Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I think a lot of this is bullpoop.. "covered california" plans are PRIVATE COMPANY plans.. they are NOT government plans, etc.. like medicaid/medicare...
I think this is a bunch of phony BS dreamed up by right wing media and these stories aren't real.
I understand doctors not taking medicaid/medicare because of reduced payments.
But a private plan offered on the california or even federal exchange? That's just ridiculous.. cause ALL insurance is now Obamacare - government minmum standard - insurance
Huh? Prior to Obamacare, it was common for a person to shop around for a doctor that accepted his/her insurance. Why? Because not every practitioner accepts every kind of insurance. Now that Obamacare insurance is in place, the same still holds true, although it is well known that many doctors have expanded the types and kinds of insurance that they will not accept, to include plans on the Federal/State exchanges. That's their prerogative to do so, and many have chosen to do just that.
So why would you question the authenticity of the OP? This is a well-documented phenomena....and even more so since Obamacare was put into place.
LA Times finds insureds having trouble finding in-network docs under Obamacare:
Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin's lymphoma and discovered a suspicious lump near her jaw in early January.
But when she went to her oncologist's office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.
"I'm a complete fan of the Affordable Care Act, but now I can't sleep at night," Nelson said. "I can't imagine this is how President Obama wanted it to happen."
No insurance company has an in network relationship with every MD and medical practice.
No MD/medical practice has an in network relationship with ever insurer and plan within insurer.
MDs/medical practices can and do opt in and out of plans and insurers on an annual basis.
All of this was true before and after ACA. Insurers have never been required by law to maintain in network insurance arrangements with all providers. No MD/medical practice is forced to take all insurance plans and some MDs/medical practices do not. Their patients pay at the point of service and if insured, submit their own claim for reimbursement at out of network rates.
Nothing within the ACA law changes this.
Insurers websites usually make it clear to verify information with the MD/Medical practice.
Sounds like this patient received bad information from her insurer and no indication of impending change from her MD. That sucks.
My former employer used to change insurers and plans on an annual basis. This required the annual shuffling of medical files between MDs to avoid paying out of network prices.
Now days, people in these situations blame it on ACA legislation.
No insurance company has an in network relationship with every MD and medical practice.
No MD/medical practice has an in network relationship with ever insurer and plan within insurer.
MDs/medical practices can and do opt in and out of plans and insurers on an annual basis.
All of this was true before and after ACA. No MD/medical practice is forced to take any insurance plans and some MDs/medical practices do not. Their patients pay at the point of service and if insured, submit their own claim for reimbursement at out of network rates.
Nothing within the ACA law changes this.
Sounds like this patient received bad information from her insurer and no indication of impending change from her MD. That sucks.
I know this is difficult, but right now we are discussing a lack of access to doctors in California for patients insured under covered California specifically caused by the ACA:
"To hold down premiums under the healthcare law, major insurers have sharply cut the number of doctors and hospitals available to patients in the state's new health insurance market.
Now those limited options are becoming clearer, and California officials say they are receiving more consumer complaints about access to medical providers. State lawmakers are also moving swiftly to ease some of the problems that have arisen.
"It's a little early for anyone to know how widespread and deep this problem is," said California Insurance Commissioner Dave Jones. "There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care. Network adequacy will be a big issue in 2014."
So the Los Angeles Times was able to find two people in Southern California after the first five weeks of the program who werent able to find a doctor. Wow this is a real horror story going here. Kind of like someone with Medicare having trouble finding a doctor.
This story outlines exactly why we didn't buy our health insurance on the Obamacare exchange. I could have purchased a less expensive health insurance plan on the exchange.
The Ocare exchange said our doctors were accepting the insurance they were offering. When I checked with our doctors, their office said they were not; that information on the website was not true!
The information contained on insurer's websites is often outdated. The insurer is the source of information for the healthcare exchange, thus garbage in/out.
As you noted, it is always best to check with the MD/medical practice.
In my neck of the woods it is a long time common practice for MD/medical practices to verify insurance information before the appointment to avoid surprises on both ends.
In those practices where it's all walk in business, identification and insurance is verified before one is seated.
LA Times finds insureds having trouble finding in-network docs under Obamacare:
Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin's lymphoma and discovered a suspicious lump near her jaw in early January.
But when she went to her oncologist's office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.
"I'm a complete fan of the Affordable Care Act, but now I can't sleep at night," Nelson said. "I can't imagine this is how President Obama wanted it to happen."
