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Old 01-09-2016, 07:23 PM   #21
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I also have been told by several doctors they won't take Obamacare!
I suppose individual doctors might feel that way, but as others have noted if the doctor is "in-network" they (or the group they practice in) are under contract to treat patients insured in that network plan, regardless of whether the plan was purchased on the exchange, from a broker, or as part of a group plan. In other words - I don't understand why a doctor would make such a comment. Would the same doctor prefer to treat someone with a non-ACA plan, but who was "out-of-network"? In that case, it would seem to make no difference how the plan was purchased, and they'd probably have more trouble getting paid anything as the insurance would very likely pay nothing.
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Old 01-09-2016, 07:27 PM   #22
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What is this political silly season already?
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Old 01-09-2016, 07:52 PM   #23
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We/EMS had to take my 60 yr old BIL to the the hospital on 1/4/16 for a seizure from a stroke. The hospital was in Chandler,AZ (Phoenix area). The hospital was over run with patients in the hallways and we were told there was were 200 people Waiting for rooms. My brother in law waited for 48 hrs in the emergency room, before getting a room. We were told this was the same situation in the other hospital in Chandler.....
I hope your BIL is okay now! That seems like a terribly long time for a stroke patient to be seen--isn't there a "golden hour" to get treatment?

With 400 people in Chandler waiting for hospital rooms ("this was the same situation in the other hospital in Chandler")--bet that city has lost its place on any best places to live list. Some of those people must still be waiting for a room.
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Old 01-09-2016, 08:37 PM   #24
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Mesa, an adjacent city to Chandler, has had the reputation of being a winter haven for snowbirds even before I moved here 40 years ago, and is overrun by geezers in the winter. I wonder if the snowbirds have overflowed into Chandler.
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Old 01-09-2016, 09:20 PM   #25
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I have read several stories about how limited some of the networks for some ACA plans are. I don't have facts to back that up though.

But the networks were key even before the ACA. When I had my heart attack in 2004, the hospital cardiologist that saved my life was in a different network (same insurance) than my regular physician. To keep the hospital cardiologist, I would have had to change networks. I didn't and ended up with a fine cardio network.

I'm on Kaiser now, but when I retire in a couple years I'm going to have to jump back into the network mess again.
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Old 01-09-2016, 09:47 PM   #26
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The hospital was over run with patients in the hallways and we were told there was were 200 people Waiting for rooms.
This happened to me when I had my appendix out in Calgary about 8 (?) years ago. They had beds in the halls and tacked up sheets for privacy. I later read that one person in the next province died in a waiting room, having waited 24 hours just to be seen.
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Old 01-10-2016, 09:42 AM   #27
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When the admissions person enters the information into the computer what will appear is coverage limits, reimbursements, much more- along with data that shows if it an employer sponsored plan or an exchange plan. So.. Yes.
The data is provider network which could be translated into employer based plan or "individual" plan. Each on-exchange plan is required to have an identical "mirror plan" offered off-exchange and it's impossible for the provider's office to know this difference by swiping the patient's card. Because of this, some states require ID card labels.

Texas Card Branding: Obamacare Health Plans to Get Special Label | The Texas Tribune

The on-exchange plan and its mirror can have lower reimbursement rates than group plans. This leads to fewer providers choosing to participate in the network tied to the lower reimbursement.
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Old 01-10-2016, 10:16 AM   #28
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HDHPs, in theory, make the insureds more careful about what they agree to pay for... after all - the insured is on the hook for the high deductible. HDHPs also were around before the ACA.
Personally, I agree regarding the benefits of high deductible policies. However, many make the argument that high deductibles are unfair to low income folks since paying the the first $5k or $10k of the cost could be "unfairly" burdensome.

It's hard to have it both ways, but we try.
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Old 01-10-2016, 10:24 AM   #29
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When the admissions person enters the information into the computer what will appear is coverage limits, reimbursements, much more- along with data that shows if it an employer sponsored plan or an exchange plan.

