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Quiz: why are the hospitals being excluded from the Obamacare networks?
There will always be a class of people in America who receive excellent healthcare at first rate facilities. It just won't be Obamacare patients.
Who are "Obamacare' patients? There is no insurance called 'Obamacare" or ACA.
Quote:
Originally Posted by Ponderosa
In these parts the only people going to Mayo are the wealthy and those on the state's Medicaid plan.
Word. I know one Medicaid patient that got the best care my money certainly couldn't have bought. I didn't begrudge him that because he was gravely ill, and died a very young man. I often wondered, though, if my son would have gotten the same care with our employer -sponsored health plan. Surgery after surgery after surgery. I'll bet my out of pocket expenses would have been astronomical. Luckily, I never had to find out.
I know a man, disabled and a Veteran who obtained gastric bypass at a VA hospital; then had numerous skin removing surgeries also at a VA hospital. I was never clear if we the people were footing the bill for that or not.
Quote:
Originally Posted by winkosmosis
Hospitals can't "opt out of Obamacare". Obamacare isn't an insurance plan.
Yet, thread after thread after thread discusses "Obamacare' as if it were.
First, Obamacare is not a "plan" to opt out of. Obamacare is a regulation on the health insurance industry that set standards that health insurance must comply with.
So, in turn health insurance structured different plans at the different levels with levels of service required for each level set forth in Obamacare.
Then, they set their prices. As is and was always the case, prices are based on many things, including their negotiated rates with doctors within the "networks" for which insurance plans draw their "preferred in network list". This includes hospitals.
If a hospital is "opting out" of anything, they are simply saying they will NOT take a certain insurance companies insurance and they become "out of network". This could happen for several reasons.. like the hosptial and the insurance company couldn't agree on prices paid out for services.
And, the insurance companies, because they are not competing on an open marketplace with other insurance companies, are ultimately working to negotiate the best prices possible in order for their insurance plans to remain competitive and affordable. (this is a god thing)
What's kind of ironic is that, when you are picked up in an ambulance to be taken to the hospital, you aren't asked which hospital you prefer, or which hospital is in your network. AND just because a hospital is in network doesn't mean that every doctor that sees or treats you will be in network - so you could be in a network hospital but seen by someone that is out of network and billed appropriately .. but I'm getting a little off track.
Now, soon a hospital that opts out of insurance plans will ultimately loose patients because those patients will go to the hospitals that a) are in their network that b) their network doctors are affiliated with. If patients come in that are "out of network" through emergencies, and the bill is too high for someone whose insurance doesn't cover that hospital, that hospital will be losing money because most likely the treated patient won't be able to pay.
Eventually, hospitals will NEED to join these networks in order to get patients. Patients=customers=revenues...
Unless you have a Michelle Obama waiting near the emergency room door telling telling the driver to take the patient to that "other" hospital because they don't have the right insurance that will pay.
I know, I know, at this point the news just keeps getting worse and worse (but remember what Pelosi said...).
From US News and World Report - "Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies. Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare." Top Hospitals Opt Out of Obamacare - US News and World Report
Well, who wants top-quality healthcare anyway, right Democrats? Thanks for helping screw up the best healthcare system in the world.
This story doesn't sound correct to me. While attempting to verify the information, I followed the links in the Watdog.org story for the Cleveland Clinic.
Chances are the individual plan you purchased outside Obamacare would allow you to go to these facilities. For example, fourth-ranked Cleveland Clinic accepts dozens of insurance plans if you buy one on your own. But go through Obamacare and you have just one choice: Medical Mutual of Ohio.
This list is subject to change. Coverage limitations are dependent on individual group contracts. For questions about insurance coverage and specific plan products including Medicare and our Las Vegas location, please contact your insurance carrier directly.
FROM the K-N tab
Kaiser National Transplant Network
Kaiser Permanente
Kohl’s Department Store
LCA-Vision, Inc. (Cole Managed Vision)
LifeTrac Network, Inc. (fka RW Morey, Inc.)
Lord Corporation
Lowe's Companies, Inc.
Lutheran/TRMA, LLC
Managed Care Services Signature Care PPO (aka Parkview Health Plan Systems)
Marymount Behavioral Health Services( MBHS)
Medical Benefits Corporation Medical Mutual of Ohio
Mercer First Choice
Multiplan
National Healthcare Solutions, Inc. d/b/a National PPO
North American Health Plan, Inc.
Northcoast Healthcare Management Services
Not necessarily. If they don't take exchange plans people won't go there for non-emergency care, and if they do accept exchange plans below their normal price, they'll be concerned it will open the floodgates for the same companies to demand the same discounts for the bigger and more important employer-sponsored plans.
It then becomes a decision on whether the administrators think it is more important to fill beds with paying patients or to protect margins, and how that will play out is anyone's guess and will likely vary hospital by hospital.
Don't most "bigger and more important employer-sponsored plans" already get a discount? Every employer sponsored plan I have ever been enrolled in had discounts. I believe that is one of the primary selling points of group insurance.
This story doesn't sound correct to me. While attempting to verify the information, I followed the links in the Watdog.org story for the Cleveland Clinic.
Chances are the individual plan you purchased outside Obamacare would allow you to go to these facilities. For example, fourth-ranked Cleveland Clinic accepts dozens of insurance plans if you buy one on your own. But go through Obamacare and you have just one choice: Medical Mutual of Ohio.
This list is subject to change. Coverage limitations are dependent on individual group contracts. For questions about insurance coverage and specific plan products including Medicare and our Las Vegas location, please contact your insurance carrier directly.
FROM the K-N tab
Kaiser National Transplant Network
Kaiser Permanente
Kohl’s Department Store
LCA-Vision, Inc. (Cole Managed Vision)
LifeTrac Network, Inc. (fka RW Morey, Inc.)
Lord Corporation
Lowe's Companies, Inc.
Lutheran/TRMA, LLC
Managed Care Services Signature Care PPO (aka Parkview Health Plan Systems)
Marymount Behavioral Health Services( MBHS)
Medical Benefits Corporation Medical Mutual of Ohio
Mercer First Choice
Multiplan
National Healthcare Solutions, Inc. d/b/a National PPO
North American Health Plan, Inc.
Northcoast Healthcare Management Services
Are you trying to say that is contradictory? Not necessarily.
Did you also check to see if that long list are insurers that ssell policies that can be purchased in the exchange ?
Or are they all companies that sell private plans.
No, they are opting out of being "in network" which means those with Obamacare insurance will foot the entire bill out of their pockets.
That is not my experience with Insurance that has In/Out network providers. They only thing that changed is the percentages paid by the insurance and the loss of a negotiated fee.
Some of these policies don't even define out of network providers. It's either in network, or you're stuck with the entire bill.
Enjoy!!
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