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So, it's official: I cannot keep my medical team together with a marketplace policy through ACA in Indiana. I am a cancer survivor, 18 years post treatment and N.E.D. For the uninitiated, N.E.D = No Evidence of Disease. For breast cancer survivors, this is as good as it gets, even 18 years later. Follow me over the orange squiggly-do for a reality check.

So here's the deal. This afternoon I finally attempted to navigate www.healthcare.gov around 4pm ET. Although I already had an account it still took me a full 90 minutes to fill out the application that confirmed that I qualify for a marketplace policy and subsidy. Yea!!

Finally got to see what was available in Indiana. The good news? There are 12 plans. The not-so-good news: they are from 3 insurance providers. I live north of Indianapolis in Hamilton County which is the southern edge of one provider: PHP or Physicians Health Plan of Northern Indiana. i ruled them out immediately because my oncologists are out-of-network in Indianapolis, one county south of Hamilton. Next!

Anthem. They have served me relatively well for the decade that I've been in Indiana's high risk pool (ICHIA). Expensive, but comprehensive.

MD Wise. A relative newcomer that looks like they've got it together. They are currently serving Hoosier Healthwise, the Healthy Indiana Plan, Indiana Care Select and now the MDwise Marketplace.

So I'm thinking ... so far so good.

Then I dig into the details. Not so good. Narrow networks and more narrow networks Ugh!!

Check provider networks.

It's been widely reported that one of the ways that insurers have been able to keep premiums more affordable on the exchanges is by limiting provider networks. If it's important to you that certain doctors or hospitals be in your network, check those details before signing up.

Smaller isn't necessarily less desirable, say experts. "If all your providers participate in a narrow network, it's not a problem," says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

Anthem will be providing services through the Community Health Network,, a progressive organization where my primary care physician (I've been with her for a decade) and my physical therapist (I've been with her for 18 years) practice.

If I stick with the new Anthem network (my primary care doc and physical therapist) the IU Medical Center where my world-class oncologists are located will be out-of-network. No coverage. Zip. Nada. These guys saved my life. Literally. I'm here today because of the care I got from them in 1995.

So what to do? Do I stick with my primary care physician and physical therapist that I see on a regular basis? Or do I take a catastrophic policy that will give me the coverage I need if cancer returns? For the record, I'm from a cancer family. I've had more than 12 family members die of cancer in my life time (including my mom and dad) and we currently have 6 survivors. Obviously, it's in the DNA.

I qualify for a hefty subsidy, so I really need to do this. However, this is a real dilemma for me.

Don't let anyone tell you that it's a myth that you can't keep your doctor. It's not. It's a trade off that I'm willing to make, but it's not going to be an easy choice.

Love to hear your opinion on this.

::

UPDATE:
Several people suggested that I update the diary with a bit of history about how I got into this situation. In the comments I clarified that although I currently have health insurance, it's through a high-risk pool that will be dissolved on 12/31/2013.

Indiana Comprehensive Insurance Association, (8+ / 0-)

its a 30-year old non-profit that Indiana created to insure the uninsured. Anthem has been managing it and it's expensive. We've been paying a 50% premium over individual insurance rates to obtain coverage.

ICHIA will be dissolved on December 31, 2013 because the ACA mandated that pre-existing conditions no longer automatically disqualified us from individual insurance policies.

It's a long story, but ICHIA has been my only option and now I have to move to the ACA

.
The long story is that I was diagnosed with breast cancer in 1995 at a time when I had an excellent individual health insurance policy through my business. In 1999 that insurance company sold it's individual policies to another insurance company. Same rates, lesser policy, but I had no choice since I now had a serious pre-existing condition. In 2003 the second company made a "business decision" to no longer insure individuals.  Arrivederci! Good luck! Sayonara! No one would insure me except ICHIA, a progressive, visionary non-profit that Indiana created 30 years ago before Indiana went nuts.

Now the ACA has taken away the need for ICHIA. I actually wrote a diary about this here.

I am a fan of the ACA. I love Obamacare. It's not my intent with this diary to bash it. Simply to open eyes to one more thing that needs tweeking.

AND to ask for you thoughts about how to navigate this, so thanks for stopping by!

::

Second Update:

I want to give a h/t to guyeda in the comments for pointing out that

MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 by the Health and Hospital Corporation of Marion County and Indiana University Health to help vulnerable populations needing health coverage in Indiana.  Our mission is to provide high quality health care. We only take care of families in Indiana.
Thanks to everyone who has helped me think through my dilemma. How can I not support the local, nonprofit health care company? Decision made. Thank you.

Originally posted to annan on Sat Oct 05, 2013 at 05:21 PM PDT.

Also republished by Indianapolis Kossacks.

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Comment Preferences

  •  Tip Jar (188+ / 0-)
    Recommended by:
    madmojo, SuetheRedWA, a2nite, chancew, sturunner, Mr Robert, marykk, Louisiana 1976, pixxer, Just Bob, PinHole, Chaddiwicker, Pat K California, sow hat, SadieSue, salmo, jwinIL14, guyeda, DeadHead, Wee Mama, Shockwave, Bisbonian, FloridaSNMOM, buffie, churchylafemme, old wobbly, hester, viral, Chinton, jeff in nyc, CorinaR, Catte Nappe, SoCalSal, devtob, River Rover, Tunk, Habitat Vic, ratador, Blue Boy Red State, blue aardvark, Marihilda, Anne was here, mollyd, leonard145b, hungrycoyote, Icarus Diving, weck, TX Freethinker, fcvaguy, worldlotus, Terre, quill, roberta g, puakev, Aaa T Tudeattack, Rogneid, cpresley, ActivistGuy, dreamweaver1, edrie, eeff, micsimov, Mad Season, ArthurPoet, beverlywoods, gfv6800, BlueDragon, lunacat, oldliberal, poco, bluesheep, gooderservice, muddy boots, LSmith, jcrit, tsackton, Lujane, Vatexia, BlackQueen40, alwaysquestion, Aunt Pat, greenbell, envwq, KateCrashes, Tamar, javan, zerelda, peregrine kate, pvasileff, sunbro, tegrat, revsue, IndieGuy, 88kathy, Loonesta, magnetics, drdana, Actbriniel, FogCityJohn, Neuroptimalian, jck, Hirodog, majcmb1, Only Needs a Beat, RainyDay, markthshark, leftywright, Dumbo, jayden, celdd, CA Nana, JayC, yawnimawke, jan4insight, JDWolverton, wasatch, createpeace, CJB, DaveP, BRog, geordie, Livvy5, RubDMC, blue91, snazzzybird, wader, mamamedusa, ThatSinger, terabytes, Alice Venturi, dRefractor, jadt65, GeorgeXVIII, StellaRay, WisVoter, SanFernandoValleyMom, hwy70scientist, Susipsych, chmood, monkeybrainpolitics, notrouble, Mickquinas, dradams, WisePiper, GreyHawk, BeninSC, sethtriggs, Sister Havana, CharlieHipHop, Shippo1776, Tailspinterry, dharmasyd, Flying Goat, Betty Pinson, Seldom Seen, MsGrin, AaronInSanDiego, dotdash2u, Assaf, mzinformed, operculum, BasharH, ladybug53, myboo, fromcascadia, liz, Willa Rogers, caul, auapplemac, riverlover, badlands, radarlady, Noodles, MartyM, freakofsociety, Byron from Denver, emmasnacker, PhilJD, petral, ItsSimpleSimon, CroneWit, rja, CityLightsLover, Oh Mary Oh, Hawksana, Carol in San Antonio, im2004lurker, OrdinaryIowan

    "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

    by annan on Sat Oct 05, 2013 at 05:21:16 PM PDT

  •  Why are you prohibited from keeping (11+ / 0-)

    the insurance you have?

    "Who is John Galt?" A two dimensional character in a third rate novel.

    by Inventor on Sat Oct 05, 2013 at 05:30:16 PM PDT

  •  Sorry, but the point of the ACA (6+ / 0-)

    was to extract money from you and put it into the pockets of the insurance companies. So it's working exactly as it was designed to do.

    The only trouble with retirement is...I never get a day off!

    by Mr Robert on Sat Oct 05, 2013 at 05:32:32 PM PDT

  •  Talk to your oncologist. (107+ / 0-)

    I do appreciate your situation.  She will too.  If she cannot make some kind of accommodation, or become a member of one of the plans, perhaps she might help you select among the oncologists in the plans being offered in your state.  I do understand how you must feel about your oncologist.  She is your hero.  There are other heroes out there, so don't dismay. The networks may in all likely hood expand. Congratulations on your 18 years of good health.  May you have many, many more.

  •  You can keep your doctor if you keep your plan (13+ / 0-)

    The story is that if you are already covered under private insurance, then you can keep your doctor.

    I do not recall anyone promising that you can keep your doctor if you switch plans.

    "The Obama Administration has been an unmitigated disaster" - Osama Bin Laden

    by Explorer8939 on Sat Oct 05, 2013 at 05:34:46 PM PDT

    •  She wants the subsidy. (3+ / 0-)
      Recommended by:
      davidkc, Wee Mama, annan

      Which I can appreciate, but the idea that one could fundamentally change one's plan and it have no affect on a wide-ranging group of doctors seems unreasonable.

      "Who is John Galt?" A two dimensional character in a third rate novel.

      by Inventor on Sat Oct 05, 2013 at 05:38:17 PM PDT

      [ Parent ]

      •  You seem to have no concept of what people (25+ / 0-)

        With pre-existing conditions have had to go through and what lack of choices they have had.

        She wants fucking insurance, not the subsidy. The high risk pool ( which was the only insurance available to her before the ACA) will no longer be available. She has to change plans. She is not complaining about that. She is stating that she has a choice that she has to make and asking input about that choice, as well as noting that if you do have to change insurance, you may run into the same thing.

        You not only missed specific parts of the diary, but you seem determined to miss the whole point of the diary.

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Sat Oct 05, 2013 at 06:16:43 PM PDT

        [ Parent ]

        •  actually, she does want the subsidy (2+ / 0-)
          Recommended by:
          freakofsociety, Cedwyn

          she says so specifically.

          the choice appears to be between going to the ACA plan and getting the hefty subsidy but losing the doctors that helped her,

          or finding some non ACA options that will let her keep her specialist but will be prohibitively expensive

          a hard choice

          When POTUS promised that people could keep their doctors, I thought the point was that no one would be forced to change to the ACA.  If you already have good insurance you can keep it.

          If insurance companies and/or employers are kicking people off of their plans because of the ACA, I don;t see why the ACA is being blamed for that.

          Everyone who has ever been in a high risk pool knows that the coverage can stop anytime they get tired of providing it

          Politics is like driving. To go backward put it in R. To go forward put it in D.
          Drop by The Grieving Room on Monday nights for support in dealing with grief.

          by TrueBlueMajority on Sat Oct 05, 2013 at 09:09:29 PM PDT

          [ Parent ]

          •  I read that as she qualifies for a subsidy with (2+ / 0-)
            Recommended by:
            annan, TrueBlueMajority

            The one plan, but can't see her oncologist, or she can get just a catastrophic plan that essentially covers nothing unless her cancer returns- not that the subsidy is what she is really looking for, which is what the other poster seems to be saying.

            You can't scare me, I'm sticking to the Union - Woody Guthrie

            by sewaneepat on Sun Oct 06, 2013 at 03:15:13 AM PDT

            [ Parent ]

            •  Actually, it's the narrow network that is the (1+ / 0-)
              Recommended by:
              sewaneepat

              problem in my case. Both parts of my medical team are participating in ACA plans, but the hospital networks they have joined are separate, don't overlap and by my reading of the plans on offer, the insurance will not cover physicians out-of-network, even specialists.

              I shouldn't have used the term "catastrophic plan"' in my diary. In ACA terms it means something different that I intended.

              What I meant was that my premiums would be going toward supporting normal preventative care in the Anthem plan.  

              Or I could choose the MDWise plan and not have access to my regular doctors for routine care, but have access to my oncology team in case of catastrophe.