So.. Yes.
Not in my state (GA), the Humana exchange plan group we are in is listed as 'HUMANA EMPLOYERS HEALTH PLAN OF GA,INC' on their website.

I don't see how any facility would care if it's an exchange plan or an employer plan. The insurance company is going to pay them for covered services either way, and if it's either an emergency or in-network they have to accept it anyway.

Agree that the OP in this thread really just wanted to start another political rant against the ACA, btw.
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Old 01-11-2016, 12:54 PM   #30
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I was unaware that Obamacare was some sort of insurance policy that doctors could accept for payment or not. I always thought it was just a colloquial name for the Patient Protection and Affordable Care Act (PPACA), a federal law. To the best of my knowledge, the PPACA required states to set up health insurance exchanges where you can obtain a private insurance policy from a variety of commercial insurance companies if you don't otherwise have insurance from Medicare/Medicaid or your employer. Perhaps you can clarify what you mean when you say "I also have been told by several doctors they won't take Obamacare."
ObamaCare is ACA everyone in the USA should or does know this, it has been on every TV station for the last 7 years. And yes my Cardiologist and my primary care physician said if I change from Cigna $16,700.00 per year to Obamacare/ACA they would have to drop me as a patient. I asked why, and they responded that it take ACA months to pay and they get paid much less regardless of whether it is a Bronze, Silver plan, etc.
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Old 01-11-2016, 12:58 PM   #31
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Thank you for asking, he is not OK because of the delay the clog ended up bursing the vein in his neck and he now has a dark spot (dead) brain cells the size of a baseball. He mostly says no to every statement asked. It has taken him 2 years to be able to stumble around walking instead of a wheelchair, he is only 59 it hard for his wife. Luckily he had disability insurance from work and a separate policy that provides $1,200.00 per month until age 64.
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Old 01-11-2016, 01:40 PM   #32
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ObamaCare is ACA everyone in the USA should or does know this, it has been on every TV station for the last 7 years. And yes my Cardiologist and my primary care physician said if I change from Cigna $16,700.00 per year to Obamacare/ACA they would have to drop me as a patient. I asked why, and they responded that it take ACA months to pay and they get paid much less regardless of whether it is a Bronze, Silver plan, etc.
I'm lost. You replied to Gumby with the above where he admitted that ObamaCare was a colloquial name for the ACA (Patient Protection and Affordable Care Act (PPACA)) which is commonly called the ACA. There may some people who extend that to mean an exchange purchased health insurance plan.
Later this year I will have to either go back to work or buy an individual plan as my COBRA will run out. I've looked at the exchange for my present insurers plans and also look at what they sell directly to individuals... guess what, they are the same plans! Thru the exchange you may get a subsidy, direct you won't. They have the same networks from what I could tell (both greatly reduced from my COBRA plan)). I also did not see any additional plans on their site for individuals. But this is a sample of one insurer in one state.
I agree that the narrowing of networks on insurance policies (on or off exchange and especially for individuals) has caused many problems. I'll have to see how these plans work for me when I fall off COBRA.
BTW... both my Cardiologist and PCP is in network for the exchange or direct plan I have been looking at.
I'm just not sure which insurance plans you are referring to when you use ObamaCare or ACA. On exchange? Any individual plan? Any plan (including employer plans) the meet the ACA's (the law's ) requirements? ,,, or what?

But I can sympathize with the frustrations with health insurance in general. I think we have a long way to go for it to be affordable.
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Old 01-11-2016, 02:00 PM   #33
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I am confused about Dogman's example patient. The incident happened 2 years ago? He was, evidently, employed so wouldn't have had an individual ACA policy.

