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View Diary: ACA in WA: First Week Signup Success! (8 comments)

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  •  Skinny WA Plans a Hoax. (4+ / 0-)

    There is some buck passing between the Insurance Commissioner (Kreidler) and the Governor (Inslee) over who approved the new skinny exchange health care plans which exclude most major Seattle area hospitals.  Childrens Hospital has filed a lawsuit over disclusion from the exchange networks.  Here are a few links to look over.  I strongly recommend reading all the comments where more details and discussion ensue.

    Hospital sues...

    Balance Billing Issues

    Drastically Thin Provider Networks in Exchange Plans

    These three go together and show an ugly picture of what we now confront.  This is very important stuff.

    •  Cancer Edition (1+ / 0-)
      Recommended by:

      A Touching Story...

      The heartwarming story/myth
      I perused the web site of Evergreen Medical Center, an Exchange-plan friendly hospital in my state. There, I found lovely marketing materials, success stories of breast, colon, blood and other cancer cures. I could almost hear the violins playing.

      For a second, my cynical heart melted. Maybe I’m being a little too shrill about this whole thin provider network problem. What’s so wrong if only certain hospitals offer care? We Exchange plebes would still get high quality care, as it seems!

      Then I searched to see if the doctors mentioned in these lovely stories are in-network on Exchange plans and…..


      The Reality
      With very, very (,VERY) few exceptions, none of the cancer care providers mentioned in these feel-good articles were in-network for Exchange plans.

      Even the director of the cancer program at Evergreen, Dr. Michael Hunter, is not contracted with any PPO Exchange plans except Community Health Plan of Washington, which gets terrible ratings for not paying even the simplest of claims.

      The same holds true for the director of radiation oncology, Dr. Eric Taylor


      Cascade Cancer Specialists, the group Evergreen uses for outpatient chemotherapy has been absorbed by our mega cancer center, Seattle Cancer Care Alliance, which has not contracted with Exchange plans.

      The Moral and the Shell Game
      Moral: Yes, some hospitals have contracted with Exchange insurance plans. However, please don’t go to them assuming that you can get in-network care, even for “routine” cancer. Even I was surprised about this. I thought only our hardest cases would be out of luck and the rest had at least reasonable access to care. The reality is that orgs like Seattle Cancer Care Alliance grow tentacles everywhere. When you eliminate them from the choices, you eliminate most or all of the choices.

      Congress addressed the “holes” in insurance policies via creating the “10 essential benefits”. Access to doctors who treat serious illnesses was NOT one of those 10 essential benefits. Thus insurance companies created new holes in their policies, severely curtailing access to treatment for illnesses they have traditionally covered.

      The Democrats are too busy protecting Obama to help us. The Republicans are too busy screaming "socialism". We have to protect each other, keep each other informed.

      Rough road ahead when reality sinks in...

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