS Silver plan last Dec info on which doctors were in-network wasn't available (we're in Illinois).

After we picked a plan, two of our doctors sent us a letter saying they were no longer going to take our ACA plan.

So, we ended up dropping the ACA plan in May as we were paying for something we weren't using and got a much cheaper temporary plan for the rest of the year. Right now we are shopping for a private plan for 2015.
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Old 11-17-2014, 10:12 PM   #72
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I asked my primary care doctor and they seemed confused as to why they wouldn't accept the insurances from big name insurers like BC, Aetna, UHC, (what's available through the exchanges). Of course there might be some insurers they don't accept at all, but I didn't get the impression that they were planning on discriminating based on exchange/non-exchange procured insurance.
I wonder if this is a red state/blue state issue. We live in a heavily Republican area and I suspect not taking ACA is a way for Republican Doctors to directly boycott ACA.

I have no idea if this is true but I have suspicions.
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Old 11-17-2014, 10:53 PM   #73
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If enough of the population ends up the ACA plans (early retirees, young adults, small business owners, dole proprietorships, entrepreneurs, the doctors who refuse to take ACA plans will find themselves with fewer patients. From what I've seen in my Spam doctor political emails, doctors who aren't taking ACA insurance are doing for pure anti-Obama politics.

I'm willing to find a new doctor if they are that unreasonable about health insurance. High priced doctors are not necessarily the best doctors. They're just high priced. One of my friends was chief resident at UCSF and she deliberately chose a career in a free clinic for homeless children.


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Old 11-17-2014, 11:05 PM   #74
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Maybe the insurance companies need to provide the doctors for their plans?

"Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent"

http://www.nytimes.com/2014/11/18/us...=top-news&_r=1
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Old 11-17-2014, 11:57 PM   #75
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Maybe the insurance companies need to provide the doctors for their plans?

"Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent"
What do share prices of insurance companies have to do with getting more doctors? Are they paying the docs in shares?

If the law makes it easy for insurance companies to make a lot more money--well, that's what they wanted, and what they bought.
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Old 11-18-2014, 06:03 AM   #76
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There's a big difference between "checking your insurance card" and "actually logging into the Insurer's network to verify if you are paid-up on your health insurance". I don't quite know how many times a doctor's office will do the latter. Without directly logging into the insurer's database, they have no way of knowing that your insurance is paid-up. I doubt the insurer will have a field of phone operators standing by to take calls at all hours, day and night, and on weekends (including, but not limited to, emergency room visits, which might involve several different healthcare providers in the same hospital).
I went to a dermatologist yesterday. I haven't been to this doctor for about 3 or 4 years. I filled out my insurance information (it had changed) and they made copies of my insurance card and drivers license. When I was leaving, they had the bill ready that showed I had met my deductible for the year. Clearly, they had contacted my insurance carrier in the nominal hour between when I turned in my information and when I was leaving.
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Old 11-18-2014, 06:12 AM   #77
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Just got (an expected) letter from my doctor. Starting December 1, he is NOT accepting insurance at all! He's setting up a new practice where a visit is $50 to be paid at the time of visit.

He figures the new regulations and general insurance hassle costs him so that he had to charge $200 to get the $50. Now he has two secretaries (instead of a room full of insurance chasers) and a credit card machine.

I may be off on the actual numbers but that's the gist of it.
This is what I'd like to find. I started another thread about getting a lower rate by not using insurance at my primary care physician's office and possibly others. It's unlikely I'll meet the deductibles for non-employer based policies ($6,000/yr!!!!) so it seems to make sense to get a lower rate ($50/visit) rather than paying $80 to $120 that goes against the deductible I'll never meet.

My insurance would only be for true catastrophic situations where I would expect to run up a big bill.
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Old 11-18-2014, 06:31 AM   #78
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A discussion of their partisan views is probably not going to lead to any useful conclusions for us early retired folk, but it might have some unintended effects. Back on topic, is their anything other than anecdotal evidence that a significant number of doctors are not accepting ACA policies?
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Old 11-18-2014, 06:44 AM   #79
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I wonder if this is a red state/blue state issue. We live in a heavily Republican area and I suspect not taking ACA is a way for Republican Doctors to directly boycott ACA.

I have no idea if this is true but I have suspicions.
EastWest Gal says her emails support this premise but I can't help thinking that the doctors, as small business men/women, are trying to maximize their profits. It's no secret that some ACA plans have pushed lower reimbursement rates in their policies. I'm not sure if the ACA exchange plans have additional requirements that may also be more costly for the offices to comply with.

I certainly can agree that the doctors should refuse to accept plans that cause them to reduce their practice's income.
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Old 11-18-2014, 06:51 AM   #80
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A discussion of their partisan views is probably not going to lead to any useful conclusions for us early retired folk, but it might have some unintended effects. Back on topic, is their anything other than anecdotal evidence that a significant number of doctors are not accepting ACA policies?
I don't think this forum has the resources to answer your question although I would think that our HHS data hounds should be able to determine a decent estimate rather quickly. Unfortunately, do the people running HHS want this number thrown around if it is high? I'm sure they would love saying "less than 1% of doctors aren't participating in exchange plans." Since I believe the number could be determined easily for anyone with total access to the ACA site, I'm leaning on the number being higher that "they" would like to publicize.

Moving beyond any political intrigue, we know that some plans have more limited availability of doctors. If you care about keeping your doctor, you need to research this before deciding on a plan.

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