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View Diary: Obamacare Made Me Fire My Doctor - And It’s Not Why You Think (293 comments)

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  •  We also have the premium plan (15+ / 0-)

    and it's with a large insurance company. Your experience is even creepier than mine. That's not a good.

    •  Never saw this coming (12+ / 0-)

      I was looking forward to being insured again in part because I wasn't getting the same service I received when I had insurance in the past.

      Don't get me wrong, I'm glad I have some kind of insurance, but I'm still being treated like I'm uninsured.

      •  Is your health care through Medicaid? (2+ / 0-)
        Recommended by:
        Quasimodal, Rogneid

        the dog you have, is the dog you need. - Cesar Millan

        by OregonWetDog on Sat Jun 21, 2014 at 03:00:34 PM PDT

        [ Parent ]

        •  No (5+ / 0-)

          A major insurance company, maybe the biggest.

          •  There are plenty of people (5+ / 0-)

            who have insurance from "the biggest", who didn't purchase it through the ACA.

            I'm not saying you're making this up. I'm saying either there's a point or two missing that would help clarify this--or else your former doctor is going to get his/her ass sued off by someone sooner or later.

            "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

            by lunachickie on Sat Jun 21, 2014 at 03:18:55 PM PDT

            [ Parent ]

            •  I don't have all the answers (3+ / 0-)
              Recommended by:
              mint julep, terabytes, Betty Pinson

              I do know that I'm not the only one with this problem. Not leaving anything out.

              http://www.latimes.com/...

              Many consumers have also encountered difficulty finding a doctor who accepts their new coverage, as well as frustration with inaccurate provider lists, according to the California Department of Managed Health Care.

              "If you have a medical condition and can't get care that is a very serious issue," said Marta Green, spokeswoman for the managed healthcare agency. "We are still working to resolve many of these cases."

              •  Then someone is blowing smoke (15+ / 0-)

                up our asses.

                Many consumers have also encountered difficulty finding a doctor who accepts their new coverage
                It's one thing for a medical practice to say "We're not taking new patients". They've always done that. It's another thing entirely to deny the use of insurance based solely on where and how it was purchased.

                I believe that person who told you "that's the only insurance we don't take" was completely full of shit, for a variety of reasons. It probably goes without saying by now that it's best to take American media utterances with a metric fuckton of salt. They lie regularly.

                "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

                by lunachickie on Sat Jun 21, 2014 at 03:34:43 PM PDT

                [ Parent ]

                •  I don't know what the deal is Lunachickie (8+ / 0-)

                  Just relaying my experience with this new coverage. I bought the best plan I could find with the most coverage. I shouldn't have to drive 60 miles to another city to see an ENT.

                  •  No, you shouldn't (4+ / 0-)

                    which is precisely why if I were in your shoes--especially here in Florida--I'd be putting feelers out to attorneys.  

                    "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

                    by lunachickie on Sat Jun 21, 2014 at 03:51:59 PM PDT

                    [ Parent ]

                    •  I'm leaving FLA and getting another plan (4+ / 0-)

                      I'm going to do more research and see if any laws were broken and who is ultimately responsible. This is all very confusing. I'm not leaving any info out. I do know that my platinum plan feels more like the kind of plan you would buy from the back of somebody's trunk.

                    •  And do what? (1+ / 0-)
                      Recommended by:
                      ladybug53

                      I had to be extremely persistent in dealing with the BC BS.  They worked very hard at refusing to even take my premium money.  As for the actual insurance, I haven't even used the plan yet.  I expect when I do the experience will be the same.  I hate those fuckers, but I have no confidence that legal recourse would be helpful.   There's probably a tort deform law to squash any effort by actual people.  The corporations rule this state.  Their politicians choose the judges.  Hell, the biggest insurance crook around is the governor.

                      Yes, I'm pessimistic.  I recommend anyone considering legal action against the insurance companies look hard and long before committing their energy and their money to fighting them.

                      It might be cheaper, and not as physically or emotionally draining, to move to a different country.  And ain't that a royal mess.

                      I am become Man, the destroyer of worlds

                      by tle on Sat Jun 21, 2014 at 06:16:37 PM PDT

                      [ Parent ]

                      •  If there is (0+ / 0-)

                        one of these:

                        There's probably a tort reform law to squash any effort by actual people.
                        and mind you, it wouldn't surprise me a bit--but rather than deal in "probablies", why don't we find out for sure?

