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

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  •  Your insurance company that you have now, (4+ / 0-)
    Recommended by:
    poco, annan, flo58, worldlotus

    Anthem, is offering an ACA plan that doesn't cover your current doctor. Correct?

    Anthem might have removed your current doctor from your current plan without the impetus of the ACA. They do make such changes from time to time. However, let's assume for the sake of argument they wouldn't have done so.

    In this case, you are being subsidized, but losing your current doctor. This is in part due to there being only 3 plans offered in your area, which may be attributed to the GOP resistance to setting up exchanges in Indiana. Which is to say, Obamacare has forced you to chose a new doctor, but it may be that it is Obamacare as implemented by people determined to see it fail that did that.

    At any rate, I am sorry for your loss of current doctor.

    I'm on a mission! http://www.dailykos.com/comments/1233352/51142428#c520 Testing the new site rules.

    by blue aardvark on Sat Oct 05, 2013 at 06:10:18 PM PDT

    •  Yes, you are correct. (8+ / 0-)

      And it's the new "narrow networks" that are the problem. If you follow the links in the diary you'll see that Anthem isn't alone in doing this. It's how they are containing costs for the ACA.

      What appears to have happened in Central Indiana is that the 3 highest cost hospital networks (including the IU Med Center) won't play ball with Anthem, so they have affiliated with a new insurer MD Wise.

      The network that is working with Anthem is actually pretty progressive, which is why my primary care physician and physical therapist have affiliated with them.

      However, there isn't an Urgent Care Center in the Anthem network within 30 miles of my house even though they practically populate every commercial intersection.

      This will all work out. But it's going to take some advocacy on our part to make things right.

      "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 07:16:55 PM PDT

      [ Parent ]

      •  I've been worried about "narrow networks" . . . (8+ / 0-)

        since the very beginning.  

        I have HIV, which is obviously a serious, chronic disease.  When the ACA was being debated, there was talk about how insurers might try to save money by reducing their provider networks.  Specifically, they might try to keep people with expensive, chronic diseases from signing up for their plans by refusing to include in their provider networks physicians who specialized in those diseases.  

        So while an insurer can't turn down an applicant because of  pre-existing condition, it can make its plan less attractive to people with that condition by offering a provider network that includes either no specialists in that condition or very few.  If you don't have any HIV docs in your network, then people with HIV aren't going to sign up.  

        I frankly don't know if there's anything in the ACA or its implementing regulations to deal with this particular problem.  But for people with diseases like HIV, it can be serious.  We can't just go to any old doctor.  Even otherwise talented physicians simply don't have the knowledge required to deal with someone who's HIV+ unless they specialize in HIV treatment.  

        I sympathize with your situation, and I'm sorry you're going through it.  It makes me sad to see that one of my original concerns about the legislation was well founded.

        "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

        by FogCityJohn on Sat Oct 05, 2013 at 07:41:36 PM PDT

        [ Parent ]

        •  I don't think that's exactly the situation here. (1+ / 0-)
          Recommended by:
          annan

          It's not that Anthem doesn't have oncologists.  They don't have the same ones that she's been using.  And another insurance company does have the ones that she's been using.

          •  I wasn't suggesting it was. (1+ / 0-)
            Recommended by:
            annan

            I was commenting on a closely related issue, which is the ability of insurers to discourage chronically ill people from signing up by limiting their provider networks.  This is an issue that affects people who have serious, chronic diseases, and who thus happen to be among those who most need health insurance and access to good care.  

            For all its benefits, the ACA relies on the for-profit model of health insurance.  Carriers are going to find ways to maximize their profits, and one way they can do it is by minimizing the number of chronically ill plan members for whom they are responsible.  

            And believe me, they have evey financial incentive to do so.  My antiretroviral medications alone cost about $24,000 per year.  This doesn't count the cost of the frequent doctor visits, lab tests, and other things that go into providing proper care to someone who's HIV+.  I'm lucky, because I have employer-provided health insurance, but there are many poz people and others who are chronically ill who will have to buy policies on the exchanges.  For all of them, this is a very serious issue.

            "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

            by FogCityJohn on Mon Oct 07, 2013 at 09:55:35 AM PDT

            [ Parent ]

      •  Yes. These medical centers are slow to change. (1+ / 0-)
        Recommended by:
        annan

        They have to change and they know it. I work for an academic medical center. They are incredibly slow. In fact, I'm fairly sure that my medical center takes none of the ACA plans unless Aetna offers one. I would contact your doctor. They will come around or they will lose massive volumes. Does your medical center even have decent outcomes? I know that you mentioned your specialist but many of these centers have done a lousy job over the years both with costs, standards, and outcomes.

      •  But no one is telling the providers that are (1+ / 0-)
        Recommended by:
        annan

        affiliated with Anthem that they can't affiliate with another insurance company also, are they?  Since MD Wise is new, isn't it possible that your primary care physician and your physical therapist will eventually be on MD Wise's plans also, as well as staying on Anthem's plans?  Since you have time before you have to enroll, it might be a good idea to put off making the choice right now, and see if anything changes.  In the meantime, I think the suggestion to check with your primary care physician's office and your physical therapist's office to see if they'll be getting on MD Wise's plan on the exchange is a good one.  You might also try contacting MD Wise to ask if they're making an effort to get more primary care physicians and physical therapists signed up with them.

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