              I'm healthy and NED, so I'm leaning toward the former.

              A huge benefit is that I can actually change next year if that's the wrong choice. That's something that hasn't been true in nearly 20 years. Hallelujah.

              "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 Sun Oct 06, 2013 at 07:46:02 AM PDT

              [ Parent ]

            •  yes i agree with you (1+ / 0-)
              Recommended by:
              sewaneepat

              Politics is like driving. To go backward put it in R. To go forward put it in D.
              Drop by The Grieving Room on Monday nights for support in dealing with grief.

              by TrueBlueMajority on Sun Oct 06, 2013 at 07:01:38 PM PDT

              [ Parent ]

      •  Actually, her current plan will cease to exist. (3+ / 0-)

        So she doesn't have the choice to keep her current plan.

    •  Re: (7+ / 0-)
      The story is that if you are already covered under private insurance, then you can keep your doctor.

      I do not recall anyone promising that you can keep your doctor if you switch plans.

      The diarist stated she has been a member of Indiana's high risk pool for a decade.  

      With the establishment of a health insurance market, does this then close down/abolish/eliminate the need for a state's high risk pool?  

      If it does, then the diarist & all those on the high risk plan would be without insurance...

    •  Au contraire! My president actually went on record (24+ / 0-)

      that i could keep my doctor with Obamacare. I admire and respect my president but my plan (the high-risk pool in Indiana) will no longer be in existence on January 1, 2014 so I have to move to the federal marketplace.

      It's a fact that I won't be able to keep one or more of my doctors and it's the insurance companies who are making that decision.

      A friend, another cancer survivor, was just by her insurance broker told that she would still have to be underwritten in 2014 (that will change in a year) and probably wouldn't be accepted outside of the  marketplace until 2015.

      This isn't perfect and I will make choices, happy to have choices to make.

      But in a perfect world: Single-payer!

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 05:59:45 PM PDT

      [ Parent ]

      •  I think he meant (17+ / 0-)

        people on ordinary insurance policies. He probably wasn't thinking of high-risk pools created by various states when he said that.

        My two cents: Over the years, some of my favorite and best doctors have retired, moved out of the area, or left the practice for some other reason. Other times, I moved to a different area and thus had to find someone new.  

        Because of some genetic defects, I often have reactions to medications that have sometimes been potentially disabling, and genetic testing by one doctor showed that I'm lacking the pair of genes that process foreign chemical substances in the body. But despite having the genetic test results, it can be hard to find a doctor who doesn't look at me dubiously and pooh-pooh my concerns when they want to prescribe me something. Taking any new medication feels like playing Russian roulette, but a lot of doctors act like it's all psychological and tell me they're sure I'll be fine and insist on prescribing it for me anyway.

        So every time I've had to find another doctor, it's like, "Oh, no! Not again!" It just happened to me again a few weeks ago when I called to make an appointment and was told she was no longer there. But eventually I've always managed to find another good one. It's an unfortunate fact of life that we often have to face for various reasons, and you are in the great position of having doctors you trust to ask who they would recommend! The way I found my best doctors in the past was through asking other medical professionals.

      •  You should understand (5+ / 0-)

        First you have to blame Indiana, not Obama, and it may be that being  smaller population pool you will have fewer choices. And second, you need to appreciate as I'm sure you do that there is a certain amount of adjustment in any ordinary insurance plan. Doctors may well come in and out, drug formularies change, etc. And there is a tradeoff of cost for flexibility and depth/breadth of coverage above the minimums.

        If you had a high-risk state plan you liked in Indiana you were lucky. Very lucky. A friend of mine with multiple issues has had nothing but trouble and little coverage in another state on the same kind of plan. The top facilities were NOT on her plan.

        Yes, for single payer, and we have to keep working on that.

        •  I wrote a diary on our high-risk pool recently (3+ / 0-)
          Recommended by:
          poco, worldlotus, auapplemac

          didn't realize until we had a Town Hall this summer just how good our plan was.

          It was very progressive and extremely well managed. It was considered one of the best, if not the best, high risk pool in the country.

          In fact, many comments on this diary are reminding me just how lucky I have been all these years.

          "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

          by annan on Sat Oct 05, 2013 at 08:02:20 PM PDT

          [ Parent ]

      •  PBO was liberal in a few of his descriptions (0+ / 0-)

        about the ACA.

        E.g., I have heard him say a 100 times that now people won't go bankrupt if they get ill.... WRONG!!!!!!!!!!!!!

        I've had health ins continually for the last 20 years. I was extremely ill, and had an expensive surgery 5 yrs. ago. When I have the energy to do so, I will file bankruptcy to pay for all the co-pays, and out-of-network specialists that my ins didn't cover. Then there is the little matter of them not wanting to pay about 120,000.00 worth of charges related to the surgery!!!  I sued them and got some of that reimbursed, but the rest will go in the bankruptcy.

        That sort of stuff will continue even with the ACA.

        WITH THAT SAID....... I'd much rather have ins, get excellent healthcare, and have to file bankruptcy to pay all the charges that the ins didn't cover, rather than go without care like so many MILLIONS are doing currently. I feel extremely fortunate to have my coverage.

        I don't like the ACA, and am a big believer in Single Payer, but I'm so happy that many millions of people will not get care where before it was unavailable to them for various reasons.

        Corporations before people.... it's the American way!

        by Lucy2009 on Sun Oct 06, 2013 at 12:02:39 AM PDT

        [ Parent ]

    •  Sounds like she has to switch plans (7+ / 0-)

      The state plan she has been under is closing down, expecting patients to go to ACA exchange plans.

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Sat Oct 05, 2013 at 06:05:32 PM PDT

      [ Parent ]

    •  She's in a state run high risk pool. (3+ / 0-)
      Recommended by:
      annan, worldlotus, freakofsociety

      They're going away at the end of the year.

      Economic Left/Right: -7.38
      Social Libertarian/Authoritarian: -8.00
      Two steps to the right of Trotsky.

      by jvance on Sat Oct 05, 2013 at 06:08:57 PM PDT

      [ Parent ]

    •  But ALL the plans may be changing (5+ / 0-)

      BCBS in my state is changing ALL of their plans not just their ACA plans so ACA may indeed be prompting changes.  Some will be good.  Some may not be so good.  The people who will be helped the most are of course those who could not afford insurance before.  The well off will still find a plan they like.  The question is going to be how this plays out for the middle of the middle class who may have some issues with how the plans change.

      •  Good point. Another reason to keep an eye on (3+ / 0-)
        Recommended by:
        greenbell, worldlotus, auapplemac

        these narrow networks. I understand the need to contain costs and in theory they shouldn't be too bad.

        But we MUST maintain escape routes for people to see specialists, both for individual consumers and the quality of our overall health care in the US.

        "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

        by annan on Sat Oct 05, 2013 at 08:04:39 PM PDT

        [ Parent ]

        •  I still don't get it about the narrow networks and (1+ / 0-)
          Recommended by:
          annan

          no overlap.  If I understand what you said, it's not that some of your providers aren't in a network at all; it's that your primary care physician and your physical therapist are in one network while your oncologists are in another.  I don't see why it should have worked out that way.  It does make me wonder if it's just that some of your providers haven't gotten on all of the plans yet.

          •  The providers appear to be carving up the pie (1+ / 0-)
            Recommended by:
            auapplemac

            amongst themselves without too much consideration about the fact that it hasn't worked this way before.

            Or maybe it has, but my old ICHIA policy was just more generous? Or maybe my case is not the norm?

            In any case, the hospitals are clumping up providers and services into networked systems (doctors, labs, radiology, ect) that used to have a lot of overlap.

            Maybe they still do with more generous health care policies?

            But the ACA policies are demanding narrow networks of providers to contain costs. I discovered this afternoon that my team has been divvied up by the insurance companies into 2 separate narrow networks that do NOT overlap.

            All I am saying is: Pay attention. If you're buying an ACA policy ... heads up!

            "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

            by annan on Sat Oct 05, 2013 at 11:56:30 PM PDT

            [ Parent ]

  •  Have you thought of (12+ / 0-)

    contacting the people at the IU Medical Center directly?

    If not the actual doctors, then most practices today have a "practice manager" or "insurance manager".  Ask them your questions.

    You can also contact the various carriers, and ask if they have had any indication of WHY these health ctrs will not accept patients.

    Isn't Indiana one of the places where the Gov/Leg has rejected the state involvement with the ACA?  This may have something to do with it.

     Then pressure on state politicians is in order.  A letter to the editor or contact with a local TV station's investigative reporter is in order.  If enough people like yourself start squawking .......

    sorry....and best wishes.

    •  You could ask either sub-set of docs if they will (12+ / 0-)

      continue to see you and accept the in-network contracted amount for your care.

      Usually even for out of network providers your insurance company will offer you what is called the "usual and customary" amount and than the OON provder bills you for the difference.  This is called "balance billing".

      So your costs are not usually for the whole amount, just the diiference between what your insurance company will pay for U&C and whatever the provider wants to hit you with.  For existing patients sometimes they can be persuaded to take the U&C in full settlement.

      And you can't count anything you spend on balance billing toward your insurance plan deductible, either.  (Though if these and any other charges amount to more than 10% of your income, you can deduct them on your Fed. - and poss. state - income taxes.)

      It can't hurt to ask the providers about this, as well as request they get themselves in-network, ASAP.

      BTW, it's often the providers who balk at the low payments the insurance Co. is willing to offer. But if the provider sees their patient base leaving because of in- network issues, they may become more interested in getting a contract set-up.

      And finally, you mention a "catastrophic" policy.  Just to clarify: the so-called HBX catastrophic policy is  only available to to people under 30 or older people whose premiums on the exchange would exceed a certain percentage of their income (in the range of 7 - 9%, but I'm not clear on the exact number, please check this for yourself.). And, I think for older people, there is no subsidy nor income-based out of pocket reduction nor reduced co-pays and deductibles on catastrophic plans, so it might wind up being more expensive than a silver, or even a reduced- benefit bronze which also doesn't have the income-delimited cost reductions that some of the silvers do. This is a really tricky thing to work out.

      I think you may have to do more legwork, and perhaps some hassling, but I wouldn't count yourself beaten, yet.  And defintely don't sign up for a plan until to you've been to the mat with your providers to see what can be arranged, either accepting the U&C in full settlement, or becoming in-network.  I doubt the incurance company would balk at adding providers who would take what they offer.  And in the case of the cancer docs, make sure the hospital (and ancillary services of the hospital) signup or accept the U&C, as well.

      Good luck!

      Araguato

      •  Great advice! (7+ / 0-)

        A couple of yrs ago, when DK was offering life time memberships, we could not afford the $100. due to a medical bill from a hospital Emergency Room visit  (Over $2,500) due to life draining forces from a bad norovirus which was sweeping the area.  

        I had been jerked around from one plan to another, and forced to accept a new plan (or none) which would cover ER visits with a $50. co-pay.  I had doctors in the hospital I went to.  

        But guess what?  The hospital wasn't one which had signed up for that insurance co plan.  Nor was the hospital a little further away.  I would have had to go to a hospital 60 miles away to get covered.   grrrrrr

        The plan covered some of the lab work, but left us with a huge bill, which they dumped on us at the last minute.  The last minute being the week-end of Thanksgiving, for a visit which had occurred 22 months previously.

        We had to scramble - and a DK membership was out of the question.  Thank goodness some people stepped in, and helped us.  We were then able to make a donation via charge card to help others.

        The pt of this long winded note is to show how some hospitals move in and out of accepting coverage.  And of how one has to read the fine print.

        •  PinHole, my cousin had a similarly bad (5+ / 0-)

          encounter with an ER. What a horrible story. While investigating this narrow network choice that I have to make, I discovered that the nearest in-network Urgent Care Center in that plan is 30+ miles away! And there are Urgent Care Centers in nearly every shopping center around here.

          This is unacceptable. We are all going to have to become well-informed advocates to make Obamacare every bit as good as it's potential.

