Hospitals out of room!

[Ed_The_Gypsy]

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.

 

[MBSC]

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.

 

[youbet]

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.

 

[GTFan]

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.

 

[Dogman]

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.

 

[Dogman]

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.

 

[bingybear]

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.

 

[Brat]

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.

 

[audreyh1]

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.

 

[timo2]

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.

 

[Texas Proud]

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....

 

[Hermit]

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

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.

 

[athena53]

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.

 

[timo2]

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.

 

[NW-Bound]

...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.

 

[Hermit]

I have two friends with resent major medical. One had a brain tumor and had the best hospital in the state on cheapest Medicare policy (AARP) available. No issues with the results. The other had Medicare and I am sure he did not pay for the most expensive. He lives on SSDI. Had a plate put on the front of his spine and two rods down the back sides of his spine to support a crushed vertebrae. He is doing well three months after the surgery. I think that is pretty outstanding service and results for folks on the low end of the medical cost scale.

 

[Gumby]

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.

Your original post (and some of the posts following yours, particularly Bingybear's and Irishgal's) got me thinking, so I called some people today and learned that, in Connecticut, the network for the Anthem plan provided through the ACA health exchange may indeed be narrower than the network for Anthem employer group health plans, primarily due to the fact that reimbursement rates to doctors are lower for the former. The people with whom I spoke said it was like that in some other states too. I did not know that, so I thank you for bringing it to my attention.

I still don't know if the network expands or contracts depending on whether the plan is gold or silver or bronze. Perhaps I'll follow up with my contacts again tomorrow and see if they know.

 

[rodi]

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).

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.

I sense a morphing story.

Is the brother in law 60 or 59. Did he go to the hospital last week, or 2 years ago?

This entire story seems to be playing loosely with the facts to try and make a rant.

 

[razztazz]

I sense a morphing story.

Is the brother in law 60 or 59. Did he go to the hospital last week, or 2 years ago?

This entire story seems to be playing loosely with the facts to try and make a rant.

Hee hee. This is gonna be good.

 

[ziggy29]

We now have to pay $16'700.00 with 7500.00 deductible HSA to get our same doctors.

If a deductible is $7500 it is not eligible for an HSA, because that exceeds the maximum deductible allowed for an HSA-eligible HDHP. What am I missing?

 

[rodi]

If a deductible is $7500 it is not eligible for an HSA, because that exceeds the maximum deductible allowed for an HSA-eligible HDHP. What am I missing?

Just to be devil's advocate - if it's a family deductible it can be higher. Our exchange purchased plan has $4500 deductible/person, $9k deductible for family. OOP max's are even higher at 6500/person, 13k family.

 

[iac1003]

The private individual plans may have different doctors in network from the employer-run plans which in turn are different from the exchange plans which are eligible for a subsidy. Usually the plans that are subsidy-eligible are narrower and may pay a different rate to the physicians. Sometimes you can get lucky and the networks will be the same. Just because it is from the same insurance company, it does not make the plans equal.


Sent from my iPhone using Early Retirement Forum

 

[NW-Bound]

If a deductible is $7500 it is not eligible for an HSA, because that exceeds the maximum deductible allowed for an HSA-eligible HDHP. What am I missing?

Perhaps the law was changed recently. Pre-ACA, up to 2014, I had an HSA account with a $10K deductible policy.

 

[Texas Proud]

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.

I did not say that your plan was good or not good... I was saying that (at least where I live) there are options that include out of network coverage... but the cost of those plans are HIGH... the out of network deductible is twice as high and the premiums are about twice as high.... that is a LOT of costs to pick a doc...


BTW, if you are run off the road you will get whoever is there at the time or on call...

Also, since one of my sisters has been a nurse for over 30 years I doubt if you would know who is a good doc and who is not.... she has said a few times that there are some highly thought of docs who actually are not that great.... just got a reputation and have lived on it for years.... not saying you would or would not, but IMO it is kinda a crap shoot...

 

[AllDone]

If the uncle went to the ER in the first week of January in any year, pre- or post-ACA implementation, the place was packed from floor to ceiling and people were stranded in the ER for hours if not days waiting for beds. That has nothing to do with the ACA -- it's the season for COPD, flu, pneumonia, falls, and most of the other ills that beset the elderly.