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[UPDATE]  See update after fold

The Obamacare haters are in the last gasp of trying to shoot down the ACA before people realize what a great thing they’re getting.  To that end, they have resurrected the old canard that you won’t be able to choose your own doctor.   Of course this is just more misdirection from our friendly neighborhood nihilists, but maybe we all should take a deep breath and think through just what is meant by the concept of choosing your own doctor.

First of all, if you are paying out of your own pocket, you can go to any doctor who will accept your money.  This would be pretty much all of them except for some who might not be accepting new patients; any doctor you are currently seeing will presumably continue to see you as long as you pay (unless he/she drops dead, retires, is indicted, etc.).  So, if you don’t have any health insurance at all, I guess that means you are completely free to “choose your own doctor,” as long as you pay the full cost.  

OK, but let’s say you now have health insurance.  In most policies these days, there are  “in-network” and “out of network” doctors, sometimes called “preferred providers” and “non-preferred providers.”  Basically, the in-network providers have negotiated favorable rates with a specific insurer.  Some doctors belong to multiple networks; some don’t belong to any network at all.  You usually can determine whether a physician is in-network for a specific insurance plan by consulting the plan’s website.  

This does not mean that you can’t see an out-of-network physician under your plan, only that it will cost you somewhat more to do so.  The normal practice is that an in-network doctor visit is reimbursed at, say, 90 percent (after you have met your deductable), whereas an out-of-network visit might be reimbursed at 70 percent.  This is not a feature of the ACA; it has been standard practice in the medical insurance industry for at least two decades now, and I presume that most of the plans offered by the exchanges will have some form of the in and out of network distinction.   Like many people, I have several doctors I have seen regularly over the years; most are in network but at least one is not.  I continue to go to him because I think he is good, but I could save some money by switching to someone in-network in his specialty.  

Now if you have a major medical issue, the whole thing will basically become moot.  You will most likely exceed your yearly out-of-pocket limit (usually around $6000) and everything else will be paid at 100 percent, even if the providers are out-of-network.  Some policies have two different out of pocket limits; mine is $4000 for in-network and $6000 for out-of-network.  However, I assume that if anything that bad ever happens to me, the treatment will probably include consultations with specialists and outside providers who are out-of network, so I figure that I will have to satisfy the higher out-of-pocket limit.  

The bottom line is that there is no question of not being able to choose your own doctor.  The only question is the rate at which it will be reimbursed below satisfaction of the out-of-pocket limit.  Even if you had an insurance policy that wouldn’t pay for a specific doctor for some reason (most likely because it is some unproven alternative therapy), you would still be completely free to consult that doctor at your own expense.  There is absolutely no requirement in the ACA or anywhere else that says you must claim a medical expense on your insurance; you can always just pay for it on your own.  

So what if you are uninsured and have no financial resources?  Well, you can't choose much of any doctor, can you?  Our GOP potentates are fond of reminding us that these folks can just head to the emergency room, but my experience with emergency rooms is that you don't get to "choose your own doctor" there.  

Update.  Thanks to all those who commented.  There seems to be a fairly wide range among plans as to how big a difference there is in reimbursement rates for in-network and out-of-network doctors.   However, keep in mind that, in a true medical crisis, it should become mostly moot after you hit the out-of-pocket limit.  This underlines why the out-of-pocket limit is the most important aspect of any health insurance plan and should be the first thing you look at when comparing (you want it to be as low as possible).  

What it gets down to is that "choice" in any consumer product or service is to some extent related to how much you are willing or able to pay.  We have a choice of what car to drive, but if our resources are limited, it will be a Chevy or Honda rather than a BMW or Rolls Royce.   I may want Dr. Oz as my personal physician, but I suspect he's too busy raking it in on the talk show circuit to take me on right now.  Maybe if I were Jeff Bezos...  Even in that most "socialistic" of health care systems, the British, you still have the option to "go private."  

The other point, of course, is that the ACA will not affect this situation one iota.  Everyone who has a good plan now will be able to keep it and continue to see their current doctors.  Physician networks are a fact of life now, and have been for twenty years.  The ACA won't change that.  The ACA will just make it possible for most people to get affordable insurance, and will protect all of us from the worst insurance industry abuses, such as yearly limits and rescissions.  

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Comment Preferences

  •  It Takes 7 Syllables to Say You Can't Choose Your (26+ / 0-)

    doctor, in these ads that are running. It took you 7 paragraphs on a full page to refute it.

    That's the problem in a society that doesn't have a journalistic mainstream press.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sun Aug 18, 2013 at 08:23:31 AM PDT

  •  Changing jobs is more of a risk (23+ / 0-)

    to not be able to see the doctor you want to than Obamacare ever will be.

    Go from one job with a carrier your doctor accepts to a job with a carrier your doctor doesn't accept, BANG, can't see your doctor any more.

    Heck, your employer can cause you to not see the doctor you want to see simply by changing HMO plans where your doctor is no longer in the plan!

    John Roberts? Melville Fuller?? WTF is the difference???.

    by Walt starr on Sun Aug 18, 2013 at 08:29:00 AM PDT

  •  I'm actually not sure about this. . . . (15+ / 0-)
    First of all, if you are paying out of your own pocket, you can go to any doctor who will accept your money.  This would be pretty much all of them
    I was recently shopping around for a new doctor, and several times the first question was who my insurer was - whenever I said I'd pay myself, they (and by "they" I don't mean the physician but their office staff) would tell me they weren't accepting new patients.  