                        "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

                        by lunachickie on Sun Jun 22, 2014 at 02:01:05 PM PDT

                        [ Parent ]

                  •  No ENT's (1+ / 0-)
                    Recommended by:
                    SunnyDay

                    You need to ask some of the ENT's in your area why they are not accepting your policy so you can understand what the problem is.  

                    I asked my hospital why they didn't accept a certain insurance company and it took some prodding but they finally told me that the company wouldn't negotiate a fair payment for services.  Simple economics.  So I chose another company because I like my hospital.  

                    Ask questions before you buy.  You can change companies.

                    •  I've heard the same thing that some rates (0+ / 0-)

                      the big insurance companies are paying for those on Individual plans are even below the Medicaid rates.  What Obamacare needs to do is make it a law that no insurance corporation can pay less than at least Medicare rates.  Most doctors will take Medicare while many have to limit Medicaid patients because often the reimbursement is below cost.

                      Congressional elections have consequences!

                      by Cordyc on Mon Jun 23, 2014 at 11:11:11 PM PDT

                      [ Parent ]

                •  Exactly. (28+ / 0-)

                  Doctors can't accept or reject Obamacare because there is no such thing. At least no such thing as Obamacare Health Insurance. It's Blue Cross/Blue Shield or Aetna or one of the other health care insurers. Not Obamacare.

                  It's one thing for a medical practice to say "We're not taking new patients". They've always done that. It's another thing entirely to deny the use of insurance based solely on where and how it was purchased.
                  •  I can see some ignoramus (8+ / 0-)

                    at the front desk of some two-bit practice in suburban Orlando telling someone "That's the only insurance we don't take", but it's got to be illegal as hell.

                    "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

                    by lunachickie on Sat Jun 21, 2014 at 03:53:13 PM PDT

                    [ Parent ]

                    •  The doctor has breached a contract ... (4+ / 0-)

                      but its a contract with the doctor and the insurance company. The patient is not a party to that contract. (The insurance policy is a completely separate contract.

                      And that may be why this type of situation may be turning into a huge issue: it's the insurance company that has to take legal action over the contract breach. Indeed, the patient probably cannot sue directly over that contract breach, as they aren't a party to it.

                      It sounds like the insurance company is (as usual) screwing over the patient ... this time by intentionally failing to sue the doctor over the breach of contract. That may leave the patient in the ugly position of having to sue both the insurer and the physician, in an area that may have little legal precedent.

                      "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

                      by nosleep4u on Sat Jun 21, 2014 at 04:22:48 PM PDT

                      [ Parent ]

                      •  But it's a breach of contract (1+ / 0-)
                        Recommended by:
                        terabytes

                        between the insurer and the customer if the insurer claims certain doctors were available through their plan as a selling point, and they turn out not to be.

                        But I know insurance companies have special little laws to protect them from a lot of wrong-doing.

                        •  Technically yes (0+ / 0-)

                          but to prove that, the patient has to prove the insurer is willfully allowing the doctor to breach contract.

                          Which they are of course ... but proving that in court is quite difficult.

                          "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

                          by nosleep4u on Sun Jun 22, 2014 at 10:37:55 PM PDT

                          [ Parent ]

                        •  No the problem is that the insurance co (0+ / 0-)

                          has excluded many doctors and hospitals from having the contracts.  Its called Narrow Networks.

                          Congressional elections have consequences!

                          by Cordyc on Mon Jun 23, 2014 at 11:16:56 PM PDT

                          [ Parent ]

                      •  Gee (1+ / 0-)
                        Recommended by:
                        JayRaye
                        it's the insurance company that has to take legal action over the contract breach
                        I'm shocked to think that granting the power of our health to the for profit health insurance industry should have problems like this.
                    •  I don't think so (9+ / 0-)

                      I don't think there's anything illegal about it. Insurance companies contract with doctors to accept their insurance. In some states, they contracted with a very limited number of doctors. Part of it was because insurance companies were limiting the size of their networks. Part of it was because they were offering insufficient reimbursements so fewer doctors wanted to participate. There's been quite a bit of news lately about insurance companies expanding their networks, particularly out of California.

                      In some states, insurance companies offered identical policies on and off the exchanges, with identical physician networks. Some had slightly different networks. Both are ACA compliant.

                      "That's the only insurance we don't take" might be misleading. It could be the doctor wasn't offered participation in any exchange policy networks. It may be that the physician declined to contract to service exchange policy patients. It's impossible to know which it is.