          "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

          by annan on Sat Oct 05, 2013 at 08:09:18 PM PDT

          [ Parent ]

      •  EXCELLENT COMMENT!! (6+ / 0-)

        Thank you, Araguato. I didn't know about "balance billing" and I'll definitely check into that.

        About the "catastrophic" policy. You're right. That type of policy isn't available to me.

        However, I was thinking that I might go for a bare bones bronze policy with a huge deductible that would only cover a  recurrence of cancer. I'm healthy and have rarely met my $2,500 deductible anyway.

        So I'm thinking that instead of paying a monthly premium to get a $500 or $1,500 deductible maybe I should go for a tiny premium and save the extra for a rainy day in an HSA.

        There are so many variables and I thought it might be interesting to get feedback - which it certainly working! ;-)

        Thank you for taking the time to post this.

        "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

        by annan on Sat Oct 05, 2013 at 07:06:20 PM PDT

        [ Parent ]

  •  The law is complicated. Definitely speak with (35+ / 0-)

    your Doctors.  Look, on behalf of this community I apologize for how you were treated above.  It's reprehensible and disgusting.  Thank you for your post.  I admire your courage in your struggle with cancer and I am very interested in knowing if this law is not working for you.  I also understand the anxiety something like this may be causing you. I'd like to know more about your situation and see if some of the great and intelligent members who are on this site may have some advice for you.  

  •  I think when it was said, "You can keep your (16+ / 0-)

    doctor," it was referring to people who are on employer's insurance and who in most cases aren't going to be changing insurance. For folks who don't have insurance now, if they have been paying out of pocket then they could pick who they had as doctor (when they could afford that). Clearly you're picking up a situation where insurance coverage is not comprehensive. I'm sorry for the extra worry that brings.



    Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

    by Wee Mama on Sat Oct 05, 2013 at 05:46:05 PM PDT

    •  "if you already have insurance ... you can keep .. (4+ / 0-)
      Recommended by:
      blue aardvark, Miss Blue, annan, tofumagoo

      ... your plan and keep your doctor".

      I don't recall the President, in the context of providing health insurance for uninsured Americans, telling them that they could keep their doctor.

      "The Obama Administration has been an unmitigated disaster" - Osama Bin Laden

      by Explorer8939 on Sat Oct 05, 2013 at 06:14:50 PM PDT

      [ Parent ]

      •  I post link to O's Promises. (0+ / 0-)

        He said it many times.  Looks like he did not mean it.

        •  Obama: "You can keep your Doctor. Period." (0+ / 0-)

          A Shocker:  He said That????

          That whole “you can keep your plan – you can keep your doctor” foundation that was used to “sell” the Affordable Care Act to the American People? To me, that’s a pretty important foundation for this reform: the whole point is to add options for those who need it, while maintaining current choices for those who don’t wish to make a change.

          Well guess what – I’m finding out in a hurry that this core foundation of my support for Obamacare was a fantasy. I – the individual healthcare purchaser (in New Hampshire) – am about to get royally screwed. New Hampshire residents who purchase their own health insurance basically have one option: Anthem. The Marketplace under the Affordable Care Act will also only have one provider option: Anthem. One might think that if there is only one provider, that the Government might go to great lengths to make sure that this one provider isn’t going to hose their subscribers – but one would be mistaken.

          See, Anthem’s new plans will only include coverage for 14 of the state’s 26 hospitals. “Kid Dynamite,” you say, “you live in the Greater Concord Area. Concord is the capital of New Hampshire. Concord Hospital is one of the major hospitals in New Hampshire. You’d be crazy to think that Anthem could get away with excluding Concord Hospital from their exclusive monopoly coverage that will be offered under the Affordable Care Act.” See, pragmatically, your words would make total sense: it seems impossible that the Government, regulators, New Hampshire Lawmakers, etc would allow Anthem to exclude major hospitals like Concord Hospital from their coverage, right? Yet somehow that is exactly what is happening.

          “But Kid Dynamite,” you say, “forget about the new plans – just keep your current plan and ignore the impact of the Affordable Healthcare Act.” Great idea! I might just have to do that – BUT WAIT – Anthem has informed me that my current plan is ceasing to exist. They’re making it so that I don’t even have the option of keeping my current plan.

          All of this would go away if we had Single Payer.  O'care is a very costly detour down a dead end street when we need the highway.
  •  Really wish you best of what shouldn't be luck. (9+ / 0-)

    I'll pray for you annan, and hope you will for me too.  I haven't had any care for an insane amount of time, but now might at least get a few really freakin' troubling issues dealt with.  Be well, and wish former loophole dwellers same.

    Living the austerity dream.

    by jwinIL14 on Sat Oct 05, 2013 at 05:48:35 PM PDT

  •  Here's the actual quote: (13+ / 0-)

    "First of all, if you've got health insurance, you like your doctor, you like your plan - you can keep your doctor, you can keep your plan. Nobody is talking about taking that away from you."
    President Barack Obama

    However, if you change your plan . . .well . . .

    Discussed on CNN:

    http://politicalticker.blogs.cnn.com/...

    "Jersey_Boy" was taken.

    by New Jersey Boy on Sat Oct 05, 2013 at 05:49:15 PM PDT

    •  unless your plan goes away because of the law... (18+ / 0-)

      which it does, in her case.

      "Time flies like an arrow. Fruit flies like a banana." --Townes Van Zandt

      by Bisbonian on Sat Oct 05, 2013 at 05:57:44 PM PDT

      [ Parent ]

      •  The law is not forcing the plan to end (7+ / 0-)

        unless it did not meet the minimum requirements of coverage, which is what happened to my boyfriend. His bare bones plan did not provide enough benefits per the ACA, so Blue Cross is ending the plan. I don't see how one can blame the president for a private company's decision that they would no longer offer a certain plan or a state deciding no longer to offer that on its exchange.

        Obviously, the Affordable Care Act is going to result in changes in the decisions insurers make about coverage, and it will come as no surprise to anyone that it will all be based on providing as little care as possible for as much money as possible. That is the biggest problem with for-profit insurance and why we need single payer.

        **Electing Republicans to the government is like hiring pyromaniacs as firemen. They all just want to see everything burn to the ground.**

        by CatM on Sat Oct 05, 2013 at 06:53:30 PM PDT

        [ Parent ]

    •  Also (11+ / 0-)

      Since doctors can and do change what networks they are in, there's not even a guarantee that you can keep your doctor if you keep the same insurance.

      Looking at all the horror stories and FUD about ACA, one would think we have a wonderful health care/insurance system that we need to preserve, instead of the bane of many people's existence now for years.

      I'd bet that next year the bigger insurers will be in the exchanges & people will be much more likely to find a particular doctor in network.

      •  THat's what happened in my case (5+ / 0-)

        My primary care doctor, after being with Cigna for years, stopped accepting it.

      •  Great comment. I keep thinking the same thing. (7+ / 0-)

        Which is part of my dilemma for 2014. Things are going to look different in 2015.

        The chances of cancer recurring are slimmer than me needing my primary care doc and the physical therapist in the next 12 months.

        The possibility of making a choice today and being able to change next year is actually a huge relief. I've been locked into contiguous line of 3 health insurers since my diagnosis in 1995. No choice whatsoever about insurer.

        But I have been lucky to live where I live and have a broad network for all those years. These "narrow networks" are new to me.

        "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

        by annan on Sat Oct 05, 2013 at 06:24:22 PM PDT

        [ Parent ]

    •  NJB, thanks for providing that quote. (4+ / 0-)

      I obviously only heard the part I wanted to hear. it's good to get the real deal into this diary. Thank you.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 06:17:36 PM PDT

      [ Parent ]

      •  No problem. I had to look it up. We all hear what (2+ / 0-)
        Recommended by:
        annan, worldlotus

        we want.

        Reality is your doctor could stop accepting insurance and convert to a "Concierge Practice."

        ACA can't prevent that. It can't guarantee that you can keep your doctor. It just doesn't mandate that you have to change your doctor.

        Hell, your doctor could retire.  People have to change doctors for all sorts of reasons.

        "Jersey_Boy" was taken.

        by New Jersey Boy on Sat Oct 05, 2013 at 08:11:29 PM PDT

        [ Parent ]

    •  What was the date of this (3+ / 0-)
      Recommended by:
      ahumbleopinion, annan, worldlotus

      quote?  It might have been made before half the states messed with the ACA as best their RePIG governors could.

      It also might be that Prez Obama was mis-informed.  I am sure that keeping your present doctors was his goal.  

      If such situations were little known, and the Tea Partiers & FAUX found out about them, you can be sure that is why they made a point to strike another log of fear into the flaming pile.  They have been doing this, but never (that I've seen) given actual facts for their charges.  

      Then they went out and made it happen with all the obstruction in certain states and with the medical community.

      As has been stated above, practices and hospitals move in and out of insurance coverages all the time.  

      We know those against ACA have been working on the medical community too - we just don't hear about it because it is at by 'invitation only' dinners.

      •  The quote is from summer '09 (2+ / 0-)
        Recommended by:
        annan, worldlotus

        That's from well before healthcare was passed or the states got involved.

        In reality that quote is mostly true.  It's unfortunate that the author of the diary is having problems, and given that she's had health problems in the past it must make it doubly scary to change someone who is so important to their life, but she's unfortunately has a plan that becomes antiquated next year.

        We always knew that some people who face changes, I think we've been fortunate that far more will be affected positively than negatively and I hop that the author will ultimately benefit more than she'll lose.

    •  Well, actually she had no insurance (3+ / 0-)
      Recommended by:
      annan, poco, TrueBlueMajority

      In the sense of the private market. She had a state provided benefit.

  •  The insurance industry is the problem. (17+ / 0-)

    I'm afraid as more people are forced into the arms of the insurance industry many will find it doesn't work for them. Then they'll blame Obama and big government for problems that wouldn't exist if healthcare reform had been focused on single payer or creating non-profit co-ops. This may be especially true for young people who are supposed to make the system solvent by paying for high deductible insurance that they'll rarely get to use for actual health care.

    Health insurance does not equal health care.

  •  IM SORRY, I feel bad for you but my impression (7+ / 0-)

    Was that it was ok for me to not get anything because you have to give up  your doctor. I appreciate that having a relationship with a doctor is important, but maybe it was your doctor who bailed on you. Lots of them are looking selfish.

    I have not had anything for a long time. I'm tired of feeling like a loser although I pay taxes but I don't have health insurance.

    nosotros no somos estúpidos

    by a2nite on Sat Oct 05, 2013 at 06:09:04 PM PDT

    •  Tell us more about your situation. (2+ / 0-)
      Recommended by:
      annan, worldlotus

      Maybe someone here can figure out a way to get you covered.

      Economic Left/Right: -7.38
      Social Libertarian/Authoritarian: -8.00
      Two steps to the right of Trotsky.

      by jvance on Sat Oct 05, 2013 at 06:17:00 PM PDT

      [ Parent ]

      •  I thinkfirst can sign up; I waiting for the first (5+ / 0-)

        Onslaught of people to die down.

        I do NOT qualify for Medicaid esp since I live in OH where they have not expanded coverage. I am not going to give up my home, nor my small savings  either. & I'm too young for Medicare.

        nosotros no somos estúpidos

        by a2nite on Sat Oct 05, 2013 at 06:27:36 PM PDT

        [ Parent ]

        •  Yeah healthcare.gov sucks (2+ / 0-)
          Recommended by:
          annan, wasatch

          It's not just traffic.  It's design.  

          Medicaid expansion:  If you make under these amounts, you're fucked.

          http://aspe.hhs.gov/...

          if you make less than 4 times those, you qualify for a subsidy, including cost sharing on your out of pocket.

          You may be able to get insurance on the exchange via an insurance agent.  I'm investigating that path myself.  The agent fees are built in, so it wouldn't cost more.  Either way you have until December 15th.