    I suspect that it is simply way to much hassle to try to collect from individual people than from an insurance company, so many physicians simply do not accept non-insured patients.

    •  Agree. But it's not entirely about collecting the (8+ / 0-)

      physician's fees. Doctors want patients who can afford lab tests, cat-scans, hospitalization, etc. when they get sick. Without all that, the physician's hands are tied.

      Hence, the ACA individual mandate... everybody should be insured.

      “It is useless to attempt to reason a man out of a thing
      he was never reasoned into” - Jonathan Swift

      by jjohnjj on Sun Aug 18, 2013 at 08:53:26 AM PDT

      [ Parent ]

    •  I'd like to learn more about that (9+ / 0-)

      I see a couple of out-of-network doctors, one of whom accepts no insurance whatsoever and charges top dollar (she also saved my life twice, which is why I'm still her patient). Until I became eligible for Medicare (yay!!), I paid her full-freight out-of-pocket and submitted the bill for reimbursement. Now that I'm on Medicare, which will not reimburse in this situation, she gives me a 20% discount on my bill.

      I cannot imagine that she wouldn't accept a new patient. And from what I've heard from doctors, collecting from insurance companies is a hassle beyond belief. One practice I've used has a person on staff whose only job is fighting with insurance companies for payment. The insurance will try almost anything to disallow claims.

      "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

      by sidnora on Sun Aug 18, 2013 at 08:54:27 AM PDT

      [ Parent ]

      •  Well, I do know one clinic, in a strip mall (5+ / 0-)

        right beside a Dunkin Donuts - that according to the sign on the door * only * accepts cash.  And by  cash, that's what I mean (e.g., you can't even pay by credit or debit cards).

        But from the looks of things, I'd get better medical care from the staff of Dunkin Donuts . ..  .(the clinic seems to cater to medical exams needed for immigration purposes, etc).  

        So maybe it's the very top (your example) and bottom (this post) that take cash.   The middle seem to be wary.

        And yes, while I realize that insurance companies can be a hassle, they typically do pay.  At least some of the bill.

        •  Well, I'd have to be pretty desperate (1+ / 0-)
          Recommended by:

          to use the strip mall clinic, I will admit. I did once use a doctor-on-call service as an alternative to what would have been a Sunday afternoon ER visit, and IIRC he required cash for service, though I was able to submit his receipt for reimbursement afterwards. He didn't make me wish I had him for my PCP, but he was a lot cheaper, and faster, than the ER would have been.

          My hoity-toity doctor cheerfully accepts all non-insurance forms of payment, but you sign a statement of understanding of the payment terms before you get seen.

          "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

          by sidnora on Sun Aug 18, 2013 at 10:38:24 AM PDT

          [ Parent ]

          •  Huh? (7+ / 0-)

            University of Washington Physician (and several of its specialty ) clinics are located in strip malls. They're convenient, accessible and have lots of parking.

            UW Medicine hospitals and programs rank high in U.S. News & World Report’s 2011 edition of America’s Best Hospitals.  UW Medical Center was ranked #13 in the nation overall, and has made the U.S. News national Honor Roll since the rankings began in 1990.

            It's not where a physician's office is located. It's who is working inside.

            © grover

            So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

            by grover on Sun Aug 18, 2013 at 11:19:03 AM PDT

            [ Parent ]

            •  I didn't say (1+ / 0-)
              Recommended by:
              Roadbed Guy

              "a strip-mall clinic", I said "the strip-mall clinic", meaning the one that was described above. We don't even have strip malls where I live.

              "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

              by sidnora on Sun Aug 18, 2013 at 11:51:32 AM PDT

              [ Parent ]

      •  sidnora - your physician ia part of a trend (11+ / 0-)

        where physicians fed up with fighting insurance companies will demand payment in advance of service and provide patients with the documents they need to seek reimbursement from their insurance provider. This is an expanding trend.

        "let's talk about that"

        by VClib on Sun Aug 18, 2013 at 09:07:19 AM PDT

        [ Parent ]

        •  you can afford to pay upfront (1+ / 0-)
          Recommended by:
          historys mysteries

          however, there are many more Uncomfortable patients who cannot.

          “Vote for the party closest to you, but work for the movement you love.” ~ Thom Hartmann 6/12/13

          by ozsea1 on Sun Aug 18, 2013 at 10:38:52 AM PDT

          [ Parent ]

        •  If it's a trend, then she's the cutting edge. (1+ / 0-)
          Recommended by:

          I've been her patient for almost a quarter-century, since the practice was founded, and it's always been this way.

          "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

          by sidnora on Sun Aug 18, 2013 at 10:40:59 AM PDT

          [ Parent ]

          •  It's how medical practice was before the 1960s (1+ / 0-)
            Recommended by:

            It's really only been since the late 60s that physicians took over billing insurance companies and being paid directly. I recall as a child that my mother would always pay the healthcare provider when services were rendered. Some physicians, like yours, never changed or never adopted a new model. However, we went through a few decades where most people had very good employer provided health insurance and some physicians started the practice of billing the insurance companies directly. Now with high deductibles and co-pays we are in another time of transition. It will be interesting to see how the ACA changes the business procedures of community clinical practices.

            "let's talk about that"

            by VClib on Sun Aug 18, 2013 at 02:16:24 PM PDT

            [ Parent ]

            •  Based on the Supreme Court decision (1+ / 0-)
              Recommended by:

              that Medicaid expansion is optional, along with the various ways that Red states are not just refusing to set up exchanges but actively screwing with federal attempts to reach uninsureds in those states, there are going to be plenty of people who will fall through the cracks and remain uninsured. There will still be a need for affordable care for cash-paying patients.

