ER Taxable income, and ACA MAGI

[Another Reader]

Not all providers on the BCBS directory are part of the ACA networks. And the directories are not accurate. When it looked like the pension system was going with ACA for 2014, I called around. Most of the folks I called were either not included in the ACA network or were still in limbo with BCBS or the alternative, although they were in the directory.

In addition, you are probably limited in choice of doctor by distance from your home or work address. I ran into that while I was still working, when the insurance company tried to reassign me to a doctor within 10 miles of my home address. I had to get them to verify that the office was within 30 miles of either my home address or work address to keep the doctor.

 

[daylatedollarshort]

Not all providers on the BCBS directory are part of the ACA networks.

Yes, that was what I posted. The Blue Shield site has a sub category search field where you can search for providers and see what plans they accept or search by plan and see what doctors and hospitals are on the plans.

I don't really know what you mean by "probably limited by choice of doctor by home address" or getting reassigned a doctor. We have a PPO plan and aren't assigned any doctor at all.

 

[Another Reader]

The information that was available last Fall was not very accurate or up to date. I found that I had to verify with the providers when I was trying to work through this, as there were a lot of problems. Maybe this will get straightened out in time for the second year.

 

[bmcgonig]

I live in the Bay Area also. I remember when I moved here that Kaiser had a terrible reputation. However it seems to be totally different now. Now some of the best doctors are going there. They have the pick of UCSF and Stanford grads according to a friend who is a practicing Radiation Oncologist who is trying to get in there. Anecdotally I have heard nothing but good things from people who are using Kaiser, although my sample size is under 5. Doctors also love it because they have zero paperwork to do. They earn less than private practice but are fine with less stress.

Blue Shield no longer has the PPO inside the ACA, only the EPO. Less doctors possibly and no out of network docs at all allowed. You have to call your doctor to find out if she is part of that as at least for a while the website was unreliable.

As a data point the pseudo concierge group My One Medical takes the old Blue Shield PPO and a bunch of other pre ACA groups, but only take Aetna and Health Net now. Obviously fewer plans than before, but the fact that they take those two is a sign to me that a lot of groups will take them, as those guys offer same day appts etc for a yearly modest fee, and would tend to be the fussiest.

 

[Another Reader]

Well, your friend must believe Kaiser's ever present radio ads, because that's exactly what they say. However, looking through the adult medicine (primary care/internal medicine) directory of available doctors at the two South Bay centers, I see no Stanford or Harvard grads. There are several UCSF and UCLA grads, a few grads from the second tier UC's, and a number from lower tier schools across the US. A majority of these doctors got their medical degrees in India or China or another foreign country and did a residency in the US. There are even a couple of grads from those Caribbean schools that were last resorts for folks that could not get in anywhere in the US.

I wonder if it is possible to combine a catastrophic plan with a concierge practice. That would probably still be less expensive than a limited network ACA metal plan.

 

[aja8888]

Just a side note: We had a H*ll of a time getting a doctor lined up for our daughter who is on the BCBS Bronze plan (she was required to pick one before getting the insurance). Many of the ones on the "list" were not accepting ACA patients . It took a while, but she finally found one within 30 miles of here. But we are not in the Bay Area, only Houston with 5 million people.

(I'm really glad I'm on Medicare + Supplemental (never thought I'd say that).

 

[daylatedollarshort]

Blue Shield no longer has the PPO inside the ACA, only the EPO. Less doctors possibly and no out of network docs at all allowed. You have to call your doctor to find out if she is part of that as at least for a while the website was unreliable.

On the Covered California web site, my plan is called Blue Shield Bronze 60 Health Savings Account PPO. I see lots of other Blue Shield plans called PPO for Blue Shield on the exchange site. Why do you think they do not have PPO plans under the ACA?

I don't know what 'no out of network docs allowed at all" means. Doesn't out of network refer to providers that do not have negotiated rates with your insurance carrier and may balance bill? What would be an example of an allowed out of network doc?

 

[MichaelB]

The BCBS plans I checked in Fl are listed on their website as "PPO/EPO". They list it this way because the same broad national PPO network (Bluecard) applies for all policy coverage except pediatric vision, which is an EPO network. It is also mandatory. BCBS Bluecard PPO is basically the same network available to all members across the country, hard to believe it's not available in California.

 

[M Paquette]

However, looking through the adult medicine (primary care/internal medicine) directory of available doctors at the two South Bay centers, I see no Stanford or Harvard grads

You will find that this is the case in general, not just at Kaiser. Looking at the match results from Stanford from 2011, 2% of graduates became primary care doctors. Harvard has similar results after correcting for some statistical fun and games around acceptance vs completion within some programs.

