Hospitals out of room!
- Thread starter Dogman
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I think you'll find most employer plans fall under the law too. Even grandfathered plans fall under it as it has provisions for accepting them. Exchange plans to fall under the law. Off exchange individual plans are covered under the law. I think you'll find most employer plans are compliant to the ACA law.
I think the difference is pretty much the difference that existed before, large employer plans have a well defined risk pool while individual plans don't as everyone is not complying with the law and signing up.
Also, some people are gaming the system by signing up for plans when they need care by claiming non-existent special enrollments (United Health Care news recently) and then cancelling them after getting care.
I don't know what to think of a single payer plan in the US. I had no issues when I lived in the UK with their single payer system.
I agree with employer plans often (hard to say always) have broader networks. Mine does. What I have found in the few cases I checked was that individual on exchange and off exchange (direct through insurer) seemed to have the same network. For my present insurer and state, the individual plans on and off exchange seem to be the same.
My guess is that the only people that could accurately describe the differences among Anthem's networks in Ct would be Anthem employees. A quick check shows 19 networks for individuals and 34 for employer groups.
Networks for employer groups are designed the same way as for individual policies. Some are large and broad (and pricier), others are small and restricted (and less unaffordable). Mega corp and large public sector employers tend to offer the insurer's biggest networks as a benefit, such as BCBS Bluecard. Smaller companies are not so generous, and even larger employers are now offering policies with restricted networks as a way to reduce or contain benefit costs (as my daughters have found out
)There is no easy way to analyze or compare insurer networks, they do not share this information, so misunderstanding among consumers is common. The administrative cost of managing so many different provider networks is probably one reason why private insurers have so much more overhead than Medicare.
Across the country there are many individual plans that share the same nationwide insurer networks as the large group policies (such as BCBS Bluecard), so the report that some healthcare providers "do not take ACA policies" is impossible to prove, but most likely not factual. It would be more realistic to say
- The only providers that "don't take any ACA" policies probably don't take any insurance at all.
- Most providers accept some private insurance. They do not care if it is group or individual, the only thing that matters is the network, which determines how they are reimbursed.
- Most providers probably don't take most of the new policies. That is because they are so restrictive. This is not the doctors and providers choosing not to participate, the insurers are excluding them as they all compete for a bigger share of the healthcare spending.
- the ACA standardized how insurance must be offered and what a policy must cover. Insurers can no longer limit coverage as a way to artificially lower premiums, so they now design networks to achieve their cost objectives.
- Healthcare is very expensive, unaffordable for the average family. Insurers offer policies with restricted networks so they can have a lower premium.
- this whole debate is about individual policies because they are the only ones that are subject to public scrutiny. It's happening with employer group policies, just not visible to us or the media, so not subject to the same intense public debate.
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+1My guess is that the only people that could accurately describe the differences among Anthem's networks in Ct would be Anthem employees. A quick check shows 19 networks for individuals and 34 for employer groups.
Networks for employer groups are designed the same way as for individual policies. Some are large and broad (and pricier), others are small and restricted (and less unaffordable). Mega corp and large public sector employers tend to offer the insurer's biggest networks as a benefit, such as BCBS Bluecard. Smaller companies are not so generous, and even larger employers are now offering policies with restricted networks as a way to reduce or contain benefit costs (as my daughters have found out
There is no easy way to analyze or compare insurer networks, they do not share this information, so misunderstanding among consumers is common. The administrative cost of managing so many different provider networks is probably one reason why private insurers have so much more overhead than Medicare.
Across the country there are many individual plans that share the same nationwide insurer networks as the large group policies (such as BCBS Bluecard), so the report that some healthcare providers "do not take ACA policies" is impossible to prove, but most likely not factual. It would be more realistic to say
- The only providers that "don't take any ACA" policies probably don't take any insurance at all.
- Most providers accept some private insurance. They do not care if it is group or individual, the only thing that matters is the network, which determines how they are reimbursed.
- Most providers probably don't take most of the new policies. That is because they are so restrictive. This is not the doctors and providers choosing not to participate, the insurers are excluding them as they all compete for a bigger share of the healthcare spending.
- the ACA standardized how insurance must be offered and what a policy must cover. Insurers can no longer limit coverage as a way to artificially lower premiums, so they now design networks to achieve their cost objectives.
- Healthcare is very expensive, unaffordable for the average family. Insurers offer policies with restricted networks so they can have a lower premium.
- this whole debate is about individual policies because they are the only ones that are subject to public scrutiny. It's happening with employer group policies, just not visible to us or the media, so not subject to the same intense public debate.
I did look up Anthem in my state. Two networks for direct individual plans that are not the same as on the exchange, but all the exchange networks were also there for direct purchases plans.
We likely need something more disruptive to get healthcare more affordable and with better outcomes.
Maybe some clarity will help. After reviewing all plans, talking to my doctors, and what hospitals they service I chose Cigna Access Plus HSA Bronze 6000 plan that was closest to my plan in 2015. The cost was increased by 1,500.00 in Phoenix AZ. I contacted my doctors and asked them directly what insurance plan works best at their office. I was told if you chose an ACA/ObamaCare plan will not accept you as a patient any longer. I could have gotten an ACA plan, but the price was not much different but it included only HMO plans to doctors that no one I know had heard of and most name were extremely foreign. I chose to pay more for confirmed coverage with the doctors and hospitals I know. If I have a heart attack I did not want to have the lower care afforded by the ACA.