              "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

              by Alice in Florida on Sun Aug 18, 2013 at 03:04:55 PM PDT

              [ Parent ]

            •  Her practice was founded in 1989, (0+ / 0-)

              when I, at least, had excellent insurance, and long after the days when i expected to go to the doctor and pay when we were done.

              I think it was intended to be a gilt-edged practice right from the start. But she is an awfully good doctor, too.

              "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

              by sidnora on Sun Aug 18, 2013 at 04:19:10 PM PDT

              [ Parent ]

      •  May I ask why Medicare won't reimburse? (0+ / 0-)

        I am starting Medicare on Sept. 1 and I'm trying to ask questions. Do parts A & B cover only the most basic stuff?  Did you choose a 20% 'medigap' insurer? I don't want to. Thanks!
        All I need is Chiropractic for the moment, which IS covered after a $148 deductible, then visits are <$7.

        "He went to Harvard, not Hogwarts." ~Wanda Sykes

        Blessinz of teh Ceiling Cat be apwn yu, srsly.

        by OleHippieChick on Sun Aug 18, 2013 at 12:56:14 PM PDT

        [ Parent ]

        •  Part A only covers hospitalization, Part B (1+ / 0-)
          Recommended by:

          covers outpatient care, I believe both cover 80% leaving the patient to pay the other 20% (and deductible), which is why many people buy "Medigap" policies (but of course, you have to pay a monthly premium for that, so it's like insurance for your co-pays).

          There's also a Part C (the "Advantage" plans which are the successors to Medicare HMO's--basically it's private insurance that covers what Medicare does. Some people can save money with these, which may include drug coverage without an additional premium for "Part D" which is Medicare's prescription coverage, which is entirely administered through private insurance plans.

          "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

          by Alice in Florida on Sun Aug 18, 2013 at 03:14:50 PM PDT

          [ Parent ]

    •  Plus... (5+ / 0-)

      I'm sure there are a lot of uninsured people like my sister-in-law that ultimately just refuse to pay. If she pays for a doctor visit (or health insurance for that matter), that is one less Coach bag, pair of Prada sunglasses, or brand new car. She can't have that.

      •  Yes, I think that's it (4+ / 0-)

        many simply refuse to (or often legitimately can't) pay.

        After all you go in expecting the cost to be $200 at most, and after a day of testing, etc, it's 10x that much, what are you supposed to do?

      •  BB - physicians are learning (1+ / 0-)
        Recommended by:
        Alexandra Lynch

        and many now demand payment in advance of treatment for those who are uninsured.

        "let's talk about that"

        by VClib on Sun Aug 18, 2013 at 09:08:36 AM PDT

        [ Parent ]

        •  But how is that done, logistically? (4+ / 0-)

          Seriously, I really can't see how a health care provider can bill in advance, not knowing what is wrong even, or if that much is known, how to foresee complications that might greatly increase the costs involved.

          In fact, this has always been a powerful counterargument to RWers who suggest that health care would be so much more affordable if consumers would just "shop around"

          •  A hospital did just that in my case (5+ / 0-)

            earlier this year.  Called Blue Cross to determine what the allowable charges would be, and how much BC would cover; then charged me for the rest.  I had to pay -- in advance, in full -- in order to receive the procedure.

            Of course, given BC's tendency to change its mind and then not cover, there's some risk involved, but the risk is always there anyway.  BC once rejected coverage for colonoscopy anesthesia after initially approving it; took eight months to iron that one out.

            Dogs from the street can have all the desirable qualities that one could want from pet dogs. Most adopted stray dogs are usually humble and exceptionally faithful to their owners as if they are grateful for this kindness. -- H.M. Bhumibol Adulyadej

            by corvo on Sun Aug 18, 2013 at 09:24:57 AM PDT

            [ Parent ]

          •  RG - as someone noted in this thread (4+ / 0-)

            there are physicians who don't accept any insurance and require payment in advance. They give you the documents to negotiate with your insurance companies.

            Regarding payment in advance, it's not that difficult. Unless it's an emergency or trauma the typical first appointment is a diagnosis of some type for which a fee has been established. Patients are required to pay for that initial exam/diagnosis in advance of treatment. If additional physician services are required those have listed fees as well.

            On a separate, but related point, physicians who have a good business staff require all co-pays and deductibles to be paid before service is provided for those patients who are insured. Physician offices can't afford to be in the billing and collection business with their patients.  

            "let's talk about that"

            by VClib on Sun Aug 18, 2013 at 09:49:39 AM PDT

            [ Parent ]

    •  RG - In addition most physicians won't accept (3+ / 0-)

      Medicaid patients and an increasing number won't accept new Medicare patients.

      "let's talk about that"

      by VClib on Sun Aug 18, 2013 at 09:04:10 AM PDT

      [ Parent ]

      •  Yes, but that's not really all that new of (3+ / 0-)
        Recommended by:
        VClib, Alexandra Lynch, Kevskos

        a problem . . . ..

        •  I agree, but the ACA is dramatically increasing (2+ / 0-)
          Recommended by:
          Alexandra Lynch, divineorder

          the number of Medicaid patients. Who is going to treat them?