          Economic Left/Right: -7.38
          Social Libertarian/Authoritarian: -8.00
          Two steps to the right of Trotsky.

          by jvance on Sat Oct 05, 2013 at 07:01:57 PM PDT

          [ Parent ]

          •  I've even had issues signing up. (1+ / 0-)
            Recommended by:
            annan

            It let me sign up, but then when I tried to log in, said my username/password was incorrect.  So then I did the "forgot my password" thing, and when I went to change it, said the answers to my security questions were wrong.

            •  Give it a week. (1+ / 0-)
              Recommended by:
              annan

              Then go back and try again.  Right now even if you register and complete the application (good luck with that) you still might not be able to enroll.

              You may wind up having to go to an insurance broker.

              The signup and enrollment process for my State's SHOP (small business exchange) was seamless.  I dicked around in it just to see whether it would be a good deal for my employer.  It may be.

              Economic Left/Right: -7.38
              Social Libertarian/Authoritarian: -8.00
              Two steps to the right of Trotsky.

              by jvance on Sat Oct 05, 2013 at 07:56:40 PM PDT

              [ Parent ]

            •  Happens all the time (0+ / 0-)

              Mostly it is "bad user," but never in my case.  

              I'm from the Elizabeth Warren wing of the Democratic Party

              by voicemail on Sat Oct 05, 2013 at 08:04:05 PM PDT

              [ Parent ]

          •  Yeah, that website does suck once you get (3+ / 0-)
            Recommended by:
            jvance, worldlotus, Mr Robert

            past the info and into the application and sales pitch. A real dinosaur but I think that's all part of the "drown it in a bathtub" plan: website on the cheap.

            Two thoughts. Be very careful about working with a broker/agent. The website is horrible and slow, so it's going to be tempting to get help. Just make absolutely positively sure that the help is really taking you to the federal marketplace. I just saw ads for "ACA Compliant" policies that weren't marketplace policies.

            I figured out who was providing plans, then went to the providers website to investigate the plans, networks, providers, etc. It was much more comprehensive.

            I'll go back to www.healthcare.gov actually make the purchase.

            "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

            by annan on Sat Oct 05, 2013 at 08:23:31 PM PDT

            [ Parent ]

        •  You can go to the Kaiser Family Foundation (4+ / 0-)
          Recommended by:
          annan, poco, freesia, worldlotus

          website and get a pretty good estimate of what you will have to pay for a silver plan in your state. KFF set up a calculator for the ACA that has been running for months and it is a good, easy, and uncrowded way to answer just three or four questions and see where you will stand on cost.

        •  Sound like you're in my situation. (2+ / 0-)
          Recommended by:
          annan, worldlotus

          Also in Ohio, single, childless, able-bodied adult, so I don't qualify for medicaid in Ohio.  And I have no income to speak of.  My income for the last 3 years combines has totalled $2600 or so.  Still trying to see whether the healthcare.gov site says I qualify for subsidies, I have an ugly feeling that I'm screwed because if I lived in a blue state, I'd already be fully covered by medicaid.

          Just got to get the healthcare.gov site to actually feed me my 'detailed eligibility results', rather than just a link to a blank page to find out.

          •  What would happen if you lie about your income? (0+ / 0-)

            Overstate your income in order to qualify for subsidies on the exchange?  

            Economic Left/Right: -7.38
            Social Libertarian/Authoritarian: -8.00
            Two steps to the right of Trotsky.

            by jvance on Sat Oct 05, 2013 at 10:52:50 PM PDT

            [ Parent ]

            •  You're signing a statement that says everything (1+ / 0-)
              Recommended by:
              annan

              you're giving them is correct and accurate to your knowledge, and you already agreed to let them have access to all your accessible records.  So it'd be the same as lying on your taxes, only even easier to catch and prosecute you.

              I'd rather not go to jail to get coverage.

            •  They'll catch up with you on your tax return (1+ / 0-)
              Recommended by:
              annan

              What they're asking for now is an estimate of your 2014 income, so they can provide the subsidy (technically an "advanced tax credit").

              When you file your 2014 tax return (in the winter of 2015), there will be a reconciliation form. If your income estimate was too low, you will have to pay back the excess subsidy. What I'm not sure about is if you estimated too high, whether you can claim the extra subsidy -- I think so.

              My income fluctuates a lot (teaching adjunct, I can't predict how many classes per semester they'll give me) so the person at the state exchange assured me that it's only an estimate.

              My understanding is that in the initial application process, the system does check with either IRS or Social Security's computers to see if the number you're putting in is consistent with your 2012 return, to keep people from cheating. But obviously there are people who legitimately have much lower incomes, like they lost their high-tech job and are flipping burgers instead.

              This is the "evil IRS enforcement mechanism" that Issa and the other right-wingers have been trying to get rid of.

              •  So you project increased income (0+ / 0-)

                and it doesn't happen.  Now they come to collect, and you have no income to garnish, no savings to confiscate, no assets to execute on.

                However, you got your cancer treated.

                What then?  

                Economic Left/Right: -7.38
                Social Libertarian/Authoritarian: -8.00
                Two steps to the right of Trotsky.

                by jvance on Mon Oct 07, 2013 at 12:56:52 AM PDT

                [ Parent ]

        •  Lets work on that Ohio Medicaid expansion (1+ / 0-)
          Recommended by:
          annan

          There are some grassroots groups in OH working on Kasich and Bachelder.

          "The international world is wondering what happened to America's great heart and soul." Helen Thomas

          by Betty Pinson on Sat Oct 05, 2013 at 10:28:50 PM PDT

          [ Parent ]

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

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

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

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

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

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

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

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

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

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

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

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

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

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 07:16:55 PM PDT

      [ Parent ]

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

        since the very beginning.  

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

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

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

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

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

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

        [ Parent ]

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

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

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

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

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

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

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

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

            [ Parent ]

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

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

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

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

  •  It's only natural that you trust the doctors who (3+ / 0-)
    Recommended by:
    johnny wurster, PinHole, annan

    helped save your life implicitly and feel some panic at the idea that you may not be able to see them under your new plan.

    BUT, those are not the only world class cancer specialists in the world. It's an understandable emotion to have a intense attachment to the doctors you are used to seeing but there are others out there that can do just as good a job if you happen to need their services in the future.

    Medicine is like following a cookbook. If you've got that, you look in the book, and this is what they give you. These men and women don't make things up as they go along.

    It's science.

    I ask him if he was warm enough? "Warm," he growled, "I haven't been warm since Bastogne."

    by Unrepentant Liberal on Sat Oct 05, 2013 at 06:10:51 PM PDT

  •  Isn't there usually an exception to get covered (4+ / 0-)

    out of network if the in-network isn't capable of what you need done. That may apply here, but I don't know.

    The modern conservative is engaged in one of man's oldest exercises in moral philosophy;the search for a superior moral justification for selfishness

    by CTMET on Sat Oct 05, 2013 at 06:10:56 PM PDT

  •  I can somewhat relate (7+ / 0-)

    I'm employer covered. But, through the turmoil of the past several years, they've changed insurance companies three times. Each time they change, its an anxiety-inducing experience to see if the doctors you've trusted for years are still in the plan. Through the first two changes, I still had all my doctors. In the last change, I had to make a difficult choice. Keep my oncologist and urologist and give up my primary care doctor who is not in the plan. Like you, I could have went with a catastrophic plan and kept them all. But, I chose to find another primary physician. I don't blame my company, or the insurance company. I blame my old primary physician. When I asked him why he wouldn't take Cigna anymore, he basically said he was tired of doing paperwork for multiple insurance companies and now he only accepts 2.

    •  Thank you for the insights. (3+ / 0-)
      Recommended by:
      poco, wasatch, worldlotus

      I have never had to deal with the employer based insurance changing periodically. That would be unnerving for sure!

      I really appreciate your insights. Thank you.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 07:19:04 PM PDT

      [ Parent ]

      •  fcvaguy's experience is very widespread (3+ / 0-)
        Recommended by:
        worldlotus, annan, fcvaguy

        a lot of employers are changing their plans now and blaming the ACA for it, when companies have changed plans for years without caring whether employees' doctors were affected.

        my employer has changed plans 3 times in 12 years

        Politics is like driving. To go backward put it in R. To go forward put it in D.
        Drop by The Grieving Room on Monday nights for support in dealing with grief.

        by TrueBlueMajority on Sat Oct 05, 2013 at 09:13:41 PM PDT

        [ Parent ]

  •  Can you ask your current doctor for help? (5+ / 0-)
    Recommended by:
    PinHole, poco, annan, wasatch, worldlotus

    Perhaps they intend to join one of the plans eventually and you can choose accordingly.

    Failing that, perhaps they can recommend someone who does accept one of your available choices.

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

    by blue aardvark on Sat Oct 05, 2013 at 06:16:25 PM PDT

  •  Ask the governor of Indiana about their ... (3+ / 0-)
    Recommended by:
    PinHole, annan, worldlotus

    ... implementation of the ACA.

    "The Obama Administration has been an unmitigated disaster" - Osama Bin Laden

    by Explorer8939 on Sat Oct 05, 2013 at 06:16:43 PM PDT

    •  Yeah ... (2+ / 0-)
      Recommended by:
      poco, worldlotus

      Thursday I attended a conference downtown and arrived just as the Gov and his entourage were leaving the conference center. Walked right past him, he nodded and said hello.

      After doing my research today, then writing and responding to this diary I'm sure I would have screwed up my courage and given him a piece of my mind!

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 07:23:31 PM PDT

      [ Parent ]

  •  Thanks for the info, annan. Your diary provides (9+ / 0-)

    valuable heads up for those entering the ACA market exchange with regards making an informed choice.

    I find it very curious that Anthem is not including what was once their own preferred provider.  I wonder what other states & which insurance companies are currently excluding teaching/research hospitals such as IU?  And why.

    I agree with other posters that this is not an ACA thing but rather a state commissioner & individual health insurance company thing.  

    These entities-not Washington DC-are the ones who have chosen what to offer on the exchanges they have set up.  

    When people find out what the limits imposed are in your state, the hollering will start.  No doubt blaming it all on the President, his puppy dogs & all the hippies running the government.  

    I think it is crucial to tell our stories while taking great care with facts & framing to avoid myths & legends & widespread falsehoods.  

    Loudly, make those who put this in place at the state level own it.  Now not later.

    •  There really are consequences (6+ / 0-)

      to adopting the Heritage, all-corporate all-the-time health insurance model.  One big one is that there is NO public leverage over the provision of services.  Democrats have tried to pretend that this is somehow a step toward the sort of health-care system that exists in the rest of the industrialized worlf, but in reality it goes in absolutely the opposite direction.  Now hundreds of billions of tax dollars a year will be poured into the private insurance industry with a guaranteed profit rate of 20%.  I would say that serves to create a mighty institutional barrier to there ever being any sort of government-driven health system, and just as Heritage intended.  

      Clap On, Clap Off, The Clapper!

      by ActivistGuy on Sat Oct 05, 2013 at 06:34:00 PM PDT

      [ Parent ]

      •  Yeah; there's gonna be hollering in blue states... (1+ / 0-)
        Recommended by:
        annan

        ...too, given that narrow networks are the new normal, and prevalent under California's plans, as well. That's what we get for having industry lobbyists write and implement "reform" legislation.

        People will holler themselves hoarse when they see the other new normal of increased "cost-sharing," which requires those grossing $24,000k/year to cough up $6,000 of it in medical costs above and beyond premiums in a byzantine hybrid of deductibles, co-pays and maximum out-of-pocket costs.

        I'm glad for expanded Medicaid, and for those who will be able to afford and/or obtain insurance in the first place. But the narrow networks and the high cost-sharing, if not fixed, are going to risk blowback from middle-class voters.

    •  worldlotus, thank you for your comment. (3+ / 0-)
      Recommended by:
      greenbell, worldlotus, wasatch

      Up thread and in the body of the diary I comment on the "narrow networks". This is something everyone needs to explore before they sign up for a plan.