Med School Mapper

When you look at the total debt load from getting through the Stanford, Harvard (or even Touro...) medical programs, plus undergrad and other items, it's not surprising the grads avoid the relatively low-paying generalist positions and go for the specialties.

Feel free to go for the Famous Diploma doctors, though. You might have to put up some additional cash, but hey, nothing is too good for you, and besides, it's only money. Should you come down with onychocryptosis or some similar horror, only that Stanford or Harvard graduate will be able to give you the specialized care needed.

 

[Rosie]

I would like to offer a dissenting opinion to Another Reader's.

My husband and I have been insured through Kaiser in the SF Bay area for over 4 years now, and we have both been very satisfied with our physicians and with the care we have received during that time.

 

[MRG]

Feel free to go for the Famous Diploma doctors, though. You might have to put up some additional cash, but hey, nothing is too good for you, and besides, it's only money. Should you come down with onychocryptosis or some similar horror, only that Stanford or Harvard graduate will be able to give you the specialized care needed.

My old manager was sick, real sick, after weeks in hospitals his PCP brought in a specialist that was not trained in the US. His PCPs opinion was he neeeded to be seen by a DR. who had broader experience, perhaps worked in a third world country.

The specialist determined in short order my manager had contacted malaria years before, and was going through a relapse.
MRG

 

[rodi]

I'm in So. Cal with Kaiser. I'm not much of a med-school snob but was curious how our doctors ranked. Turns out most either went to school at UCSD Med school, or did their residency there. Since that's a school that ranks 15th overall, and 5th in public schools, I'm ok with that.

I've talked at length with our pediatrician about why she likes working for Kaiser... She can earn a comfortable living and have fewer "on call" hours and have a normal work schedule. They let her work 1/2 time in research and cases in her sub-speciality (neonatology) - and 1/2 time doing pediatric general case load. She couldn't find another situation that let her pursue her specialty and have normal hours. She's been consistently good in the 13 years we've been using her.

 

[Another Reader]

I'm simply responding to the poster who said that Kaiser had their pick of doctors from the better schools. The whole field of medicine is changing. Pretty soon no one will want to go to med school and we will have barefoot doctors like China in the 1970's.

To me Kaiser is a lot like GM. No matter how many times GM swears it has reinvented itself and builds great cars, they never have been able to eradicate the corporate culture that builds garbage. I think the same is true of Kaiser.

 

[bmcgonig]

I'm simply responding to the poster who said that Kaiser had their pick of doctors from the better schools. The whole field of medicine is changing. Pretty soon no one will want to go to med school and we will have barefoot doctors like China in the 1970's.

To me Kaiser is a lot like GM. No matter how many times GM swears it has reinvented itself and builds great cars, they never have been able to eradicate the corporate culture that builds garbage. I think the same is true of Kaiser.

I don't think anything we say here could change your mind . I think many of us here think differently, even though we have heard the stories of olden days. As Keynes would say "when the facts change, I change my mind..."

 

[bmcgonig]

On the Covered California web site, my plan is called Blue Shield Bronze 60 Health Savings Account PPO. I see lots of other Blue Shield plans called PPO for Blue Shield on the exchange site. Why do you think they do not have PPO plans under the ACA?

I don't know what 'no out of network docs allowed at all" means. Doesn't out of network refer to providers that do not have negotiated rates with your insurance carrier and may balance bill? What would be an example of an allowed out of network doc?

I tried to get on to the covered ca website just now to verify what I thought but it's down for maintenance.

I have individual coverage that wasn't cancelled so I didn't have to buy anything on covered ca, but when I was looking at Covered CA last year my zip code in the Bay Area only had EPOs , altho I do seem to remember that other parts of CA did have PPOs. EPOs do not allow out of network doctors at all. If you have a PPO you can go to a doctor who doesn't deal with Blue Shield and they will still pay a portion (half?) of the bill after u bill them. EPOs you can't do that. Also according to this article EPOs have about 70% of the doctors that are available to the PPO subscriber. It's very confusing and I don't pretend to understand it fully.

http://medcitynews.com/2014/02/covered-california-takes-doctor-list-much-bad-data/

 

[Another Reader]

When the facts change, I change my mind as well. I haven't seen any facts here, just assertions. Some of the people I know that have Kaiser are happy with Kaiser, most are not. People with no health issues tend to be happier with them.

The insurers' lists of doctors and medical groups on CoveredCA proved unreliable. Part of the problem was the last minute nature of some of the negotiations, part was sloppiness. I can't say if there was intent to mislead. Maybe the information will be more accurate for 2015.