          "let's talk about that"

          by VClib on Sun Aug 18, 2013 at 09:12:08 AM PDT

          [ Parent ]

          •  My feeling is that this is where increasing (1+ / 0-)
            Recommended by:
            Alexandra Lynch

            (or maybe "emerging" would be a better word) abilities of "robots" to provide health care is going to be key.

            There was a diary in which this was discussed at some length in the past 2 to 6 weeks . . ..

          •  there is a move to increase the clinics (3+ / 0-)

            available to people for basic care.  We really really need single payer...

            •  ^^^ (3+ / 0-)
              Recommended by:
              greenbell, Sue B, historys mysteries
              We really really need single payer...

              Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

              by divineorder on Sun Aug 18, 2013 at 11:55:09 AM PDT

              [ Parent ]

              •  Yes we do (0+ / 0-)

                but that would exacerbate, not ameliorate, the topic at hand  - which is the looming shortage of physicians.

                •  Maybe (2+ / 0-)
                  Recommended by:
                  divineorder, Roadbed Guy

                  Part of the single payer argument is more efficient physician time.

                  I can see more patient if less of my time is spent dealing with insurance companies.

                  I believe this to be true, but it's possible there a big element of faith rather than evidence to support it.

                  The plural of anecdote is not data.

                  by Skipbidder on Sun Aug 18, 2013 at 02:08:00 PM PDT

                  [ Parent ]

                  •  Most physicians have staff who deal (1+ / 0-)
                    Recommended by:

                    with insurance companies - so the cost of having these people in the system could be considered to be "waste" that could be eliminated.

                    Another argument is that if people could / would regular see physicians before problems became extreme, $$s (via not having to undergo crisis-type medical intervention) would be saved.

                    However, stats that I have seen that "end of life" medical care consumes a huge amount of this country's medical care budget don't make that argument all that convincing, either!

                    •  Staff isn't enough (1+ / 0-)
                      Recommended by:
                      Roadbed Guy

                      I deal plenty with insurance companies quite a bit on my own. It sure seems like it sucks up a large amount of time. This is in addition to my overhead cost contribution to the staff who initially screen these interactions.

                      In addition, part of the way we practice at all is geared toward trying to appease nongovernmental companies or jump through hoops to get paid.

                      Medicare is administered by private companies in different areas of the country. Amazingly enough, they have a large degree of latitude in interpreting the Medicare Documentation Guidelines, and sometimes have made rulings that are directly contradictory to those published guidelines. My own carrier will not answer any questions when I send them. They simply refer me back to the (often vaguely-worded) Documentation Guidelines or their own quite useless online material. It is difficult to usefully train resident doctors on how to document to billing standards when you know that they may practice in a different state and thus find different interpretations of the rules.

                      We do spend a lot of money at end of life. Part of this is cultural. We tend to have less acceptance of the idea that death is part of life. We tend to try non-evidence-based approaches (or ones with evidence that is shaky at best) after the evidence-based ones fail. We are sometimes ignoring what is considered to be best practice according to consensus expert opinion of our professional societies. Efforts to have better goals of care discussions with patients have been thwarted (largely but not entirely by religious conservatives). These get demonized as "death panels". And providers of hospice care have been feeling the squeeze recently, with some of the bigger organizations dealing with fraud accusations (sometimes fairly and sometimes quite unfairly).

                      The plural of anecdote is not data.

                      by Skipbidder on Mon Aug 19, 2013 at 04:26:31 PM PDT

                      [ Parent ]

    •  Maybe, but... (4+ / 0-)

      I suspect the truly wealthy will have no problem getting into any doctor they want to see.  A suitcase full of cash might change their minds.  

      I'm just making the rhetorical point that this is less about what doctor you choose and more about how and at what rate the doctor is paid.  

    •  Rather ironic since self-pay patients often pay (1+ / 0-)
      Recommended by:

      much more quickly than the insurance companies.   Ins. co's drag out their reimbursement timing as long as possible.  
        A few years ago I overpaid the county medical system about $100.  They acknowledged right away that they owed me a refund.  But when I didn't get the refund by the time they first said it'd be paid, I called to check on it's status.  They said all refunds had been put on hold until further notice.  The reason was because the county wasn't getting timely reimbursements from insur. co's.  
        I got the refund only after complaining to a county politician that the county was punishing the patients instead of insur co's.

      My Karma just ran over your Dogma

      by FoundingFatherDAR on Sun Aug 18, 2013 at 02:32:15 PM PDT

      [ Parent ]

  •  Good enough observations but wrong perspective. (7+ / 0-)
    To that end, they have resurrected the old canard that you won’t be able to choose your own doctor.
    For a lot of us, "choosing your own doctor" has always been nice in theory but unrealistic in practice.  Thanks to the rapid decline in the number of primary care physicians (it just ain't lucrative, dontcha know), one's same-day needs are usually satisfied by a nurse practitioner in the chosen doctor's practice . . . if one can even get in to the nurse practitioner.   Thus the proliferation, since the late 1970s, of those "minor emergency clinics," which used to be staffed by doctors but of course usually aren't anymore.  

    (Not that I mind nurse practitioners; they're usually more than equal to the tasks they face.)

    Dogs from the street can have all the desirable qualities that one could want from pet dogs. Most adopted stray dogs are usually humble and exceptionally faithful to their owners as if they are grateful for this kindness. -- H.M. Bhumibol Adulyadej

    by corvo on Sun Aug 18, 2013 at 08:51:28 AM PDT

  •  I think it's a dog whistle (5+ / 0-)

    "Injustice wears ever the same harsh face wherever it shows itself." - Ralph Ellison

    by KateCrashes on Sun Aug 18, 2013 at 09:00:58 AM PDT

  •  If your insurance reimburses (2+ / 0-)
    Recommended by:
    Chi, Alexandra Lynch

    70% for out-of-network service, you must have really good insurance!