      The insurance companies are creating these narrow networks to contain costs. I heard an unsubstantiated rumor that there may be a provision in the ACA for individuals to see specialists at these out-of-network teaching hospitals. This is something that requires research and may require more advocacy.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 07:27:19 PM PDT

      [ Parent ]

      •  Specifically, it sounds like Anthem is creating a (1+ / 0-)
        Recommended by:
        annan

        narrow network to contain costs, which really means to keep their profits up.  They lower the reimbursement rate to some of the providers, so they can offer a lower premium than some other company on the exchange, while still maintaining a high profit margin.  In the long run, this may not work for them, if enough people decide it's not worth signing up with them because they don't have some of the best providers.

  •  I'm not surprised (5+ / 0-)

    I became disabled through extensive loss of eyesight in layr 2012.  I live in Massachusetts, so once it was clear that I was going to end up on disability I filed with MassHealth (Romneycare).  I was fortunate enough to find a network that included my PCP and most of my regular specialists.  Unfortunately, thjat choice also excluded Mass. Eye & Ear which is the only place in New England that conducts certain tests and carries on certain treatments that I need.  Each visit with Mass. Eye & Ear will either be totally out-of-pocket, or will be subject to prior review by my new Romneycare network.  I would guess these sort of arrangements will be the norm rather than the exception for all of us with significant health problems going forward.  

    Clap On, Clap Off, The Clapper!

    by ActivistGuy on Sat Oct 05, 2013 at 06:21:38 PM PDT

    •  PA/PR is not the end of the world (2+ / 0-)
      Recommended by:
      annan, worldlotus

      Prior review or prior approval is not the end of the world. Just a hurdle to jump over. Even an initial denial in this process does not mean you can't appeal, because you can.

      Many, many Medicare part D plans are PA/PR for huge numbers of very standard drugs, by the way. It is how they keep costs down.

    •  ActivistGuy, we need to do more research about (1+ / 0-)
      Recommended by:
      worldlotus

      this. I heard a rumor that the ACA will enable a mechanism for out-of-network specialists to be covered.

      I don't have details, but hopefully enough of us will start asking questions, doing research, figure this out and advocate for it if necessary.

      I'm really sorry to hear about your vision issues. We all have untold stories, don't we?

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 07:30:42 PM PDT

      [ Parent ]

  •  1995 is a long time ago. (3+ / 0-)
    Recommended by:
    catwho, annan, worldlotus

    Is the IU Medical Center still the same?  

  •  can you get in kaiser? they have a wide array of (4+ / 0-)
    Recommended by:
    puakev, annan, sturunner, worldlotus

    specialists - all easily avaailable - and all services like lab, xray, mri, ct scans are all in house and can ususally be done within the same day.

    this is a powerful network - total awareness of your medical health situation.  they are also preemptive in many cases.

    don't know if it is a choice - but worth taking a look!  copays are low and, if subsidized, none.  my entire gall bladder er - surgery - hospital stay - meds cost me nothing. (i have medical on top of kaiser and senior advantage.)

    EdriesShop Is it kind? is it true? is it necessary?

    by edrie on Sat Oct 05, 2013 at 06:29:56 PM PDT

  •  I support ObamaCare--- (13+ / 0-)

    as a huge improvement, but flawed; and the biggest flaw is the survival of insurance companies.
    Single-payer would mean that no provider is out-of-network.
    And the insurance execs, with their numbers expertise, could go count spawned-out salmon carcasses along the rivers. In grizzly country.

    I look forward to single-payer.

    Joe

    "There is just one way to save yourself, and that's to get together and work and fight for everybody." ---Woody Guthrie (quoted by Jim Hightower in The Progressive Populist April 1, 2012, p3)

    by CitizenJoe on Sat Oct 05, 2013 at 06:31:05 PM PDT

  •  Y'know... (5+ / 0-)

    I don't know about the rest of you, but I go out a lot and do rhetorical battle elsewhere with quite a few ODS wingnuts. In doing said rhetorical battle I usually like to be armed with the right info - including that info which might support the wingnuts' position - not just so I can make effective arguments, but also so I don't say something wrong and get filleted for it.

    Not that arguing with neandrethals is the most important reason for knowing things, but it's there.

    I'd rather know about this drawback to the ACA and be able to concede that point than say "nuh-uh!" than look stupid because I didn't want to accept it when first being told.

    As for the more substantive response to this: ok, it's a drawback. I can see why it can suck for some people. But like others have already said, it's still better than having nothing, which is what a lot of people currently have.

    Crap, I just realized how out-of-date my sig is. I'll come up with something else later.

    by Erik the Red on Sat Oct 05, 2013 at 06:32:24 PM PDT

    •  Instead of conceding the argument.. (6+ / 0-)

      ..point out that problems like this are less likely in states where the legislature and Governor aren't actively trying to sabotage the implementation of the law. If Governors Daniels and Pence didn't refuse to set up a state exchange, the diarist would have many more options available to her.

      •  Not necessarily true. From NYT about CA networks (1+ / 0-)
        Recommended by:
        annan

        In California, the statewide Blue Shield plan has developed a network specifically for consumers shopping in the insurance exchange.

        Juan Carlos Davila, an executive vice president of Blue Shield of California, said the network for its exchange plans had 30,000 doctors, or 53 percent of the 57,000 doctors in its broadest commercial network, and 235 hospitals, or 78 percent of the 302 hospitals in its broadest network.

        Mr. Davila said the new network did not include the five medical centers of the University of California or the Cedars-Sinai Medical Center near Beverly Hills.

        http://www.nytimes.com/...

        It’s the Supreme Court, stupid! Followed by: It's always the Supreme Court! Progressives will win only when we convince a majority that they, too, are Progressive.

        by auapplemac on Sun Oct 06, 2013 at 02:55:17 AM PDT

        [ Parent ]

        •  My point stands (0+ / 0-)

          The variety of plans and options available on California's exchange is still undoubtedly much greater than the federal exchange. Besides, your anecdotal evidence is based off a single insurance company making a business decision, not something predetermined by the ACA.

    •  You got it, Erik the Red (2+ / 0-)
      Recommended by:
      sturunner, worldlotus

      That is exactly why I wrote this!!

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 07:40:05 PM PDT

      [ Parent ]

  •  As a huge supporter of the ACA, thank you (9+ / 0-)

    for this diary.  We all knew the law wasn't perfect and the only way to perfect it is by staring its flaws directly in the face rather than looking away.  I fervently hope these sort of problems get remedied.  Best of luck in receiving the care you need.

    "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

    by puakev on Sat Oct 05, 2013 at 06:33:15 PM PDT

  •  Any time insurance policies change (6+ / 0-)

    the outcome may be that you can't keep your doctor, but you can't simply blame it on the ACA. It is a problem inherent in our private insurance-driven system. I had insurance through work for 8 years before becoming self-employed and buying my own policy. During those 8 years, my insurance coverage changed fully 3 times -- as did the doctors in the network. If I wanted to keep my doctors, I had to change my policy.

    I am sorry that you have to find other doctors, but there are other doctors who can help you. The implication of your diary that this is the result of the ACA is simply not called for. It could just as well have happened if the ACA had not passed.  

    Just sayin...

    •  You know, this has been a great insight for me (5+ / 0-)
      Recommended by:
      sturunner, poco, flo58, sethtriggs, worldlotus

      tonight. I've never had to deal with employer insurance, so I've never experienced this doctor thing like so many of you have over the years.

      Sometimes you don't know what you've got until ... isn't there a song about that?

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 07:42:15 PM PDT

      [ Parent ]

      •  i almost experienced it in the state pool (2+ / 0-)
        Recommended by:
        annan, worldlotus

        The state (Utah) chose which insurance company administered the state pool, and it's changed a few times. The last time it changed, initially, none of the University doctors were going to be covered (only doctors I've seen for the last 25 years, and good care). Fortunately, that was a temporary hiccup that was quickly resolved.

        Since I haven't yet made it through the application process, I don't know yet if I'll run into this problem. Fingers crossed.

    •  this this this this this (1+ / 0-)
      Recommended by:
      flo58

      Politics is like driving. To go backward put it in R. To go forward put it in D.
      Drop by The Grieving Room on Monday nights for support in dealing with grief.

      by TrueBlueMajority on Sat Oct 05, 2013 at 09:14:58 PM PDT

      [ Parent ]

    •  flo58, under the ACA plans there will not only be (1+ / 0-)
      Recommended by:
      annan

      changes in healthcare providers, but there will be less to choose from.

      Please see my comments about CA from the NYT just a few spaces above this.

      With less doctors will there be a lower level of care. Will these doctors be overrun with patients that you may have to wait months for an appointment.

      I've had that experience with Medicare which I consider a God send, but there are problems. I had to wait over 7 months to get an appointment with a new Internist this year.

      The networks under ACA plans will pay the doctors less than standard plans. Some will not join because of this. I would think many of the better doctors don't have to because they have enough patients with employer insurance and Medicare patients (although they may limit the number of Medicare people they will treat; again due to the lower rate of reimbursement by the government).

      It’s the Supreme Court, stupid! Followed by: It's always the Supreme Court! Progressives will win only when we convince a majority that they, too, are Progressive.

      by auapplemac on Sun Oct 06, 2013 at 03:06:13 AM PDT

      [ Parent ]

  •  I think for the first year there will (7+ / 0-)

    be situations like this where people get squeezed on provider selections.

    To be clear, the ACA did not really cause this situation.  This is common practice among insurance companies and pre-dates the ACA. For example, HMOs routinely have smaller networks than PPOs.  You get a cheaper price with HMO's but often limited providers.  

    The issue is that the government probably needs to look at requiring insurers to offer additional options to add providers to a network and allow the insurer to charge additional costs (but capped at a certain level).  

    Global Shakedown - Alternative rock with something to say. Check out their latest release, "A Time to Recognize": Available on iTunes, Amazon, Google Play, Spotify and other major online music sites. Visit http://www.globalshakedown.com.

    by khyber900 on Sat Oct 05, 2013 at 06:35:15 PM PDT

  •  You are not being forced to do anything (3+ / 0-)
    Recommended by:
    wdrath, FiredUpInCA, flo58

    You can keep your physician and physical therapist by paying them yourself. You can shop around for a private insurance carrier who will be accepted by them (If you have been 18 years NED then it's certainly possible that a private insurance carrier would consider you an acceptable risk).. or you can take the plan the ACA gives you even though it means giving up your Physician and Physical therapist.

    In the long run the ACA will give millions without health care the health care they deserve. Yes, you may have to give up the physician you so love,.... but you will get A QUALIFIED PHYSICIAN and HEALTH CARE under the ACA. More importantly, impoverished breast cancer patients in much worse shape than yourself will now also get health care when before the ACA it simply wasn't possible.

    This is why we need the ACA.

  •  This is from an article in NYT (8+ / 0-)

    It's about Representative Tom Grave's district in Georgia. This is the last paragraph:

     “I just don’t trust it,” said Mr. Tripcony, who has an equal distrust of President Obama. “I don’t like him, and I don’t feel comfortable with anything he’s got to do with.”

    Mr. Tripcony said he had a better idea for a system to provide health care at a fair price. “I think it should be the same for everybody,” he said. “One big company, whether owned by the government or private.”

    Informed that he had described the single-payer system that Mr. Obama abandoned when Republican critics called it socialized medicine, he said, “Yeah, I know, it’s crazy.”

    He said he might eventually seek health insurance under the new system. “In a couple of months, when they get the Web sites working, I may do it.”

    And this is the article:

    http://www.nytimes.com/...

    A man's character is his destiny.

    by Jaleh on Sat Oct 05, 2013 at 06:39:40 PM PDT

    •  Can't win with those folks (6+ / 0-)

      they were up in arms that Obama was planning a government takeover of health care, which was precisely why a market-based solution was pursued.  But now they complain that it'd be better if we had government-run health insurance?  And if single-payer had passed these would be the ones complaining the loudest about...a government takeover of health care.

