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...Second, most people CAN keep their doctors--if the DOCTOR decides to leave the plan, how is that the fault of the president? The networks in most states are EXACTLY the same as they were with maybe a doctor here and there pulling out...stupidly..because they will lose business to do so. It's in the dr's best interest to participate in as many networks as possible....
The process of putting a network together is really a 2-party thing. The network has to agree to have the provider in its network - and the provider has to agree to the terms of his/her/its participation (especially monetary terms). It's basically a contract between the network and the provider. The provider can refuse to join/continue to participate in a network. Or the carrier can refuse to sign up/dump the provider (we've seen a lot of provider dumping when it comes to MA plans in recent weeks).
IMO - it's impossible to know now whether "some" - "many" or "most" people will be able to keep their doctors. Because people whose policies have been canceled are just starting the tortuous process of figuring out what their new policy options are. Also - when one talks about "keeping their doctors" - the doctor you need next year may not be the doctor(s) you have now. You don't start to think about getting an ob until you at least start to think about getting pregnant. You don't think about getting a pediatrician until you have a child. You don't think about getting "cancer doctors" until you get cancer. On my part - I've always tried to be in the most expansive networks possible - because you never know what kind of doctor(s) you might need in the future.
And why do you think it's in the providers' best interests to be in as many networks as possible? If I were a provider - I'd want to be in as few as possible (to minimize paperwork) - and only the ones who reimbursed the most. If I couldn't fill my practice with those - I'd go down the line in terms of desirable networks until my practice was comfortably full - but not overcrowded - and call it a day. Robyn
FIrst-if they are getting subsidized premiums that low, so are their out of pocket costs...
Second, most people CAN keep their doctors--if the DOCTOR decides to leave the plan, how is that the fault of the president? The networks in most states are EXACTLY the same as they were with maybe a doctor here and there pulling out...stupidly..because they will lose business to do so. It's in the dr's best interest to participate in as many networks as possible....
As for keeping their plans---yes, many plans are being replaced because they were not compliant--how is that a bad thing??? I just don't get it. And for about the 1,385,589 time, until people back up their claims with REAL numbers, I'm not buying how "expensive" these plans are or how much their costs are REALLY going up. I've put real, hard numbers out there.....but no one else seems to be able to do that. Sure, in our state you can get a plan for a 20 something kid for $50/month, but that is with a $30,000 out of pocket max and no maternity coverage....now, the max out of pocket will be $12,700, unsubsidized, for $150..but along with that they get free annual physicals, free annual cancer screenings, many medications are now free. 20 somethings taking those 30K plans typically are healthy and never really used the plans. If they did go to the dr, one office visit would set them back about 1/2 of the premium increase...most of these new plans have 3 office visits plus the annual physical built into the plan--those alone cover the premium difference....so, are they really more expensive...NO.
The networks are NOT the same. ACA plans have smaller networks by design to keep costs down. BTW not all plans being eliminated are garbage plans. My plan was ACA compliant with first dollar premium paying for Physical until this year when pediatric dental became mandatory.
The networks are NOT the same. ACA plans have smaller networks by design to keep costs down. BTW not all plans being eliminated are garbage plans. My plan was ACA compliant with first dollar premium paying for Physical until this year when pediatric dental became mandatory.
Then your plan wasn't compliant....
I haven't seen a shift in networks around here at all...in the 5+ states I've looked into. Do you have any links to back up that these networks have indeed changed...or is this just more hearsay?
The process of putting a network together is really a 2-party thing. The network has to agree to have the provider in its network - and the provider has to agree to the terms of his/her/its participation (especially monetary terms). It's basically a contract between the network and the provider. The provider can refuse to join/continue to participate in a network. Or the carrier can refuse to sign up/dump the provider (we've seen a lot of provider dumping when it comes to MA plans in recent weeks).