    For an out-of-network office visit, my former (now secondary to Medicare) insurer generally reimbursed somewhere around 25-40%. And that's for all doctors, not just the gold-plated one I mentioned in my comment to Roadbed Guy above. So, if the doctor charged me about $150, I'd expect a reimbursement of about $35.

    "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

    by sidnora on Sun Aug 18, 2013 at 09:01:11 AM PDT

  •  I just explained this to (8+ / 0-)

    a commenter here at Dkos who was bashing ACA.  When it got down to it, the commenter was personally concerned with his own individual case.  He has private insurance and likes his doctors and is afraid ACA would harm him.  I pointed out that if he already has insurance, he is not compelled to sign up for ACA.  But he should check his state exchange anyway because he might be induced to change if it turns out he can save enough on his premiums to make it worth the switch.  

    Since when did concerned progressives begin listening without thought to liars on the left?  

    We are all in this together.

    by htowngenie on Sun Aug 18, 2013 at 09:01:54 AM PDT

    •  fwiw, late last night I scrolled past a (9+ / 0-)

      commenter who whined that Obama was a champion at playing golf and taking vacation. Made me * smh * so hard I nearly got whiplash.

      This is all about answering your question with "since we picked up an unknown number of redstate trolls in the new-user explosion."

      "I don't love writing, but I love having written" ~ Dorothy Parker // Visit my Handmade Gallery on Zibbet

      by jan4insight on Sun Aug 18, 2013 at 09:21:13 AM PDT

      [ Parent ]

      •  When I see an awkwardly worded (2+ / 0-)
        Recommended by:
        historys mysteries, jan4insight

        concern comment that is actually a bash of the Prez or a bash at ACA, I check the user ID to see if they joined recently.  But lately, I'm running into comments from users who joined 2004-2005, many of whom have zero diaries and few comments for the most part up until this year and then suddenly a wave of concern comments.  Is it possible to hijack an old abandoned user ID and begin making comments?  I'm not a techie, so I have no idea.  

        We are all in this together.

        by htowngenie on Sun Aug 18, 2013 at 12:24:22 PM PDT

        [ Parent ]

    •  But you don't get the point that this is then NOT (5+ / 0-)

      the Affordable Care Act.  If it doesn't benefit ME, I'm not going to support it.   If the plans I like disappear or I have to pay more and all the subsidies then go to someone else, I'm not going to be happy with the program.  I used myself as an example but I'm not an atypical middle class person.  If the law fails with the middle class it fails.  

      I'm just saying that this is not a slam dunk.  It's not the Republicans you need to worry about.  You need to worry about how the implementation of the program goes for the middle class and for their providers.

      •  Ok you've outed yourself and pushed my button/ (0+ / 0-)
        "It doesn't benefit ME, I'm not going to support it."

        Sounds like you need switch parties.  

        We are all in this together.

        by htowngenie on Sun Aug 18, 2013 at 11:43:18 AM PDT

        [ Parent ]

        •  Oh no...pushing your button! (0+ / 1-)
          Recommended by:
          Hidden by:

          I'm sure we all tremble with fear.

          Now, scamper along and tell the administration. Perhaps they will dig up greenbell's phone and email records and arrange an impromptu IRS audit for good measure.

          Oh, and be careful who you implicate as a troll here, pal. You've barely been here as long as I have...and that ain't very long.

          Adequate health care should be a LEGAL RIGHT in the U.S without begging or bankruptcy. Until it is, we should not dare call our society civilized.

          by Love Me Slender on Sun Aug 18, 2013 at 01:04:46 PM PDT

          [ Parent ]

      •  So, do you like plans that don't (0+ / 0-)

        cover contraceptive care or other important categories? The only plans that may be unavailable under the ACA  are plans that leave out coverage for important things, or have annual or lifetime coverage limits, stuff like that.

        I'm personally not too happy with the payment structure, not so much because it looks like I won't qualify for a subsidy (most people will) but because I won't even be able to deduct the cost of the premiums. One way they are financing the costs (aside from the Medicare luxury tax on high-income folks) is by making it harder to deduct out of pocket medical expenses--it used to be you could deduct what you spent that was more than 7.5% of your income, now it's only spending that exceeds 10% of income. The difference between 400% of the federal poverty level, and 400% +$1.00, is huge. Of course there are few enough people in my situation that it won't matter--and certainly things are a whole lot worse for poor adults, who will not be able to find affordable coverage in red states (which, coincidentally, have a whole lot of poor, uninsured adults).

        "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

        by Alice in Florida on Sun Aug 18, 2013 at 03:38:50 PM PDT

        [ Parent ]

  •  Awesome! It needed to be said loud and clear! (2+ / 0-)
    Recommended by:
    jan4insight, Alexandra Lynch

    Thanks!  n/t

    That's one more thing to add to my long list of small problems. --my son, age 10

    by concernedamerican on Sun Aug 18, 2013 at 09:04:42 AM PDT

  •  Hey, it's just another Republican takling point... (21+ / 0-)

    hence it is a lie.