      "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

      by puakev on Sat Oct 05, 2013 at 06:51:28 PM PDT

      [ Parent ]

  •  Can you talk to your doctor about your options? (5+ / 0-)
    Recommended by:
    sturunner, poco, annan, sethtriggs, worldlotus

    Maybe she can recommend someone?

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Sat Oct 05, 2013 at 06:41:03 PM PDT

    •  Hey, Zen ... (1+ / 0-)
      Recommended by:
      worldlotus

      Thanks for stopping by. Good idea. After spending several hours chatting with folks I'm feeling much better about all this.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 08:37:30 PM PDT

      [ Parent ]

  •  I cannot believe this troll diary has been (1+ / 1-)
    Recommended by:
    wdrath
    Hidden by:
    DeadHead

    rec'ed. Sorry folks, the ACA did not any way shape or form force the writer to switch doctors, if she/he wants to keep going to doctor they can, if she/he wants the less expensive ACA plans, they can. For me and many like me, i get health insurance through employment which costs more than 10% of my salary, yes i can keep it but why the hell would I? sure i may have to change doctors, but that's a risk you face when you change jobs or lose one, staying at a job for 18 years is rare.
    Really, this is just a hit piece, and a low one at that.

    Solvent Green is Grandma

    by mad cow on Sat Oct 05, 2013 at 06:43:49 PM PDT

  •  I'm sorry for what your choices are. (4+ / 0-)
    Recommended by:
    jayden, lunacat, annan, worldlotus

    But I am not surprised in the least that these are your choices.   Health care is a right.  You should be able  to afford to see any doctor of your choice, especially the ones who have given you wonderful treatment.  

    Politicians can do that and have done that... flying from state to state to the get the best doctors in the field the pols are seeking health care from.

    It should be the same for every human being.  

  •  I apologized to annan nt (10+ / 0-)

    nosotros no somos estúpidos

    by a2nite on Sat Oct 05, 2013 at 06:45:26 PM PDT

  •  It is unfortunate, but... (4+ / 0-)
    Recommended by:
    sturunner, flo58, annan, worldlotus

    I can't tell you how, any times I have been forced to find new doctors for me and my kids because our employers decided to shop around for a cheaper insurance plan or because my husband switched jobs or the doctor decided not to take the plan anymore. It is too bad Obama apparently made a promise he could not keep, but the reality for many people is that they have not always been able to keep the doctors they have forged a relationship with.

    Perhaps you can talk with your doctor and find out why she did not sign a contract with the insurer. I had a situation where I had to have surgery, but my physician did not have privileges at the hospitals covered by my insurer. I had the surgery at an affiliated surgery center, and they agreed to accept the amount the insurer paid for out of network services.

      It is unusual, I think, that the plan does not have out of network benefits. I know in some states, the insurer must offer out of network benefits. They require higher cost sharing from the insured, but it is often a way to keep a doctor you like who decides not to sign a contract with your insurer.

    **Electing Republicans to the government is like hiring pyromaniacs as firemen. They all just want to see everything burn to the ground.**

    by CatM on Sat Oct 05, 2013 at 06:46:56 PM PDT

    •  how many, not how any *nt* (I hate typos) (0+ / 0-)

      **Electing Republicans to the government is like hiring pyromaniacs as firemen. They all just want to see everything burn to the ground.**

      by CatM on Sat Oct 05, 2013 at 06:54:39 PM PDT

      [ Parent ]

    •  That surprised me that there were no (1+ / 0-)
      Recommended by:
      worldlotus

      out-of-network benefits. I expected a higher co-pay or cost sharing, but these plans appeared to be devoid of any of that. I'm not going to purchase anything until I can clarify that point and it will be interesting to see if that changes.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 08:43:29 PM PDT

      [ Parent ]

  •  See if your PCP & PhysTherapist... (2+ / 0-)
    Recommended by:
    annan, worldlotus

    ...will either petition to join the network that would give you the better catastrophic coverage, AND/OR ask them to each if they can refer you to any of the doctors in the plan your wishing to join. They may know these physicians. Best of luck! <3

    OWS (Occupy Pittsburgh) - REAL MOVEMENT of, by, for AND from the people!

    by waiting for lefty on Sat Oct 05, 2013 at 07:00:24 PM PDT

  •  this is why we need single payer. Under (7+ / 0-)

    single payer, you would choose your doctors and payment would be automatic.
    We knew when the ACA passed that it was less than perfect. It was also far better than the mishmosh mess of health care we now have.
    But because it's based on all sorts of compromises, people like you end up losing out in some ways (though from what you say, it sounds like you might save money at least).
    I hope you find a way to work this out so that you can get the care you need from the providers that are best for you.

    While Democrats work to get more people to vote, Republicans work to ensure those votes won't count.

    by Tamar on Sat Oct 05, 2013 at 07:04:28 PM PDT

    •  I agree (1+ / 0-)
      Recommended by:
      Tamar

      I realize its a trade-off. I'll figure it out and I appreciate that I will save money.

      I just didn't want people repeating the line that they won't lose their doctors when that might not be the case.

      Thanks for stopping by.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 08:45:42 PM PDT

      [ Parent ]

      •  And I wasn't criticizing you at all. It's hard (1+ / 0-)
        Recommended by:
        annan

        when a policy that affects you is designed by people who are either ignorant or hostile or both (and in your state, that's obviously the case).
        I'd love you to do a follow-up diary so we can find out what you've decided and hear how it works out.

        While Democrats work to get more people to vote, Republicans work to ensure those votes won't count.

        by Tamar on Sun Oct 06, 2013 at 11:38:33 AM PDT

        [ Parent ]

  •  It's a Republican solution (4+ / 0-)
    Recommended by:
    fleisch, RainyDay, annan, PALiberal1

    I'm sorry you got screwed by it.  Until there is single payer, this kind of bullshit will continue, and I wish liberals would stop treating this for-profit solution as the end-all-be-all.

    Obama: self-described Republican; backed up by right-wing policies

    by The Dead Man on Sat Oct 05, 2013 at 07:14:09 PM PDT

  •  The Indiana Republicans could have shut down (2+ / 0-)
    Recommended by:
    annan, TrueBlueMajority

    the high risk pool even if ObamaCare did not exist. Doesn't that sound like something Indiana Republicans would do?

  •  18 Years Post-Cancer And You Have An Oncologist? (0+ / 0-)

    Whaaaaa?

    Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

    by bernardpliers on Sat Oct 05, 2013 at 07:22:03 PM PDT

  •  annan, sending you a Kosmail. (5+ / 0-)

    I wish you the best in devising the best possible solution.

    Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

    by peregrine kate on Sat Oct 05, 2013 at 07:22:09 PM PDT

  •  I have lost many DRs up to now. I have moved (2+ / 0-)
    Recommended by:
    annan, TrueBlueMajority

    They have retired. I change plans. Many reasons.

    I have never been sick. I don't know anything about cancer but I thought the longer you survive the better things are. I thought that if you survive 5 years that is a major milestone.

    You have been lucky and had the same DR's for almost 20 years. Do you think changing DR's now would be a great problem to your continued survival?

    Only gun owners can control their guns and they say oopsie way too much. I lost it, I forgot it, it just went off. Support Gun Kill Speed Limits and Gun Ownership Speed Limits.

    by 88kathy on Sat Oct 05, 2013 at 07:22:32 PM PDT

    •  It's a family thing ... (1+ / 0-)
      Recommended by:
      worldlotus

      lots of different kinds of cancer in our family, including blood cancers which chemo can trigger many years later.

      It's a myth that 5-10 years out you are cured of breast cancer. Breast cancer is never cured and unfortunately metastases do show up 20+ years later.

      It's just a fact of my life like tornadoes. The only time I get stressed about it is when someone I care about gets cancer or I have to deal with health insurance.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 08:54:33 PM PDT

      [ Parent ]

      •  I am thinking your DRs might retire by the time (1+ / 0-)
        Recommended by:
        annan

        you develop anything new. And you may be OK now. I don't think you should be worried about keeping the same DR as much as keeping well.

        Only gun owners can control their guns and they say oopsie way too much. I lost it, I forgot it, it just went off. Support Gun Kill Speed Limits and Gun Ownership Speed Limits.

        by 88kathy on Sat Oct 05, 2013 at 10:57:13 PM PDT

        [ Parent ]

    •  what 88kathy said (2+ / 0-)
      Recommended by:
      88kathy, annan

      Politics is like driving. To go backward put it in R. To go forward put it in D.
      Drop by The Grieving Room on Monday nights for support in dealing with grief.

      by TrueBlueMajority on Sat Oct 05, 2013 at 09:17:52 PM PDT

      [ Parent ]

  •  Your choices (2+ / 0-)
    Recommended by:
    annan, worldlotus

    The oncologists you had may not be among the choices you are presented with, but as long as there are other oncologists available under it, I would stick with the coverage that your primary care physician and therapist accept.  I understand your gratitude towards and confidence in the doctors you worked with, but that doesn't mean that other doctors in the field aren't good.  The question is whether the coverage you are eligible for includes catastrophic care at all.  If it doesn't, it shouldn't be considered insurance; it's just deferred payment for standard care, with part of the money removed by a company that makes the payments.  It's like taking out 'grocery insurance' so you have a co-pay at the checkout stand but you ultimately get fewer groceries than if you just bought them yourself.

    Losing your favored provider is not ideal, certainly, but no form of health care that still considers for-profit insurance as part of it is going to be geared toward patient needs.

    Silence is not an effective reply to propaganda.

    by fleisch on Sat Oct 05, 2013 at 07:27:27 PM PDT

    •  Thanks, I hear you. (1+ / 0-)
      Recommended by:
      worldlotus

      This has been very helpful tonight. I agree with you. Fortunately, one of the cool things about the ACA is that ALL policies are now catastrophic in that there are no lifetime caps. No more junk insurance!!!

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 08:56:46 PM PDT

      [ Parent ]

  •  It's the same as changing jobs (1+ / 0-)
    Recommended by:
    annan

    If you move from one job to another, you'll have to change all your health care providers.

  •  My GF Had A Mastectomy About 15 Years Ago (1+ / 0-)
    Recommended by:
    annan

    But I don't think she's seen an oncologist in 10 years, so she's was surprised to hear this story.

    Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

    by bernardpliers on Sat Oct 05, 2013 at 07:31:02 PM PDT

    •  It's a family thing as I mentioned upthread. (2+ / 0-)
      Recommended by:
      bernardpliers, worldlotus

      This has been interesting to think out loud as I reply to people. Most everyone has been very helpful tonight and I'm grateful.

      Apparently my family is interesting to the research docs. which means that I'll probably be able to work this out "off-line" with my docs.

      The take-away for other kossacks is to check the narrow networks to make sure you are getting what you need with the policy you select.

      Happy to hear about another long-term survivor, give her my best!

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 09:01:12 PM PDT

      [ Parent ]

      •  I Had A Close Friend Die From Breast Cancer (3+ / 0-)
        Recommended by:
        Betty Pinson, sethtriggs, annan

        She was getting yearly mammograms because her breast were   somewhat fibrocystic. She'd also had several rounds of unsuccessful fertility treatment, FWIW.  Fast forward a couple years and her clinically narcissistic husband dumped her, she got laid off from a really good job, and her mother died on the other side of the country. And she skipped her annual check up, then wham, inoperable stage 4 metastatic breast cancer in the  liver.   She actually hung on a couple years.  I took care of her dog for her until the dog died of cancer, and she died the next year.

         

        Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

        by bernardpliers on Sat Oct 05, 2013 at 09:20:52 PM PDT

        [ Parent ]

      •  I'm Sorry I'm In Such A Bad Mood Tonight (1+ / 0-)
        Recommended by:
        annan

        This shutdown thing is hurting our business really bad.

        Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

        by bernardpliers on Sat Oct 05, 2013 at 10:41:21 PM PDT

        [ Parent ]

  •  18 years later they may have retired or moved (1+ / 0-)
    Recommended by:
    annan
  •  Just take the silver plan (5+ / 0-)
    Recommended by:
    voicemail, edwardssl, annan, flo58, worldlotus

    and be happy for what you've got

    It's going to be $700 a year for me with an assload of PECs.   I've not had insurance in over ten years and this is literally going to save my life.