My Friend Can't Afford Healthcare, this is what he is doing.
My friend told me he has had it with everything. He and his wife have decided to sell his business (small repair business) pull all his money from his bank and put it in a safe at home. He is 61 and going to apply for medicaid, food stamps, and anyother state/federal program. Wait until he can draw SS, and live frugally.
This is the state lower income middle American has gotten to, it is a shame. He has a neighbor who brought his mother over from China and within months she is now on SS earning as much as he will when he can draw.
My friend told me he has had it with everything. He and his wife have decided to sell his business (small repair business) pull all his money from his bank and put it in a safe at home. He is 61 and going to apply for medicaid, food stamps, and anyother state/federal program. Wait until he can draw SS, and live frugally.
This is the state lower income middle American has gotten to, it is a shame. He has a neighbor who brought his mother over from China and within months she is now on SS earning as much as he will when he can draw.
John Galt III
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Maybe this is urban myth, but I read somewhere that the first 3 letters of your insurance ID can (sometimes?) allow the provider to tell whether you are on an Obamacare policy or not.
The brother in law had a stroke two years ago in Feb., then cancer was discovered in his thyroid in May, then in August they discovered cancer in on his colon. In January the time I was referring to in my original post he was taken to the hospital for a seizure at which time there were people in the corridors in beds and the ER was packed. My brother in law was 59 at the time of his original stroke and will be 61 in Feb. His employer insurance had a 7,000.00 ded. but is now running out as of Feb. 2016 he will go on cobra until May of 2016 at which time he will be able to go on Medicare as he is fully disabled. He has had a hell of a time and lucky he is still with us. The first ER room did little and let the vein in his neck burst. His family is now sueing the hospital for their lack of service and who conveniently loss the important scans now that they are getting sued.
It is a mess but he has extensive damage that should not have occurred if the clot buster drug was administered timely. He was in the emergency room for 6 hours before the vein burst.
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Reviewing the summary of benefits and coverage (here), the Cigna Access Plus HSA Bronze 6000 is an "ACA Plan" for individuals in Arizona. Looks like you snuck this one past your doctors.
Another Reader
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Same network does not equal same reimbursement. And just because a medical practitioner or group is "in network" does not mean they will accept you as a new patient.
That is not the way SS works. You pay into the system for at least 40 quarters (10 years) and you can collect. 39 quarters and you can't collect.... If she was here before, and paid into the system via payroll taxes, and did so for 40 quarters/10 years- then her collecting is legit. If her husband paid into the system for 10 years she could collect spousal. But if she recently arrived and doesn't have a US work history she can't. Something is fishy about this story. Your friend maybe misunderstood.
HFWR
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
The Mom from China might be drawing SSI, but it's unlikely she's drawing SS or SSDI, as she would not have the required work history.
From direct observation, living "on the dole" isn't all it's cracked up to be...
I really don't know about the 3 letter and I'm not sure how your are defining "Obamacare", but I'd bet it is real easy to know the network that your insurance covers. I'm not sure if they could tell if you bought the plan on or off exchange. I've checked 2 major insurers now in my state and both offer the same plans on and off exchange for individual with the same network. One of them also offers other plans for individuals (direct) that have different networks from the exchange.
I think I understand what you are telling me, with the exception of how you define a ACA/Obamacare plan. If you mean "on exchange", then I think that you are missing the real point. I checked two major insurers in my state. Both offer the same plans that are on the exchange for direct purchase by individuals. One of them offers additional individual plans for direct purchase that have larger networks. If you were to buy a plan direct that is also on the exchange, you would still have your network problem. So, if ACA means on exchange, this invalidates what you claim since the same thing happens on or off exchange. If you buy a direct plan that has a larger network, your doctors may ... or may not be on that network depending upon your doctor's choice of accepting it.
Now if ACA means complying with the ACA law... I throw out that the plan you purchase likely complies with the law.
I don't think what you are seeing is that much more than what happened in the 1990's when my employer changed insurance carriers and we had to shift doctors or be out of network. It's been well publicized that you should check if you doctors participate in your insurance plan every year and when you change plans.
I think your doctors just know they don't take what is on the exchange. I would expect there are many other insurance plans they don't accept either.
But I'm pretty confident they would not take the exchange plans purchased directly from the insurer.
While $ may provide better care, it is not always true. I had a "high end" medical provider perform substandard work. I've switched to a more moderate end provider that is working out great. I use my reference for better and worse being feedback from a professor who not only practices the field, but teaches at the university. But I agree it is important to stay with providers your trust.
GTFan
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Like I said, typical political rant against Obama regardless of the 'care'. OP doesn't understand who pays.
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GTFan
Thinks s/he gets paid by the post
ALL new private plans are ACA plans now, so I guess you'll be paying a lot more until you understand what networks you have and how insurance covers them. Do some research on the exchange with the providers available to you, there's ways to search for providers and drugs that are covered. Yes, HMOs do tend to suck but they are *usually* not the only option available.
This website is a good place to start:
http://www.healthsherpa.com
What your doctor's office said is 100% wrong btw unless they don't take private insurance. Your plan is an ACA plan and is probably the exact same one you could've gotten on the exchange.
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