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

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  •  Are you being forced by the ACA to change plans? (1+ / 0-)
    Recommended by:
    annan

    "Who is John Galt?" A two dimensional character in a third rate novel.

    by Inventor on Sat Oct 05, 2013 at 05:46:39 PM PDT

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    •  Re diary: to lose his/her CA specialist--BIG deal. (15+ / 0-)

      nt

      "Get in the way. Create chaos. Cause trouble. " "On global warming there is no more time to change the Overton Window. We have to break it."

      by sturunner on Sat Oct 05, 2013 at 05:54:09 PM PDT

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    •  Yes. I am being forced by the ACA to change. (51+ / 0-)

      As a cancer survivor I have been a member of the high-risk pool in Indiana since 2003 when my private insurer dropped insurance for all individual policy holders.

      ICHIA - Indiana Comprehensive Health Insurance Association - will be dissolved on December 31, 2013. All 2,300+ of us will be moving to the ACA since insurers who offer individual policies are still able to refuse people with pre-existing conditions. That will change in 2014, but in 2013 these are the facts.

      "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 06:04:33 PM PDT

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      •  Would you be able to return to your present (1+ / 0-)
        Recommended by:
        annan

        doctors in 2014, since you mention that insurers will no longer be able to refuse people w/ pre-existing conditions?  I mean if you stuck with your current doctors for now, would they then become available to you later in 2014 as the other ACA provisions kick in?

        I am really confused about how everything works in the states with asinine rightwing guvs.  Sorry if my question to you makes no sense.  But, I'm hopeful that if you decide to hang on with your own doctors at this time, maybe they  would be added to the ACA exchanges as the networks expand in the future.

        •  Not how it works (33+ / 0-)
          I am really confused about how everything works in the states with asinine rightwing guvs.
          Alas, this isn't limited to states with asinine right-wing governments/governors.

          Here's the skinny: basically, every health insurance company has a network. These are the providers that they have contracted with to provide health care. The bigger companies can contract with a lot of people, because they have a lot of clout. But even within those companies, there are often different networks, for different plans. The health care providers that the company can browbeat into the lowest possible prices get bundled together and used in the lowest-cost plans. This is how it's always worked (or, at least, for the last 60 years).

          And there are always providers that do not want to deal with a given insurance company, or charge that company too much to be put on some of their specific plans.

          What happened here is, Indiana used to have a nonprofit that provided insurance for high-risk patients who nobody else would take. They were quite expensive, and were not exactly perfect, but what they did have was a really good network... because all of their patients were high-risk, and therefore tended to have special needs that required good specialists in many different fields. (IU Medical Center is world-class medicine.) She had a plan with them.

          Now they are being dissolved. But none of the plans on the exchange in Indiana have more than a couple of her current physicians as in-network providers, because, well, experts tend to be expensive, and they're trying hard to keep their costs down for the exchanges. And since the exchanges will be a random sampling of people, instead of only the high-risk patients, there is a lot less demand for esoteric specialties. And IU Med Center is probably not particularly upset... they were probably contracted with the high-risk pool at relatively low rates, as a courtesy. But they have no reason to do such things for for-profit companies offering insurance mostly to relatively healthy people. So they'll concentrate on the networks of employer-offered insurance, which they get more reimbursement from, for the moment.

          Of course, they could change their mind, or next year the exchange plans could start offering more money to get a high-prestige medical center to join up, because that really is a draw for a plan, where it looks like there is at least a little bit of competition. But at least for now, there's no reason to expect that her doctors will be accessible to her under an exchange plan. And that's a shame.

          •  Very well put. You are exactly correct. (11+ / 0-)

            Thanks for taking the time to post such a thoughtful response.

            "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 09:05:56 PM PDT

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            •  And he is right (2+ / 0-)
              Recommended by:
              annan, awcomeon

              that the exchanges probably will offer better plans next year. The exchanges will create real competition. You can change plans next year.
              We have a somewhat similar system in the Netherlands. There is not much of a difference between the premiums for basic care package. The insurance companies compete by offering additional services and/or more flexibility. If my healthcare needs change, and my policy doesn't give me the converage I want, I change plans.