    •  Yeah, gratitude! (1+ / 0-)
      Recommended by:
      worldlotus

      Very happy to hear that the silver plan is going to work for you. I think that's the one I'm going with, too.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 09:02:32 PM PDT

      [ Parent ]

  •  Read your diary twice.... (6+ / 0-)

    to make sure I had the details in your story right.
    First, congratulations on being an 18 year cancer survivor.
    I would recommend staying with your PCP, the PCP knows your history and your other health problems. And as you explain in your diary, you are on surveillance, NED. A community oncologist could provide your care but please provide as much information as you can with your old medical history, including your most recent scans (if you have any). That will help them make  the appropriate  decisions regarding your care and if you are still cancer free in a few years, tant mieux. If God forbid you have a recurrence, hopefully the ACA will be rolling and then may be you could be referred back to Univ of Indiana for appropriate care.
    Good luck.

    What do we want? Universal health care! When do we want it? Now!

    by cagernant on Sat Oct 05, 2013 at 07:46:46 PM PDT

  •  Call your PCP and ask a lot of questions (2+ / 0-)
    Recommended by:
    annan, worldlotus

    of whoever handles the insurance company billing. My understanding is that for specialized treatment, facilities and specialists that are normally "out of network" may be approved (with pre-approval) at in-network prices. I had this experience when I requested (and had a family history that justified) BRCA1 testing; they nixed my initial choice (one of the big Boston medical centers) but OK'd my #2 choice even though it was technically out-of-network. And we had it when my son needed pediatric heart surgery, which no one in-network offered and we had to go to Children's Hospital in Boston.

    You might also try calling the "out-of-network" docs and ask them what their experience is.

    I've also heard of people arguing for in-network pricing and treatment when they had a medical emergency while travelling.

    In other words, the "in-network" list may not be as hard-and-fast as it looks on paper, for situations where you don't have any choice or where you can plan and get pre-approval.

  •  I think much of this is reactive based on part (1+ / 0-)
    Recommended by:
    annan

    business and part politics. I'd go with your primary physicians hoping that the success of the program will shutdown this exclusive dr stuff. I've always found it stupid that drs only take certain insurance. I think ACA will change this silly system.

  •  Just a note (3+ / 0-)
    Recommended by:
    poco, annan, worldlotus

    Specialists have been among the most significant groups fighting Obamacare, primarily because it takes away their license to print money.  The policies of a university system in a Republican state might also reflect politician's moves to try to sabotage the program from the start.  Both of those should be approached as local or state issues as well as political strategies of the insurance companies.

    Nothing in the law or regulations mandates that the relationships between insurers and providers be this disconnected and labyrinthine.

    So you have a practical issue to settle, but also a political issue going forward to raise.  The organizations (not necessarily the individual practicioners) that are making these decisions do need pushback from lots of patients and customers.

    Otherwise by 2015, we will have single-payer on the table as an issue.

    It's not Obamacare that has a problem.  It is the established health care insurance industry and providers.

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Sat Oct 05, 2013 at 08:06:33 PM PDT

    •  I would rec this comment 100x if I could (0+ / 0-)

      Very insightful:

      The policies of a university system in a Republican state might also reflect politician's moves to try to sabotage the program from the start.  Both of those should be approached as local or state issues as well as political strategies of the insurance companies. ... So you have a practical issue to settle, but also a political issue going forward to raise.
      I hadn't thought of it this clearly, although I knew this was a serious problem.

      I feel rather dense that I hadn't connected the dots between Mitch Daniels, Mike Pence, Dan Coats + Anthem's corporate HQ in Indianapolis + assorted big players that I won't bother naming. Duh.

      OK, Indianapolis Kossacks we may have a juicy issue on our plate.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 10:00:39 PM PDT

      [ Parent ]

    •  TarheelDem, yes! WELL said-wish I could rec this (1+ / 0-)
      Recommended by:
      annan

      a bazillion times.

      Especially so this:

      So you have a practical issue to settle, but also a political issue going forward to raise.  The organizations (not necessarily the individual practicioners) that are making these decisions do need pushback from lots of patients and customers.
      I feel,especially in the "obstructionist" states, that it is very important to push back fast, hard & often- while making it very clear to all involved that the ACA  regs are not responsible for what is being offered by individual healthcare insurance providers.

      It is going to take a long time to clear the misconceptions up that already exist amongst the populace.  It is going to take many voices to push back against the correct entities responsible.so there needs to be a concerted effort made to keep people from blaming the ACA for the shenanigans of state insurance commissioners, healthcare industries & others with skin in the game..

  •  I think the title is misleading... (0+ / 0-)

    If I understand annan's situation,  her problem is that she cannot keep her preferred medical team together rather than losing access to a single doctor.

    I realize that is a reasonable concern for her, given her medical history, but it is not the problem one would expect after seeing the title.

  •  Another thought about changing docs (3+ / 0-)
    Recommended by:
    TrueBlueMajority, annan, worldlotus

    I've been dealing with cancer almost as long as you have, annan -- two separate rounds. During that time I have moved twice, which meant changing both PCPs and oncology teams. In the past three years I've had to change PCP twice because they left town for other professional opportunities.

    Through all of this, my experience is that the new doctors are just as competent, thorough, and patient-centered as the ones I left. (Maybe oncology is a field that attracts the best docs? I did ask around for referrals, not just pick people out of the phone book.) I have felt as if each team handed me off to the next. At one point I got back in touch with my original oncologist to ask a question about my old pathology slides, and was able to get an answer quickly.

    So changing doctors is not the worst thing that can happen to a person. As I recommended upthread, I would talk it over with your PCP or their office staff, but in general I would go with the ACA policy and your known PCP, and then negotiate for the best oncology team available, if you really still need to see one. At worst, the additional cost of seeing an out-of-network specialist may well be more than offset by the subsidized insurance.

    Go well, stay well, and don't let the stress of having to deal with all this eat into your body.

  •  whats more important to you... (1+ / 0-)
    Recommended by:
    annan

    Access to a good (known) Pcp, or to an onc team?

    Tough choice. Good luck.

    "FK the deficit. People got no jobs. People got no money." Charlie Pierce

    by RubDMC on Sat Oct 05, 2013 at 08:21:50 PM PDT

  •  One of the most common RW charges (2+ / 0-)
    Recommended by:
    wader, annan

    regarding Canadian healthcare is that we cannot choose our own doctors.  I've never not been able to choose my own doctor or specialist.  But it seems common in the American system.  I hope this works out for the diarist

  •  Let's also put blame on the provider too (4+ / 0-)

    I understand the natural urge to come down hard on the plan providers to not include the specialist, but I think it is largely misplaced.

    Insurance companies are required by Obamacare to pay 80% of their premiums in claims, so it is not like they are coming out ahead by excluding a provider.

    Anyone shocked to see that the University of Indiana is not participating in any of these plans.  The state university and they are out of network.

    Recognize that the plan identifies a fee for service that they believe is reasonable to have in-network oncologists.  These fees are at a level that allows the plan to have reasonable premiums.  I of U has decided that the fee is not high enough so they are out of network.

    This is all a balancing act.  You may can make available a comprehensive plan that covers all care, but the price is largely going to be based on what the providers will be reimbursed for services.  I of U is world class a and they have decided that these plans do not provide them enough money.

    I could certainly understand this type of result if were in Indiana and we were talking about the Mayo Clinic or Cleveland Clinic, but this is the University of Indiana.

    You can chaulk this up to the political leadership in the state.  Certainly they will not provide any leverage to make sure that state providers (that get funding from the state) are there to deliver services to the residents of the state.

    •  Actually, Joe IU is in one of the ACA networks (0+ / 0-)

      Just not the Anthem network that my primary doctor is in, which seems really odd to me since Anthem's corporate HQ is in Indianapolis.

      Why wouldn't they have IU in-network? Was Anthem leaning too hard on IU? Is IU pushing back? This is definitely political but I don't have the info to explain it.

      Or was it Mrs. White in the dining room with the candlestick?

      I'm getting punchy. Thanks for thinking along with me.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Sat Oct 05, 2013 at 10:06:34 PM PDT

      [ Parent ]

  •  So, sent an email to HHS with a link to this (3+ / 0-)
    Recommended by:
    wader, annan, worldlotus

    Hope that is okay.  I am not sure if Congress needs to address this or if it is something they can fix.  And of course, they are swamped, but maybe it will help down the line and at least they may be more aware of this.

    Seems like there are some  good suggestions in the comments and I wish you the very best Annan.

    Sh

  •  Reality (6+ / 0-)

    First, anytime you change insurance (usually through a job change, or your job itself changes insurers), this EXACT kind of thing might happen. So this isn't the ACA doing this, it's the whole system, and unfortunately ACA is within this poor system. It was the best Obama could do.

    Second, you say you'll still save money. So..bonus.

    Third, I think we can assume that the only wonderful docs aren't the ones who saved you. Hopefully others are also wonderful.

    Tim

  •  I had the same Internist/primary doctor for 20+ (3+ / 0-)
    Recommended by:
    TrueBlueMajority, annan, worldlotus

    years, then dropped him for a different practice in which I have no lasting relationship with my choice of primary physician.  Instead, I see whomever is available most times - and, that works out fine for now.

    There are some specialists who know my particular problems very well (some of whom I have known for almost 30 years), and those are the folks I try to keep in plan when coverage changes are needed - even with insurance from my employer, plans and physician choices have meandered over the years.

    So, I'm used to making decisions somewhat like yours feel and there's drawbacks to losing someone who knows you well, but some potential advantages can be found in the change, too.

    The notion that ACA would allow you to keep your doctor is probably not a guarantee anyone can make, given that some states and doctors/practices are hesitant to support larger exchange grouping beyond the narrow ones, for various reasons.  I know that my former Internist retired his practice, in part, because he felt it was beneath him to work in an ACA-enabled world.  He had stopped taking new Medicare patients for some years, already.  Some physicians feel highly entitled.

    Good luck with your choice.

    "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

    by wader on Sat Oct 05, 2013 at 08:38:04 PM PDT

  •  We are reality and evidence based. (5+ / 0-)
    Recommended by:
    DFWmom, worldlotus, annan, Willa Rogers, guyeda

    The truth is that Obamacare is shaking up things in ways that may not have been anticipated or remedied.  

    Congratulations on being cancer-free and I hope that you get the care you have confidence in.

    We need to hear these real-life stories. My Obamacare situation is a mixed bag but a little more positive than yours. Perhaps I will diary it if I quit being so lazy. You've given me the courage to do just that.

    With your kinda spunk, I don't think anything will keep you down, including adjusting to care with a different physician if it comes to that.

    If you hate government, don't run for office in that government.

    by Bensdad on Sat Oct 05, 2013 at 09:18:37 PM PDT

  •  To use a metaphor (1+ / 0-)

    The diarist   is directly benefiting from a program designed to feed the hungry   and is complaining that TBone steak cooked medium rare isn't on the menu.

    •  thetruthinator, not really. Consider this: (1+ / 0-)
      Recommended by:
      annan

      Alot of people have neverhad to choose healthcare insurance in an open market.  At most, perhaps some have had a couple of plans to choose from during their employer's open enrollment or during an insurance provider change.

      What this diarist has done is provide her experience thus far as  reminders to those that read her diary.  Reminders to take care when making a choice on the marketplace, a reminder to stay informed in your own state, a reminder to become or stay pro active in promoting needed changes or reforms.

      She also merely asked for suggestions regarding the dilemma she faces.

  •  My Dr does not take my current plan, Cigna (1+ / 0-)
    Recommended by:
    worldlotus

    so even when you have good finance company insurance, does not mean you won't have an issue with a doctor...