                      I think part of the confusion is that the diarist is using incorrect labels. As a practical matter, all insurance is now ACA compliant (except the very small minority of grandfathered policies), and therefore all insurance is "Obamacare", including employer sponsored policies. All non-Medicaid , non-medicare and non-VA coverage policies are private insurance. The only differences is how they were acquired; employer sponsored plans, exchange plans, or off exchange private insurance. All three are Obamacare.

                      •  Precisely (2+ / 0-)
                        Recommended by:
                        Kane in CA, SunnyDay

                        why these doctors can't pick and choose patients based on which network they bought ABC Insurance from.

                        In some states, insurance companies offered identical policies on and off the exchanges, with identical physician networks. Some had slightly different networks. Both are ACA compliant.
                        After a day's reflection, I'm pretty sure the initial claim was complete BS--at the very lease, it's completely unverifiable, so take it with a grain of salt. And just to be clear, I'm not a huge champion of the ACA.

                        "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

                        by lunachickie on Sun Jun 22, 2014 at 01:59:08 PM PDT

                        [ Parent ]

                  •  State by state ... it gets blamed on Obamacare (4+ / 0-)

                    but its actually the way that state Insurance Commissioners allow the big companies to operate in their states. The narrowest of networks have been devised by the big companies to max their profits, approved by the state insurance commissions.

                    So some doctors are being squeezed like lemons by the insurance companies in those states and they're just saying no. In some states. Not all states. But it takes some brainpower and lack of an agenda to figure out that it's not really Obamacare at all.

                    What really makes me mad is the fact that the insurance company are getting the same $$s as they do in the private market, but it's being subsidized twice: once by the Federal Government AND twice by the doctors and hospitals who have been squeezed into taking lower fees to participate in the narrow networks. Then the uninformed blame the subsidized patients.

                    Makes no sense until you remember that for-profit healthcare is the problem.

                    "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 Jun 21, 2014 at 08:21:44 PM PDT

                    [ Parent ]

                •  Welcome to the new reality (1+ / 0-)
                  Recommended by:
                  WakeUpNeo

                  I live in Hawaii and haven't had insurance in 11 years. Luckily I finally get medicare this fall.

                  Here we have  HMSA or Kaiser. if you're in the City(on another isalnd-Oahu) you have pretty good access to good docs.If you're on one of the outer islands it's definitely 3rd world.

                  Kaiser docs here are under  a mandate to see one patient each 12minutes.

                  When Obamacare was being discussed, our Honolulu paper ran an article which explained that one of the reasons O-care would hold down costs is that people wouldn't go to the doctor as much because of factors like availability of care and cost.

                  The State run hospital system is so broken here that they are set to do another RIF targeting nurses.

                  I have another nurse friend that has been running a pediatrician's office for over 20years. She told me the paperwork for Obamacare is hammering the staff and the cost of running the office. This is one reason why doctors throw in the towel and go to work for someone like Kaiser.

                  My wife's Kaiser Doc told her if it was a serious issue she should fly to Oahu and go to Kaiser emergency at the hospital there. if she tried to go through protocol here she could die waiting for a diagnosis(it can take several months to go through the gamut of the initial appointment then a referral to a specialist. The specialists come from Oahu and only fly over once a month, maybe not even then.

                •  It's not a question of not taking the insurance (0+ / 0-)

                  it's whether your doctor is in-network or not. If they are not in-network, you have to submit your bills to the insurance company for reimbursement which is unlikely to cover the whole bill. Many of these networks have so few doctors in-network, it's a cruel joke. I signed up for a Healthnet "Platinum" plan. At the time I was investigating, the online search tool for doctors in-network showed thousands within my local urban area and included all the docs I see regularly. However, once I signed up and went to add my primary care doc to my account, I discovered that he was no longer listed as in-network! Turns out none of my docs were. In fact there wasn't even one ophthalmologist in-network anywhere within 20 miles of me! And that's critical for me. I discussed the problem with a rep but they were of no help. I decided to stay on my existing plan until it ends at the end of the year. Now I'm fighting to get my first month's premium back for insurance I cancelled before it took effect. It was a real bait and switch: I would never have chosen that "Platinum" plan if they hadn't misrepresented their networks initially.