Why are you a fan? Look... I am all for the pre-existing aspect, but not the shared misery of how this thing (ACA) is cobbled together. When Pelosi said "we have to pass it in order to know what's in it" it should have sent flags up for EVERYONE! But, no... it's blessed by Obama, so it must be awesome... right?
There are some really good things in it, and some really horrible things like the assumption that the 20-30 something's would willingly sign up to subsidize the 60-70-80+ something's. The bottom line is the bottom line, no matter your political stance. The fact is that you most likely lost your plan, doctor, and favored hospital. If you were on some sort of specialized program like bleeding edge cancer treatment... you're screwed!
I'm one of the new holders of a Medicaid card, and my doctor can see me in 6 weeks! Welcome to Obamacare folks. WE have become the cold war USSR!
@middleagedmom the cheerleading is becoming ridiculous
I think a lot of this is bullpoop.. "covered california" plans are PRIVATE COMPANY plans.. they are NOT government plans, etc.. like medicaid/medicare...
I think this is a bunch of phony BS dreamed up by right wing media and these stories aren't real.
I understand doctors not taking medicaid/medicare because of reduced payments.
But a private plan offered on the california or even federal exchange? That's just ridiculous.. cause ALL insurance is now Obamacare - government minmum standard - insurance
Of course it's not real; nothing to worry about.
Last edited by Ibginnie; 02-05-2014 at 03:38 PM..
Reason: hotlinking/copyright
I know this is difficult, but right now we are discussing a lack of access to doctors in California for patients insured under covered California specifically caused by the ACA:
"To hold down premiums under the healthcare law, major insurers have sharply cut the number of doctors and hospitals available to patients in the state's new health insurance market.
Now those limited options are becoming clearer, and California officials say they are receiving more consumer complaints about access to medical providers. State lawmakers are also moving swiftly to ease some of the problems that have arisen.
"It's a little early for anyone to know how widespread and deep this problem is," said California Insurance Commissioner Dave Jones. "There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care. Network adequacy will be a big issue in 2014."
Let's be specific then. The issue in California seems to be most profound within the individual plan market.
Insurers generally prefer the more lucrative employee sponsored large group healthcare market over individual plans. Perhaps nowhere is this more apparent than in the state of California, where, as I understand it, the state provides a subsidy for the two insurers who write the majority of individual plan policies.
Why would an MD/medical practice choose to participate in a BCBS large group plan but not a BCBS individual plan? When the specialty is something like oncology, one can assume a pre-existing condition, in most cases. Oncology is likely one of the most insurance dependent specialties going because of the costs.
How different are MD reimbursement rates between plans offered by the same insurer?
Do some medical practices shun plans with higher deductibles to reduce their own business risks?
No insurance company has an in network relationship with every MD and medical practice.
No MD/medical practice has an in network relationship with ever insurer and plan within insurer.
MDs/medical practices can and do opt in and out of plans and insurers on an annual basis.
All of this was true before and after ACA. Insurers have never been required by law to maintain in network insurance arrangements with all providers. No MD/medical practice is forced to take all insurance plans and some MDs/medical practices do not. Their patients pay at the point of service and if insured, submit their own claim for reimbursement at out of network rates.
Nothing within the ACA law changes this.
Insurers websites usually make it clear to verify information with the MD/Medical practice.
Sounds like this patient received bad information from her insurer and no indication of impending change from her MD. That sucks.
My former employer used to change insurers and plans on an annual basis. This required the annual shuffling of medical files between MDs to avoid paying out of network prices.
Now days, people in these situations blame it on ACA legislation.
Of course not every physician took every plan in the past. This problem has been magnified under Obamacare.
The rates for many of the exchange plans are terrible, therefore physicians do not participate. I can say from personal experience that I have been listed as a provider on some of these products with which we do not participate.
When we accept or reject contracts, it is based on overhead, projected % of those patients we will have in our practice, and the financial impact. When reimbursement rates cross a threshold, we reject those plans. To accept them would be to "lowball" other providers, who would be encouraged to lower thier rates as well. When patients with very cheap plans cannot get ready or available access, they complain. That is why better plans cost more money- better coverage.
We knew, or should have known, this would happen. After all, we have 50 years of MediCare/MedicAid history to go by. In Alaska only 10% of the doctors will see MediCare/MedicAid patients. So why would ObamaCare be any different?
You may have the best ObamaCare coverage on the planet, but that does not mean any self-respecting doctor would touch you with a ten foot barge pole. I certainly do not blame them either.
Your left wing heroes on the hill said they didn't need to read the law. This is what you get kfor that little bit of stupidity.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