The availability of emergency care in Chandler is a different issue. Chandler is, essentially, a suburb of Phoenix. Doesn't Arizona have a master emergency dispatch system such as what we have in Oregon? Patients arriving by ambulance are sent to a facility with the skills and space to care for a patient. If a Portland resident needs emergency care don't drive them to the hospital emergency room, call 911 (here) where the fire department responds and an ambulance is right behind. The patient doesn't choose the hospital until after they are stabilized.
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Old 01-11-2016, 02:04 PM   #34
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ObamaCare is ACA everyone in the USA should or does know this, it has been on every TV station for the last 7 years. And yes my Cardiologist and my primary care physician said if I change from Cigna $16,700.00 per year to Obamacare/ACA they would have to drop me as a patient. I asked why, and they responded that it take ACA months to pay and they get paid much less regardless of whether it is a Bronze, Silver plan, etc.
This doesn't make sense. It's an insurance company that pays, not ACA.
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Old 01-11-2016, 02:07 PM   #35
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I'm just not sure which insurance plans you are referring to when you use ObamaCare or ACA. On exchange? Any individual plan? Any plan (including employer plans) the meet the ACA's (the law's ) requirements? ,,, or what?

But I can sympathize with the frustrations with health insurance in general. I think we have a long way to go for it to be affordable.
Your post reminded me that technically every health care plan is an ACA plan, as every plan falls under the law. I'm thinking that when people use 'obamacare' they mean exchange plans.

In Colorado next year we have a ballot issue for single payer for the State. But I don't see how that is going to fix the problems with the doctor networks.
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Old 01-11-2016, 02:16 PM   #36
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ObamaCare is ACA everyone in the USA should or does know this, it has been on every TV station for the last 7 years. And yes my Cardiologist and my primary care physician said if I change from Cigna $16,700.00 per year to Obamacare/ACA they would have to drop me as a patient. I asked why, and they responded that it take ACA months to pay and they get paid much less regardless of whether it is a Bronze, Silver plan, etc.

I will agree with others that this makes no sense... the plans sold through the exchange are run by the health insurance companies.... the same companies that provide plans to most of America....

The problem you might be having is which plan you buy, not 'Obamacare'.... if I wanted, I could buy a better plan than I had at my last job.... but it would cost me in the $1500 to $1800 per month range... my doc is on that plan and they would happily take that money....

However, I bought a plan from BCBS that does NOT include my doc and has a small network... it cost in the mid $900s.... I am not willing to pay an extra $7K to $10K in premiums just so I can keep my same doc...


BTW, if this is for some routine stuff, ask about becoming a cash payer.... my doc does this and I pay him $100 or so a visit and then about the same for tests..... once or twice a year is worth it to me....
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Old 01-11-2016, 02:35 PM   #37
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Your post reminded me that technically every health care plan is an ACA plan, as every plan falls under the law. I'm thinking that when people use 'obamacare' they mean exchange plans.

In Colorado next year we have a ballot issue for single payer for the State. But I don't see how that is going to fix the problems with the doctor networks.
Colorado ballot initiative calls for $25B single-payer health system - The Denver Post

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Under the plan, a tax of varying rates on all income would be collected to raise the $25 billion needed for the single payer.
That quote is just to get it started. I'd hate to see what it would be to actually implement it.
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Old 01-11-2016, 04:22 PM   #38
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However, I bought a plan from BCBS that does NOT include my doc and has a small network... it cost in the mid $900s.... I am not willing to pay an extra $7K to $10K in premiums just so I can keep the same doc...

When Coventry said my policy would not be available in 2016 but sent me a link to one I "might like" I was furious when I found it had zero out-of-network coverage. I'm not concerned about routine doc visits; I'm concerned about what happens if some bozo runs me off the road when I'm bicycling or I develop a nightmarish disease. I don't want to choose a brain surgeon or oncologist based on who's in the network- I want the best doc for what I have.
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Old 01-11-2016, 05:10 PM   #39
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I don't want to choose a brain surgeon or oncologist based on who's in the network- I want the best doc for what I have.
My experience was my emergency hospital cardiologist was OK to be out of network, but as soon I was out of emergency care I had to use the network doctor. That's how it has been for many years unless you have lots of money.
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Old 01-11-2016, 05:33 PM   #40
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...I don't want to choose a brain surgeon or oncologist based on who's in the network- I want the best doc for what I have.
The best doc or the best hospital are going to ask "How much money do you have?" or "What insurance do you have?"

A deluxe treatment will be paid only by a deluxe policy.
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