                  Just another faggity fag socialist fuckstick homosinner!

                  by Ian S on Sat Jun 21, 2014 at 08:32:46 PM PDT

                  [ Parent ]

                  •  Blue Cross in WA State has a neat trick (4+ / 0-)

                    I had a referral to specialists at the University of Washington Medical College. The UWMC site listed themselves as in-network for Premera Blue Cross, which is also true. But only for some plans.

                    My Premera plan, which is a bronze plan, did not include UW, or any Seattle hospital as in-network. That means a separate $21,000 deductible and unlimited 50% co-pay.

                    However, WA State also has a law that says if there's no specialist of the type you need that's in-network for your plan, the insurer has to treat the nearest specialist as in-network. But the provider can do balance billing (even though Premera does have a contract with them) - that means Premera pays them their contract rate, and you can be billed for the difference between what's billed and what Premera pays (that can't happen with truly in-network providers). That can be anywhere from 20% to 70% depending on the service.

                    And if the specialist calls for a procedure that isn't covered, you're 100% responsible, unless you can win an appeal from the insurer.

                    With Medicare, on the other hand, I could go nearly anywhere in the country and still be covered - there is no "in-network" distinction.

                    Those are the kinds of things that made a public option absolutely necessary.

                    No matter how cynical you become, it's never enough to keep up - Lily Tomlin

                    by badger on Sat Jun 21, 2014 at 09:00:51 PM PDT

                    [ Parent ]

                  •  If they're in-network (0+ / 0-)

                    then it doesn't matter where the patient purchased the insurance.

                    WTF? Are we all that confused?

                    "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

                    by lunachickie on Sun Jun 22, 2014 at 02:02:10 PM PDT

                    [ Parent ]

                    •  That's true... (1+ / 0-)
                      Recommended by:
                      lunachickie

                      In Network is the key. When someone says they didn't accept the insurance, I think what they really mean is that the doctor is out-of-network so the patient has to pay and get reimbursement from the insurance company.

                      Just another faggity fag socialist fuckstick homosinner!

                      by Ian S on Sun Jun 22, 2014 at 08:29:49 PM PDT

                      [ Parent ]

                      •  Good point (1+ / 0-)
                        Recommended by:
                        SunnyDay

                        if the anecdote relayed here is as told, it's entirely possible that's exactly what the doofus at the desk "explaining" it to Quasimodal actually meant.

                        In which case, it has exactly nothing to do with the ACA.

                        "Inevitability" diminishes free will and replaces it with self-fulfilling prophecies."--Geenius At Wrok

                        by lunachickie on Mon Jun 23, 2014 at 04:58:42 AM PDT

                        [ Parent ]

                      •  That Is EXACTLY What Out Of Network Means (0+ / 0-)

                        But it's more than that.

                        The doctor NEVER gets the EOB or the check from that insurance comapny.  It is sent to the patient.

                        Thus the doctor bills the patient for the full amount of the office visit.  And if insurance paid less, guess who gets left holding the bag?

                        But if you are In Network...then you have to accept what the Payer pays and can't bill the patient the difference.

                        Not so with Out Of Network.

                  •  why can't you file a complaint? (0+ / 0-)

                    That seems highly illegal.  I would complain to the state insurance board and the Federal HHS.

                    •  ????? (0+ / 0-)

                      When we were switched over from our GP (who moved) we were told that the NEW NP was NOT covered by OUR insurance--they had not OPTED to accept HER as a covered provider!  

                      We could see some one ELSE in the office but the appointments we had BOOKED months in advance were CANCELED with NO notice to us---which admittedly was the OFFICES fault.

                      This has been an issue---these plans are NOT all equal.  IF you have an ACA plan vs an employer sponsored plan the employer sponsored plan DECIDES what THEY will elect to cover--or not.  IT might SAY BC/BS on the face of it but if it is thru an employer--say Walmart or Sears (have no clue what those offer /example only!) IF they say you can have contraceptive covered;  if they say you can get a broken leg set in the ER but NOT at an Urgent Care---this is NOT decided at a Federal level altho the NAME on the insurance CARD might be the SAME.  

                      I know this the hard way because my insurance is NOT any form of Government related (think police;  firefighter; state or county nursing home employee; state or county worker etc)  I might have the SAME name on my CARD as they do but the COVERED AREAS might be vastly different.    And the coverage I get for  certain things is VERY different for things like diabetes supplies;  where I can and cannot GO; who I can and cannot SEE.  