IMO - it's impossible to know now whether "some" - "many" or "most" people will be able to keep their doctors. Because people whose policies have been canceled are just starting the tortuous process of figuring out what their new policy options are. Also - when one talks about "keeping their doctors" - the doctor you need next year may not be the doctor(s) you have now. You don't start to think about getting an ob until you at least start to think about getting pregnant. You don't think about getting a pediatrician until you have a child. You don't think about getting "cancer doctors" until you get cancer. On my part - I've always tried to be in the most expansive networks possible - because you never know what kind of doctor(s) you might need in the future.
And why do you think it's in the providers' best interests to be in as many networks as possible? If I were a provider - I'd want to be in as few as possible (to minimize paperwork) - and only the ones who reimbursed the most. If I couldn't fill my practice with those - I'd go down the line in terms of desirable networks until my practice was comfortably full - but not overcrowded - and call it a day. Robyn
I understand fully how the networks work. It's not rocket science to figure out if a plan is in a network or not and most insurance companies have preset networks, some only have 2, others have several. A plan is or isn't in a network and a dr can choose to be in or out of a network. In our region, there is 95+% participation of practitioners in ALL of the major medical company networks...and mainly those are are not in network are chiropractors. Some individual companies (employer groups, not insurance companies) may choose to exclude some providers from THEIR plans, but the network is still the same...Mayo is one example--some companies will exclude Mayo because they are more expensive--but that doesn't mean Mayo doesn't participate in the insurance company network.
On the flip side--your employer could switch plans next year and you have to change anyway....you have no control over that.
After an attempt to sign up and look at healthcare plans yesterday (it let me sign up eventually but I couldn't access info on any plans) I can honestly say any numbers the government come up with are fraudulent, being able to sign up is one thing being able to actually purchase a health care plan something completely different.
So for now they can 'count' me as signed up but I'll leave it to bother with plans.
Last edited by Jan Alaska; 10-29-2013 at 07:51 AM..
After an attempt to sign up and look at healthcare plans yesterday (it let me sign up, eventually but I couldn't access info on any plans) I can honestly say any numbers the government come up with are fraudulent, being able to sign up is one thing being able to actually purchase a health care plan something completely different.
So for now they can 'count' me as signed up but I'll leave it to bother with plans.
Really---fraudulent? How so?
Go to the individual company websites--you should be able to look at plan info there--but maybe those numbers are "fraudulent" too?
I haven't seen a shift in networks around here at all...in the 5+ states I've looked into. Do you have any links to back up that these networks have indeed changed...or is this just more hearsay?
For some one who likes to tell others all about the ACA/exchange based plans, you seem to lack knowledge of some of the most well known aspects of it. Cost containment has to be part of these exchange based plans due to the inability to limit preexisting conditions and the new limits on how much higher you can charge an older person compared to a younger one. Limiting network size and decreased payments to providers are some of the consequences of these new rules/mandates.
Actually--those were from before the release of the plans--and if you look at the plans, a lot of them are HMO's--which already have a limited network. If you select a PPO, you have access to a larger network. Yes, premiums cost more that way, but guess what, they have ALWAYS cost more for a PPO vs an HMO...this is NOT new....and NOT limited to plans available on the exchange. That is the point you are missing--it's like all of this was "invented" by the ACA--and that just is not the case. Medicare is the same way, if you want a MA plan and select an HMO, your premium will be little to nothing, if you want a PPO that has a provider network outside of your zip code, you will pay more....
Actually--those were from before the release of the plans--and if you look at the plans, a lot of them are HMO's--which already have a limited network. If you select a PPO, you have access to a larger network. Yes, premiums cost more that way, but guess what, they have ALWAYS cost more for a PPO vs an HMO...this is NOT new....and NOT limited to plans available on the exchange. That is the point you are missing--it's like all of this was "invented" by the ACA--and that just is not the case. Medicare is the same way, if you want a MA plan and select an HMO, your premium will be little to nothing, if you want a PPO that has a provider network outside of your zip code, you will pay more....
Always an excuse. Read the link again. The networks are smaller in the health benefit exchange plans. Period. No body is claiming the ACA invented narrower networks. You claimed that health benefit exchange plans did not have limited networks, and I proved that they do.
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