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View Diary: It's official: I cannot keep my doctor with the ACA (411 comments)

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  •  Have you thought of (12+ / 0-)

    contacting the people at the IU Medical Center directly?

    If not the actual doctors, then most practices today have a "practice manager" or "insurance manager".  Ask them your questions.

    You can also contact the various carriers, and ask if they have had any indication of WHY these health ctrs will not accept patients.

    Isn't Indiana one of the places where the Gov/Leg has rejected the state involvement with the ACA?  This may have something to do with it.

     Then pressure on state politicians is in order.  A letter to the editor or contact with a local TV station's investigative reporter is in order.  If enough people like yourself start squawking .......

    sorry....and best wishes.

    •  You could ask either sub-set of docs if they will (12+ / 0-)

      continue to see you and accept the in-network contracted amount for your care.

      Usually even for out of network providers your insurance company will offer you what is called the "usual and customary" amount and than the OON provder bills you for the difference.  This is called "balance billing".

      So your costs are not usually for the whole amount, just the diiference between what your insurance company will pay for U&C and whatever the provider wants to hit you with.  For existing patients sometimes they can be persuaded to take the U&C in full settlement.

      And you can't count anything you spend on balance billing toward your insurance plan deductible, either.  (Though if these and any other charges amount to more than 10% of your income, you can deduct them on your Fed. - and poss. state - income taxes.)

      It can't hurt to ask the providers about this, as well as request they get themselves in-network, ASAP.

      BTW, it's often the providers who balk at the low payments the insurance Co. is willing to offer. But if the provider sees their patient base leaving because of in- network issues, they may become more interested in getting a contract set-up.

      And finally, you mention a "catastrophic" policy.  Just to clarify: the so-called HBX catastrophic policy is  only available to to people under 30 or older people whose premiums on the exchange would exceed a certain percentage of their income (in the range of 7 - 9%, but I'm not clear on the exact number, please check this for yourself.). And, I think for older people, there is no subsidy nor income-based out of pocket reduction nor reduced co-pays and deductibles on catastrophic plans, so it might wind up being more expensive than a silver, or even a reduced- benefit bronze which also doesn't have the income-delimited cost reductions that some of the silvers do. This is a really tricky thing to work out.

      I think you may have to do more legwork, and perhaps some hassling, but I wouldn't count yourself beaten, yet.  And defintely don't sign up for a plan until to you've been to the mat with your providers to see what can be arranged, either accepting the U&C in full settlement, or becoming in-network.  I doubt the incurance company would balk at adding providers who would take what they offer.  And in the case of the cancer docs, make sure the hospital (and ancillary services of the hospital) signup or accept the U&C, as well.

      Good luck!

      Araguato

      •  Great advice! (7+ / 0-)

        A couple of yrs ago, when DK was offering life time memberships, we could not afford the $100. due to a medical bill from a hospital Emergency Room visit  (Over $2,500) due to life draining forces from a bad norovirus which was sweeping the area.  

        I had been jerked around from one plan to another, and forced to accept a new plan (or none) which would cover ER visits with a $50. co-pay.  I had doctors in the hospital I went to.  

        But guess what?  The hospital wasn't one which had signed up for that insurance co plan.  Nor was the hospital a little further away.  I would have had to go to a hospital 60 miles away to get covered.   grrrrrr

        The plan covered some of the lab work, but left us with a huge bill, which they dumped on us at the last minute.  The last minute being the week-end of Thanksgiving, for a visit which had occurred 22 months previously.

        We had to scramble - and a DK membership was out of the question.  Thank goodness some people stepped in, and helped us.  We were then able to make a donation via charge card to help others.

        The pt of this long winded note is to show how some hospitals move in and out of accepting coverage.  And of how one has to read the fine print.

        •  PinHole, my cousin had a similarly bad (5+ / 0-)

          encounter with an ER. What a horrible story. While investigating this narrow network choice that I have to make, I discovered that the nearest in-network Urgent Care Center in that plan is 30+ miles away! And there are Urgent Care Centers in nearly every shopping center around here.

          This is unacceptable. We are all going to have to become well-informed advocates to make Obamacare every bit as good as it's potential.

          "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

          by annan on Sat Oct 05, 2013 at 08:09:18 PM PDT

          [ Parent ]

      •  EXCELLENT COMMENT!! (6+ / 0-)

        Thank you, Araguato. I didn't know about "balance billing" and I'll definitely check into that.

        About the "catastrophic" policy. You're right. That type of policy isn't available to me.

        However, I was thinking that I might go for a bare bones bronze policy with a huge deductible that would only cover a  recurrence of cancer. I'm healthy and have rarely met my $2,500 deductible anyway.

        So I'm thinking that instead of paying a monthly premium to get a $500 or $1,500 deductible maybe I should go for a tiny premium and save the extra for a rainy day in an HSA.

        There are so many variables and I thought it might be interesting to get feedback - which it certainly working! ;-)

        Thank you for taking the time to post this.

        "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

        by annan on Sat Oct 05, 2013 at 07:06:20 PM PDT

        [ Parent ]

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