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View Diary: Good WaPo editorial on "Keep Your Own Doctor" (153 comments)

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  •  I doubt this will change for most people (4+ / 0-)
    Recommended by:
    Tonedevil, ColoTim, worldlotus, ladybug53

    Most employer-based plans allow use of out-of-network providers, albeit at an increased co-pay and higher out-of-pocket limit.  I don't expect those will change much (mine hasn't).   That's probably how most people who want to go to a different city for treatment do it now and I expect that will continue to be the case for most employer-based plans.

    On the individual market (i.e. the exchanges), I expect a wider range of options will emerge as participation grows.  But we have to accept that choices come with price tags.  If your cancer patient in New Orleans wants to go to Houston for treatment, it is going to cost him more.  I suspect he could get treatment from the network provider in New Orleans that might be just as good or might not be, I couldn't really say.  But if you want a Cadillac, you have to pay for a Cadillac.  If you want a plan that will cover Cadillac treatment if you get cancer, then you will have to pay a higher premium.  

    The insurance companies claim, and I suspect they are right, that most of their customers say they prefer cheaper plans with narrower networks.  

    •  The problem will be if the "narrower networks" (3+ / 0-)
      Recommended by:
      annan, erush1345, VClib

      come with prices that are not "cheaper." The backlash will come if people perceive that they are paying about the same, or even a little more, and getting a narrower network, then yes, they will perceive that the "you can keep your doctor, period" was deceptive.  The President did not say, "If you like your doctor, you can keep your doctor, if you are willing to pay more."

      •  At least we are all talking about it (6+ / 0-)

        Trends like provider networks have been going on under the radar for many years.  One of the good things about the ACA is that health insurance is now a matter of public policy.  People are talking about it and learning about it .   These things won't happen in the dark anymore.  

        What the short term political fallout will be from some of these changes is hard to predict.  Personally, I find there's one thing that trumps pretty much everything else:  no one can ever be denied coverage.  Enshrining that principle for the long-term is worth taking some political flak in the short term.  

      •  The effect of Narrower networks will be (1+ / 0-)
        Recommended by:
        VClib

        more desirable providers will only be available under more expensive plans.

        More desirable could be for a wide range of reasons - some being potentially better healthcare, others a more pleasant experience:

        1) Beautiful and modern facilities instead of dated buildings
        2) "Known" for having the best doctors
        3) Private hospital rooms, while others have semi-private or 6 to a room.
        4) Minimal waiting for an appointment Vs weeks or months out, see a doctor within a few minutes of an appointment Vs waiting in the waiting room for extended periods.
        5) Doctors take their time talking to patients and understanding their situation, Vs focus on the reason for the visit.

        The difference could be similar to a Ford Fusion Vs a Mercedes S600.  Big difference in cost, both get you where you want to go in the same time, one more comfortable than the other, one allows oneself to think they are special.

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Thu Dec 26, 2013 at 12:20:35 PM PST

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      •  You never had any control over networks (6+ / 0-)

        Not over their size or who was in or out of network. And in fact, since you couldn't know in advance what specialists you might need to see, you couldn't control for this when chosing your insurance company's plan anyway. You do realize that doctors are free to move in and out of your network at all times, and always have been? That one or more of a team that you choose to see could be in or out of your network without your knowing it and without their working in a different hospital? Networks are a very complicated thing which preexisted the ACA and which will continue to be badly misunderstood by people buying insurance.  All you have to know or hope for is that regulators make sure that all people practing medicine and the hospitals and practices they are a part of meet some minimal standards of care.  

        •  Crazy things happen sometimes too (3+ / 0-)
          Recommended by:
          Sylv, annan, ladybug53

          Like for a while (and pre-ACA), Blue Cross did not have any in-network anesthesiologists in the SF Bay Area.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Thu Dec 26, 2013 at 02:25:03 PM PST

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          •  That is crazy (1+ / 0-)
            Recommended by:
            ladybug53

            I can see that happening in a rural area, but in the Bay area?!

            •  Check it out, from 2007 (4+ / 0-)
              Recommended by:
              annan, worldlotus, ladybug53, Sylv

              http://www.dailykos.com/...

              Dr. Gentile also singled out Blue Cross Blue Shield as the only insurance company that has no "in network" anesthesiologists anywhere in the country. The company feels that anesthesiologists are overpaid, although it is currently trying to strike a deal with the anesthesiology company that administered my epidural.
              What is happening is that these anesthesiologists have a monopoly relationship with the hospital.  All patients at the hospital must use these anesthesiologists.  These providers are increasingly dropping out of networks and billing patients the maximum they can get.  Since the patient has no choice (you don't find out until after the fact), you are stuck with a large bill that doesn't seem right.  The insurance company recognizing that you have no choice but see an out of network provider has agreed to treat the provider as an in-network provider for deductible and coinsurance purposes.  However, BCBS will not pay more for the service than what the pre-established rates are for this procedure.  In fact, there are other hospitals where anesthesiologists have agreed to accept BCBS payment as payment in full for services.  It is just that the hospital you are using is allowing anesthesologists to rip off their patients.

              Fry, don't be a hero! It's not covered by our health plan!

              by elfling on Thu Dec 26, 2013 at 05:46:48 PM PST

              [ Parent ]

      •  I think that may be what's happening here in (2+ / 0-)
        Recommended by:
        methylin, ladybug53

        Indiana. The premium for my new ACA silver plan - pre-subsidy - is about the same with the newly created narrow network as it was in the high risk pool that covered me for the past decade.

        The rate for the high risk pool was 150% of the normal rate for my age and location. Anthem is the carrier in both cases. Now the ACA will be subsidizing my rate so Anthem will be getting the same $$s while I will be getting a very narrow network with zero out-of-network coverage.

        So, the insurance industry gets subsidized by the taxpayers to provide a cheaper product to me. What's wrong with this picture?

        "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 Thu Dec 26, 2013 at 02:16:58 PM PST

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      •  or they have to travel 100 miles round trip and (1+ / 0-)
        Recommended by:
        ladybug53

        also have to change doctors.  Or only have 2 choices in total and both are far away.  

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