                      And the Ins Co's LIKE to keep us confused and NOT using "their" services.    I had a routine colonoscopy sched for the last week of the year--a year in which i had MAJOR hospitalization and surgical expenses that blew right on past ALL of my deductibles etc in JANUARY.  So there I was at 6 AM after doing all the "prep" etc;  driving 2 hours ONE WAY to the hospital and the hospital TELLING me that my insurance company was DEMANDING that I pony up $500 UP FRONT due to "Not having met the deductibles"--yet!   They could not CALL the ins co as they were not open yet.  I told them---OK I will go home now I don't happen to HAVE a spare $500 sitting in my pocket right now! And WHY was I not NOTIFIED of this before the day of the procedure?  

                      They did finally concede that it was THEIR hospital that had treated me for the MAJOR procedure and that I had indeed incurred more bills than the deductibles and they allowed me to go have the procedure.  But imagine if they had refused???  What if I actually HAD something wrong in there!  

                      Now I have one that is issuing refunds to ME and the places that treated me after my having to get my CONGRESS PERSON's office involved when BC refused to pay for a pre-approved Air Med Flight.  

                      This is only going to get WORSE ACA or no ACA as the FOR PROFIT ins co's try and maximize profit over patients.

              •  New Coverages (0+ / 0-)

                The problem with some Drs not accepting coverage's is the same as it has always been.  Not all Dr.s accept all insurance plans.  They never have.  When the exchanges were set up some players new to certain states started taking customers and writing plans.  Your Dr. may have not signed up to accept that insurance.   That would be the same whether it was through the exchanges or not.  As far as I know there is no flag on your policy that says you bought it on the exchange.  You could have bought the policy from an agent just as easily.  Sounds to me that it would be obvious only if it is a new company that wasn't doing business in your state before the ACA are if you suddenly had coverage for an existing condition that you were not previously covered for.  If the Dr. accepts the terms of the insurance company, they don't care which company you have.  If you ask them before purchasing a policy, they have a preference.  So ask.  Just remember, it is not the fault of the ACA that some Drs don't accept all policies.  That is still their decision to make.  They aren't forced to take any.  (see no socialized medicine here)

                If I thought I was being discriminated over my insurance, for any other reason than I just stated, I would contact the insurance company and file some kind of complaint with the ACA, I'm sure there must be some avenue for doing that.  If your Dr accepts your policy, you should not be treated differently as long as that insurance company pays for the services he wants you to have.  

                I just had a complete physical with my own Dr and we discussed the ACA.  She is very happy that a lot of her patients that had no coverage before are now covered and able to have the tests and procedures they need.  She did tell me that there are a few insurance companies she does not accept for varying reasons, some had to do with payments and some with controls.  People should contact their physicians offices to inquire about the coverage before they purchase any new coverage.  IF your Dr. is important to you, make sure they accept your insurance before you sign up.  That is what I did and made a decision based on that information.  I checked the Hospitals in my area as well to see which insurance companies they accepted.  None of the accepted everyone's policies.   Let the buyer beware.  Same as before.  

                My hairdresser told me that he was dropped from his wife's policy because he had not provided some information they wanted to update their files (he had been with them for 13 years) because of new regulations in the ACA.  What a crock that was.  His wife's employer was self-insured, managed by Humana and so his coverage had nothing to do with the ACA.  Maybe they were just trying to get rid of him hoping he would go to the exchange and get coverage instead of using his wife's policy since he is self employed.  How is that the fault of the ACA?  Of course his wife works for a for profit private hospital that they must use for care......go figure.  Sounds like they are looking for outside sources of new cash flow to me.  

              •  That is very true, the problem is Narrow Networks (0+ / 0-)

                that both Blue Shield and Blue Cross in CA now have for all Individual policies both from CoveredCA and outside.

                And it is not always the doctors.  I have an ear condition and see one of the best ENT's.  They are a clinic and they have always taken all insurance including Medicaid.  They are healers.

                Anyways it turns out Blue Shield won't allow them to be in network for ACA compliant plans!

                So how does that work out.  Well, with the Blue Shield PPO it costs $60 to see a Specialist on the Silver Plan.  But to see my doctor I recently paid $39 for an office visit.  And Blue Shield will reimburse me 50% of that.

                It's time to get the Insurance Corporations in line.  Why don't they just pay the Medicare rates and then we could negotiate with doctors.

                Congressional elections have consequences!

                by Cordyc on Mon Jun 23, 2014 at 11:05:34 PM PDT

                [ Parent ]

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