              •  That sounds so ... revolutionary!!! (2+ / 0-)
                Recommended by:
                amsterdam, awcomeon

                Coming from someone who hasn't been able to voluntarily change plans for nearly 20 years, that's actually an amazing benefit.

                "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 Sun Oct 06, 2013 at 12:27:25 AM PDT

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                •  Those free market (2+ / 0-)
                  Recommended by:
                  annan, awcomeon

                  benifits like better prices and quality because of competition, only materialize if there are good government regulations in place.
                  If ACA is a succes, insurance companies will have to make some other changes too. Until now the insurance companies had not much of an interest in healthcare outcomes. You get too expensive, they purge you or raised your premiums. With ACA that has changed. Getting the best providers in their network, will eventually save them money.
                  Good luck and stay healthy.

          •  There was an article the other day about CA. It (4+ / 0-)
            Recommended by:
            skohayes, gooderservice, annan, awcomeon

            said that networks were being reduced by at least half. In other words, the number of healthcare providers was being limited. Some major hospitals will not be included in the ACA plans.

            It's up to the health care providers to decide whether or not they want to be  part of any network.

            So you may not be able to keep your doctors and care givers you've depended on for years, just as the diarist explained.

            I have a friend in another state. One that opted out of ACA and therefore all coverage being offered is through the Fed system. He is also having a problem finding a plan that includes his physicians.

            Some physicians and other health care providers do not want to participate in ACA because of the lower payments they will receive. They are already being paid less for their Medicare patients and Medicaid patients ( if they even take them).

            It may not be a problem for younger people, but if you have a longstanding relationship with a healthcare provider, it's not easy making a transition.

            Are the doctors and hospitals who agreed to be in the new networks and lower payments as good as those you've been associated with. This is especially important when you're dealing with a life threatening condition or several.
            I'm on Medicare and wanted to change my Internist for someone in my neighborhood. Those who were recommended to me were no longer taking Medicare patients or already had their quota - a quota that they determine.

            While I have been a strong supporter of ACA, the more I can find out about the actual coverage, the more disillusioned I become.

            It’s the Supreme Court, stupid! Followed by: It's always the Supreme Court! Progressives will win only when we convince a majority that they, too, are Progressive.

            by auapplemac on Sun Oct 06, 2013 at 01:30:41 AM PDT

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            •  Sounds like patients need to make some (1+ / 0-)
              Recommended by:
              Sylv

              noise with their healthcare providers and tell them to get on ALL the plans in the exchanges.  we don't have to influence this JUST from the government side.....

              Listening to the NRA on school safety is like listening to the tobacco companies on cigarette safety. (h/t nightsweat)

              by PsychoSavannah on Sun Oct 06, 2013 at 09:31:39 AM PDT

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          •  Thank you so much. I try to become informed (0+ / 0-)

            about current events as much as I can, but technical/legal operations are always a challenge for me.

            Your explanation has given me a better understanding of how insurances work in general, not just the new ACA exchanges, but most past and current practices in that field.

            I appreciate you and others sharing your knowledge.

    •  It replaces all older high-risk plans (18+ / 0-)

      AnnaN is a survivor of cancer, and even NED, she would not have been eligible for private insurance except for a (usually state-run) high-risk pool.  Obamacare, with its guaranteed issue, replaces that.  So yes, she has to change.

      IMHO she should stick with her doctor.  IU is no doubt a great hospital (it is associated with a good medical school as well as a major university) but there may be a halfway decent non-church hospital "in plan".  If your doctors are able to practice there, you'll probably be okay.  It's also possible that the plan will add more hospitals -- they negotiate price, and if the hospital is out of network, it's because they haven't yet agreed on a price.

      I would avoid the limited-provider networks, though.  At least around here (Boston area), very very few doctors are in them, and the odds that yours are included is between slim and none.

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