    I currently buy individual health insurance from Blue Cross/Blue Shield of North Carolina. I now have the "Flaming Box of Shit" policy, with a $3,500 deductible, a 70/30 coinsurance with a massive out-of-pocket on top of that, and a $200 prescription deductible. It costs me - individual, no family, non-smoker, healthy - over $5,000 per year.

    I am free, however, to be treated by any doctor in the BC/BS network, which is most doctors in North Carolina.

    After "Obamacare", I am still completely free to keep my existing BC/BS policy. BC/BS has told me that in writing. So, if I desire, nothing in my health insurance will change under the dreaded "Obamacare". NOTHING.

    However, if I choose, I can purchase better coverage in the Exchange, and BC/BS of NC has had dozens of Exchange-based plans approved by the state. Since those are plans being offered under the horrible "Death-Panel Obamacare", I will qualify for federal premium subsidy and BC/BS estimates that my premium cost could be as little as half what I'm paying now, for better coverage.

    Shit, that Obamacare sure does suck!

    And, if I stay with BC/BS of NC, I will still have access to the exact same network as I have now, and I will still be receiving care from the exact same doctors from whom I am receiving care now, unless I choose other doctors.

    So, what part of the Republican claim isn't a lie?

    "Bernie Madoff's mistake was stealing from the rich. If he'd stolen from the poor he'd have a cabinet position." -OPOL

    by blue in NC on Sun Aug 18, 2013 at 09:05:43 AM PDT

  •  People may think their Dr. is their buddy (12+ / 0-)

    but I can tell you that it's a false comfort.  Anyone who gets seriously ill is in for a slew of new Drs.  Off to specialists you go, several of them.  Need hospitalization? You will get a small army of new ones.. Need to go to rehab or a nursing home? New ones.I've seen this countless times and can't understand why folks are so uninformed on how medicine works today.  Heck, from foot Drs to surgeons they are all specialists today.

    Be the change you want to see in the world. -Gandhi

    by DRo on Sun Aug 18, 2013 at 09:06:24 AM PDT

  •  Nicely done. Fwiw, the 'can't choose your (6+ / 0-)

    doctor' canard has been around since the Clinton admin tried to tackle health insurance reform. It was probably the main mantra used to defeat it. Along with trashing Hillary, of course.

    It's probably been around a lot longer than that, even. The AMA, who are not our friends in this fight even if some of them are slowly coming around, has been a major lobbyist in the war against "socialized medicine" for years. And years.

    "I don't love writing, but I love having written" ~ Dorothy Parker // Visit my Handmade Gallery on Zibbet

    by jan4insight on Sun Aug 18, 2013 at 09:15:33 AM PDT

  •  well, fwiw, I'm on MassHealth and getting a (9+ / 0-)

    doctor has been a bit of a sticky wicket.

    I received a very limited list of doctors I could choose from.

    I did so.

    I went to make an appointment with said doctor and learned that the phone was out of service.

    I asked MassHealth about this. They said his information was listed as current.

    Not one other doctor on the list accepted MassHealth and accepted new patients.

    So, I'm without a PCP on a plan which requires almost every service you might need to be referred by a PCP.

    It took 8 months to get MassHealth to cover an in-home medical treatment which I had already been getting for two years. Registering with the PCP was key to that. But, now I can't get anything else done. My neurologist wants me to get my thyroid checked. But, I don't have a recognized PCP to do the referral. (My neurologist is a specialist for my condition and I can't afford to switch, but he's not covered by MassHealth. So referrals from him don't work.)

    More and more, I am learning that many people can't find a PCP. Doctors don't want to get into that system because they don't get paid enough.

    Meanwhile, for the treatment I get, which used to come through one agency, the meds now have to come from one place, the nurse through a nursing agency, and I have to arrange for bloodwork labs to be picked up myself. Because the nursing agency only does IV infusions, they won't let the nurse - who has been my nurse for over 2 years now - give me the intramuscular injection that I used to get along with the IV. I have to figure out how to get that somewhere else.

    So, how many agencies/corporations have to make money for me to get an infusion and an injection? There is plenty of money to divvy up for the administration of product sales, but not enough to pay doctors a decent wage.

    Getting my care has been a confusing mess. I am not impressed.

    Building Community. Creating Jobs. Donating Art to Community Organizations. Support the Katalogue

    by UnaSpenser on Sun Aug 18, 2013 at 09:28:16 AM PDT

    •  Did you try Lahey? (1+ / 0-)
      Recommended by:
      Alexandra Lynch

      "It is never too late to be what you might have been." -- George Eliot

      by paulitics on Sun Aug 18, 2013 at 09:37:26 AM PDT

      [ Parent ]

    •  UnaS - the new ACA Medicaid patients will have (7+ / 0-)

      the same challenges that you did. The overwhelming majority of physicians in my area will not accept any Medicaid patents. So while the ACA has expanded healthcare for many of the previously uninsured, I wonder who will treat them?

      "let's talk about that"

      by VClib on Sun Aug 18, 2013 at 09:59:42 AM PDT

      [ Parent ]

      •  There is a shortage of PCPs regardless... (4+ / 0-)

        ... and that's been known for a while. They don't get paid enough and don't get the respect that specialists get.

        Regardless of who's paying what, there is a big problem coming up (gee, not another one?).

        There needs to be an effort to recruit med students to the field and keep them there. Allowing nurse practitioners and physician assistants to take some of the load will be necessary also... which means insurers need to recognize such folks as valid providers in their plans.

        •  Even if there was a major federal investment (2+ / 0-)
          Recommended by:
          greenbell, highacidity

          in more primary care physicians, nurse practitioners, and PAs it would take a decade to train enough primary care clinicians to meet the demand as more people become insured. However, there isn't even a discussion by the Obama administration, or even a special interest group, to invest in more healthcare providers.

          "let's talk about that"

          by VClib on Sun Aug 18, 2013 at 02:01:27 PM PDT

          [ Parent ]

      •  Even private plans on the exchanges... (1+ / 0-)
        Recommended by:

        ...are drastically limiting their pool of participating providers in some regions, I've read, so that those plans will have fewer providers than current private insurance plans.

        On the other hand, PPACA temporarily raises Medicaid reimbursment rates to parity with Medicare reimbursement rates, which should widen the number of providers who accept Medicaid.

        (I think that change should be permanent; as it is now, Medicaid serves as medical apartheid for reimbursing at lower rates than Medicare.)

    •  Massachusetts has a severe shortage (0+ / 0-)

      of general practitioners--some fear the current conditions are a preview of what will happen when the ACA is fully implemented.

      I can't understand why there is no push to expand medical education, and to limit the number of specialists. There should be some way to regulate medical practice so that we get a better ratio of GP's the specialists--maybe a surtax on specialists to subsidize GP's.

      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

      by Alice in Florida on Sun Aug 18, 2013 at 03:45:22 PM PDT

      [ Parent ]

  •  We chose our health plan (when I changed (6+ / 0-)

    employers) because it was one that let us continue with our then-and-still current primary care physician. I expect people coming into the insurance system for the first time will not find this as obvious a thing to do as we did.

    You know, a great progressive thing to do would be to be out there in the red states helping people understand how to sign up, how to choose a plan, etc. The California website seems pretty thorough, but of course, you have to do a lot of reading, or know which of the reading you need to do, in order for it to be helpful to you.

  •  I've always laughed at this line. (10+ / 0-)

    I haven't seen a doctor who could even remember my name from visit to visit since I was ten years old, and I'm 60.  In my experience, they're interchangeable.  It's in and out in 8 minutes, fewer if possible.  You can't call one on the phone.  They're far too important to answer a phone call.  Hand out a pill and send the bill.  Signs in the office warn you in bold lettering that you cannot be seen unless you pay TODAY, BEFORE you're admitted to the inner sanctum.  

    Doctors are just the people you have to pay to get access to the medicine you need - much of which you could prescribe for yourself, except for the monopoly the laws give to doctors.  (Again, with the exception of our once-upon-a-time real family doctor who made house calls, who understood that you don't drag a sick, fevered  child out into below-zero weather to sit in a waiting room and infect everyone else who's waiting and waiting and waiting.  He knew every one of us and actually gave a damn - a fine man who is long gone now.)

    I don't give a damn which doctor I "see."  They're money machines.

    Apologies in advance to any decent, compassionate, patient-first doctors out there who may read this.  Odds are there must be some of them.  I just don't know any, and I'm not holding my breath.

    •  They are, except when they aren't. (3+ / 0-)

      I had one wonderful doctor for ten years, who thought my tattoo was gorgeous and didn't bat an eye at regular STD checks since we were non-monogamous, and she treated me like a sensible partner in my own health care.

      And then she got married and moved to Texas which is lovely for them, but sucked for me.  Especially since I'm on drugs that people often abuse, and since I'm poor, everyone seems to assume I want them just to sell them.

      When you come to find how essential the comfort of a well-kept home is to the bodily strength and good conditions, to a sound mind and spirit, and useful days, you will reverence the good housekeeper as I do above artist or poet, beauty or genius.

      by Alexandra Lynch on Sun Aug 18, 2013 at 10:39:51 AM PDT

      [ Parent ]

  •  Not to mention, you "can't choose your own doctor" (2+ / 0-)
    Recommended by:
    jan4insight, DRo

    depending on what condition you have, as well. Try choosing an oncologist to treat your ankle sprain...not gonna work.

  •  I'm in Kaiser (3+ / 0-)
    Recommended by:
    jan4insight, highacidity, greengemini

    my wife was born in Kaiser
    we had the same pedie for the kids from when they were 2 to 18.  The same neurologist for them much the same time.
    I almost never go to the doctor, so I pretty much don't care
    who I see.  But the one I've got seems to remembers me even when I don't come in very often.
    The ACA will likely save me thousands a year, as my Wife and I have graduated from cobra to individual payer and pay more for coverage then we pay for our house, so I'll say it sure works for me...

  •  I Know A Woman Terrified Of Obamacare (0+ / 0-)

    She's bipolar, out of work, disabled, and bug-eyed with fear because why?  I don't think she's been brainwashed by extremely clever marketing, I just think she's vulnerable because she's bipolar.  Likewise I know a very bright guy who's bought into the who creeping sharia law story and he's bipolar as hell. Being disabled and mentally ill leaves them at home listening to Fox News all day, which exploits them as well as the elderly.

  •  since they successfully stopped clintoncare, (1+ / 0-)
    Recommended by:

    the country has  been blasted with a constant barrage of talk radio lies and exaggerations about canadian and other single payer systems.

    one of the most common talking points in describing those systems is the claim that those foreigners with the commie health care don't have a choice of doctors.

    along with very long waits for important and emergency care, surgery, etc., poorly paid doctors, and shitty care in general.

    that's what made single payer and public option impossible.

    This is a list of 76 universities for Rush Limbaugh that endorse global warming denial, racism, sexism, and GOP lies by broadcasting sports on over 170 Limbaugh radio stations.

    by certainot on Sun Aug 18, 2013 at 01:01:46 PM PDT

  •  Clarification on Out-of-Network Providers (3+ / 0-)
    Recommended by:
    DRo, greenbell, Cassandra Waites

    My background is employee benefits and a lot of people are unaware of or confused by out-of-network coverage.

    If you go out-of-network you are subject to higher deductibles and lower reimbursements - this is meant to be a deterrent  to going out-of-network. The provider has agreed to accept the insurance reimbursement + your 20% of the approved charge as payment in full. If you look at the Explanation of Benefits you'll see that the amount the provider charged for the service is a lot higher than the amount approved by the insurer.

    The cost share after you meet your higher deductible for out-of-network is usually higher than 20% - most often it's 40%,

    Your out-of-network cost share isn't just that 40% (after you meet that higher deductible) but because the out-of-network provider doesn't have an agreement with the insurer, you can be billed for the entire balance left after the insurer's payment to the provider,

    The insurer's reimbursement to that provider isn't, for example 60% of the actual charge. The reimbursement is based on the usual, reasonable, customary charge for that service and that generally isn't 60% of the provider's actual charge. It can be much, much lower.

    Anyone contemplating going out-of-network should make sure they understand how it works because you can end up with bills a lot bigger than you expected.  And you can't always rely on the insurer's customer service rep to know what they're talking about. My daughter was given incorrect information about the out-of-network deductible and cost share by her insurer.

    Also be aware that not all ancillary providers are in-network. Your surgeon may be in-network but it is unlikely the anesthesiologist is in-network. The person who reads your x-ray may not be in-network, etc.

    You don't always have control of whether others involved in your care are in-network providers.

    •  I've also read that some plans may not include (0+ / 0-)

      that difference in the out-of-network balance due above the "reasonable charge" in the out of pocket maximum so if you're assuming that regardless of the out-of-network additional cost your expenses are capped that might not be true either.

      •  That's a good point (0+ / 0-)

        My experience is that they don't include it. They only include your share of the "usual, reasonable, customary" charge. These out-of-network rules are supposed to deter you from going out of the network so they aren't going to pay 60% of the actual charge or let you include the full difference against annual maximums.

  •  The percent is based on the cost of what (0+ / 0-)

    the "health" insurance company has decided what they want to pay for a particular specialty or service in a particular area of the country.

    The normal practice is that an in-network doctor visit is reimbursed at, say, 90 percent (after you have met your deductable), whereas an out-of-network visit might be reimbursed at 70 percent.
    Hint.... it's not 90% or 70% of the bill, the percentage is based upon what the "health" insurance company determines is the appropriate price.

    For example, if your out of network doctor charges $200.00 for a visit, the "health" insurance company will not pay 70% of $200.00.    The "health" insurance company will reimburse you 70% of what "they" think the charge should be.

  •  So, the Obamacare haters are "pro-choice", eh? (0+ / 0-)

    ... Just sayin'.

    “It is useless to attempt to reason a man out of a thing
    he was never reasoned into” - Jonathan Swift

    by jjohnjj on Sun Aug 18, 2013 at 02:26:04 PM PDT

  •  I've been reading up on opening my own private (0+ / 0-)

    speech-language therapy clinic.

    I'd like to open my doors in about 18 months to 24 months or so. I'd really like to open sooner, but there are some important insurance changes coming down the pike that could be problematic on the reimbursement side of things. I'll get back to that in a minute.

    Most of the allied health providers (i.e., physical/occupational/speech therapists) who have written guides on opening your own pediatric-focused practice suggest NOT going in-network with insurance companies at least at first. Why? Because, currently, the denial rate for in-network kid-focused services is 80-90%. (Why? Because a lot of kid speech-language issues can't be directly linked to accident, illness, injury, making them 'developmental' in nature and consequently the responsibility of the local public schools according to 3rd party payors.) On the patient side of things, yes, you may have to pay more upfront to me, but at least you know you'll be partially reimbursed by your ins. company rather than getting a $2K bill in 3 months when they deny all in-network claims. On my end, the insurance company may not be willing to offer an in-network rate that actually covers my costs. We see this set-up right now with regard to immunizations at pediatricians' offices. The reimbursement rate from the in-network contracts is so low it doesn't cover the cost of the nurse's time to give the shots, much less the shots themselves.

    Things are going to change drastically in 2014. Insurance companies will have to cover HABILITATIVE as well as REHABILITATIVE services. In other words, they'll have to cover developmental, kid issues like speech sound disorders as well as acquired, more adult-focused problems like speech/swallowing issues after a stroke. It remains to be seen exactly how this will affect those of us who primarily serve a pediatric client base.

    The other BIG thing that changes on 10/1/2014 is the change-over to ICD-10 from ICD-9 billing codes. These are the diagnostic codes that the insurance companies use to deny/grant payments to providers. Right now, these are 3-5 digit codes specifying the disorder type for which we providers are requesting payment. So, a speech sound disorder in a child would be billed as 315.39. The 315 means it's a developmental disorder (and very likely will result in a denial of payment to me). The 2 numbers after the decimal point indicate that I'm billing for a speech sound disorder (e.g., a child who can't say all of the consonant sounds of English). Starting 10/1/14, these codes switch over to an alpha-numeric system. The same disorder that would be coded 315.39 today will be coded F80.0 or F80.89, depending on the cause of the disorder. Make no mistake...very few people are ready for this switch. That includes providers OR insurance companies.

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