    "The poor can never be made to suffer enough." Jimmy Breslin

    by merrywidow on Sat Oct 05, 2013 at 09:35:31 PM PDT

  •  From the get-go... (0+ / 0-)

    I gave Obama the benefit of the doubt, but I was cautious.  Knowing how this political/BIG BUCKS system works, I waited until after the election to see if he would be able to break whatever Faustian deal he had had to make with the money lenders for them to allow him to be nominated.

    The answer came quickly with 2 named to his economic team--Geithner and Summers.  The cherry on the sunday came when he, BO, retreated behind closed doors with the medical industry giants to finalize ACA.  We'd already seen that Single Payer was off the table. But, when he emerged from the final meetings, sure enough, Puff the Magic Dragon, the "Public Option" had vanished also.

    Since then, I have been waiting to hear tales like yours, Annan.  Unfortunately, I think we are going to hear many more tales like yours.  Capitalism feeds on cruelty!  It is a result of maximizing profit.

    Capitalism is antithetical to democracy.  It is also antithetical to kindness and human caring.  

    Best wishes to you, annan.  Thanks for posting this.

    Wh00t!

     

    the war being waged...is the relentless ...struggle... by the rich against the poor. " by Andrew O'Hehir in "Salon"

    by dharmasyd on Sat Oct 05, 2013 at 10:25:33 PM PDT

  •  We need to work for a system... (2+ / 0-)
    Recommended by:
    annan, worldlotus

    Where it is the U.S. citizen who has the "choice" of providers, not the insurance corporation.

  •  Sorry you may fall between the cracks (4+ / 0-)
    Recommended by:
    annan, DeadHead, Willa Rogers, auapplemac

    I wonder how you can get the word out about the cracks and how they effect the formerly ill and chronically ill who have an established medical team. People who become ill NOW can build their team from what is at hand in their plan but your situation (and mine) is different.

    I have some sort of inflammatory problem synergistic with a bunch of injuries that won't heel. I've finally found a medical team that treats me with respect rather than dismissing my concerns, and believes my experience rather than saying in not so many words that it is in my head.

    I was offered a managed care type plan (I'm in MA) that my state is trying to put disabled people who have Medicaid and MEdicare on. They kept saying that you will NOT LOSE any coverage. Well, I had a choice of two plans and looked deeply into each by having to contact each company (the Medicaid literature sent did not go deep enough)

    I found the same thing you/the diarist did. BOTH plans offered left one or more of the gang of three (PT, PCP, Specialist) out of network.And one would not pay for an important drug I am on.

    I feel so VERY SORRY for the numerous people who will sign up for this and then find out they lose their regular people. Medicaid people are not in the place usually to be able to pay out of network fees, and again this is aimed at the disabled and chronically ill. SO, the very people who need to KEEP THEIR TEAM are being pushed to not have them. I doubt that many people who got this packet had the time or energy or where-with-all to check into it as deeply as I did.

    So, I should take my advice and contact the state about this. I will.

    Of note, I did have the option to stay on regular Medicare and that is what I am doing even though it means giving up some attractive extras the new dual plans offer (like a case manager/advocate). Unlike, seemingly, the diarist. I live in fear that they will make this a mandatory change. It was so hard to find doctors that would listen and look into the causes of what was up with my body. These ones did and are finding solutions. I would be furious to have toreinvent the wheel.

    Hope your situation works out, diarist. It is really stupid when well meaning people and programs put a barrier in your path, a wrench in the works.

    •  Yes. Reaching people like you is why I wrote this (2+ / 0-)
      Recommended by:
      DeadHead, auapplemac

      diary, jplanner.  I hope that you will find the wherewithal to keep your team together.

      Unless you've been through what we've been through, its hard to truly grasp the relief: you can finally relax, knowing that you have a team of people who listen, understand, have compassion and are willing to work with you.

      Take your own advice: become an advocate in whatever way you can!

      "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 Sun Oct 06, 2013 at 12:20:15 AM PDT

      [ Parent ]

      •  To annan and all those who find themselves in the (1+ / 0-)
        Recommended by:
        annan

        same position, you have my best wishes.

        I will also do whatever I can to support changes that will make it easier for all to get the treatment they deserve.

        Healthcare isn't about getting treatment for a cold or a minor allergy. It's about life! It's about getting quality care when you're life is in question.

        It should not be a crazy maze or anxiety provoking.

        Having a major health problem creates enough anxiety. Getting the best care should not!

        It’s the Supreme Court, stupid! Followed by: It's always the Supreme Court! Progressives will win only when we convince a majority that they, too, are Progressive.

        by auapplemac on Sun Oct 06, 2013 at 03:19:12 AM PDT

        [ Parent ]

  •  Thank you for this informative diary (1+ / 0-)
    Recommended by:
    annan

    I hadn't even thought to check if my doctors would be in network. Now I'll make sure to.

    Good luck with your situation--I know it sucks.

  •  I don't care for networks. (1+ / 0-)
    Recommended by:
    annan

    When they are good, they are fabulous. When they are bad, you are trapped.

    :(

    I am so thankful you made it through this terrible disease. I hope your life is full of health, happiness and wholeness from now on.

    Gentlemen, congratulations. You're everything we've come to expect from years of government training (Zed, MIB).

    by GreenMother on Sun Oct 06, 2013 at 04:08:44 AM PDT

  •  As is sometimes the case with insurance companies (0+ / 0-)
  •  Indiana: No Regulations re OON Balance Billing (1+ / 0-)
    Recommended by:
    annan

    Important Reference for All States
    Balance billing describes the situation where a provider seeks to collect from a MCO enrollee the difference between the provider's billed charges for a service and the amount that a MCO paid on that claim. (Note that balance billing rules typically do not apply if a service or benefit is not covered by the enrollee's plan.)

    Very important to understand just how Obama shorted us.
    •  splashoil, this is an important point (0+ / 0-)

      and thanks for providing the link in this diary. The info at splashoil's link is worth knowing about.

      A commenter upthread mentioned how challenging this is going to be for individuals who have never had to navigate the health care maze before. I'm sure that's why the ACA provided for "navigators" and other reliably informed nonpartisan advisers are available to help. Of course, we all know how the saboteurs are working overtime to prevent them from doing their jobs.

      In the meantime this is an important point to highlight

      Most enrollees with private health insurance are covered under some type of managed care organization (MCO), either a health maintenance organization (HMO) or a preferred provider organization (PPO). MCOs have networks of providers with whom they have negotiated reimbursement contracts. Enrollees of these MCOs take comfort in believing that if they follow the MCO rules, they will not face costs greater than their premium and required cost sharing (copayments, deductibles, and co-insurance) for benefits and services that are covered by their plan ....

      In most states, "hold harmless" provisions are required by state law to be included in contracts between HMOs and participating providers. States may also require this type of language in contracts between providers and PPOs. To date, however, few have passed laws directly restricting out-of-network providers from balance billing MCO enrollees.

      I disagree with your comment about Obama, however. This is happening because saboteurs at the state level are applying pressure. We need to press back.

      "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 Sun Oct 06, 2013 at 09:14:09 AM PDT

      [ Parent ]

      •  These Problems are not new. (1+ / 0-)
        Recommended by:
        annan

        They were well known by the crafters of the legislation and choices were made.  The buck does stop in the WH and the current mess is the direct result of choices made there.
        With that off my chest, I will do my best to present information that goes to the actual results.  I was an early Obama enthusiast, so I do have some responsibility for his decisions.  Knowing what I know now I fear this plan will have a serious blowback at the polls.  When you start paying for something that you know is bogus because of a mandate there is a visceral reaction.

    •  Loopholes to skirt Treatment: Cancer Edition (1+ / 0-)
      Recommended by:
      annan

      Cancer Edition: Loopholes

      The myth (from the brochure)

      Taylor Wilhite of Marblehead, Ohio, was diagnosed with acute myeloid leukemia in 2007 at the age of 8. She received three rounds of chemotherapy, had a bone marrow transplant, and at one point was taking 23 pills a day along with many IV medicines. Now age 12, Taylor is in remission. But the costs of her treatment quickly reached her insurance plan’s lifetime benefits cap, leaving her family struggling to pay for the care she needed for the side effects of her treatment.

      The Affordable Care Act does not allow health plans to place lifetime caps on coverage. The law restricts and soon will ban yearly limits. This will give people like Taylor and her family peace of mind that coverage will not suddenly end because of caps on benefits.

      The Reality Scenario:

      Yes! Affordable Care Act removes lifetime caps so my child can have their lifesaving bone marrow transplant! Yayyyyyy.

      Okay, here’s the national registry for locating bone marrow transplant centers. Let’s look them up and go see ‘em and save my baby’s life!

      Okay! So for my Washington state, the transplant centers are Seattle Cancer Care Alliance (SCCA) and VA Puget Sound Health Care System.

      Okay! Well, I’ve signed up for a Blue Cross/Blue Shield plan on the Exchange. BCBS brags of having the largest provider network in the country. And WOW, SCCA is local so we don’t even have to travel!

      Oh, SCCA is not on my provider list, and nor is the VA Hospital? Gee, did I choose the wrong insurance? Well, it’s open enrollment time. I can change. What? None of the insurance companies on my state Exchange have SCCA or VA Hospital in their provider list?

      OMFG!!!!! Well, I guess we’d better not cancel those bake sales and grocery store money collection jars after all.

      •  Splash, we really need to be pushing back on this. (1+ / 0-)
        Recommended by:
        splashoil

        I agree. These narrow networks are going to be the source of many, many difficult stories.

        I read an unconfirmed report that there is (or will be?) an escape route to jump outside the narrow network to get treatment at regional med centers that are out-of-network.

        We need to make sure this happens before we start reading stories like this.

        "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 Sun Oct 06, 2013 at 01:46:44 PM PDT

        [ Parent ]

  •  Do the ACA plans say that you must use network? (1+ / 0-)
    Recommended by:
    annan

    Most policies with which I am familiar have two tiers of reimbursement, a higher level for in-network and a lower level for out-of-network.  

    I have never encountered a plan that says you must use network only.  Is that what these new plans say?

    I would be great is someone would post the terms of the actual policies so that we could compare.  

    •  Great diary idea and I'll consider it as (0+ / 0-)

      I'm sorting through my options.

      In the past that's been my experience, too. Out-of-network was a higher co-pay, but not significantly so. And most of the specialists I wanted to see were connected to a wide array of networks.

      If I am reading the ACA policies for Indiana correctly, that's not how these narrow networks are being designed. If they have a provider in network who can give you the care, that's it. No reimbursements at all out-of-network.

      "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 Sun Oct 06, 2013 at 09:38:25 AM PDT

      [ Parent ]

  •  Something that no one seems to have pointed out... (0+ / 0-)

    "out of network" does not mean that you cannot see a particular doctor.   You can go to out of network healthcare providers.  

    It's just that you'll have to pay a portion of the cost.  That's where the deductibles and the out of pocket maximums come in.  If you go to in-network providers only, then all you ever have to pay is the specified co-pays.   If you go to out of network providers, then you have to cover a portion of the costs -- the difference between what the insurance company pays to network providers, and what the out of network doctor charges, and the deductible comes off the top.  BUT that is only up to the limit of your  "Maximum out of pocket".  After that, if you've been referred to an out of network provider, like an oncologist, the entire amount will be covered by your insurance.

    This has always been true, and it will continue to be true.  Even more true, because now the insurance company can't say "you've hit your maximum coverage, we won't pay any more at all".

    People worried about limited networks need to look closely at those deductibles and out of pocket maximums.  If they are not too high, then a limited network doesn't matter that much.

    •  Unfortunately, that doesn't appear to be true (0+ / 0-)

      for our new ACA plans in Indiana. I'm going to make some calls next week, but it appears that out-of-network means you are SOL if you want to see an out-of-network doctor for whatever reason. Nada. Zip. No cost sharing at all.

      I know this isn't how it used to work and that's why it jumped out at me. These very thin, narrow networks under the ACA appear to have a new paradigm: if you're out of network you are 100% on your own.

      If I have misinterpreted the plans I will repost.

      "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 Sun Oct 06, 2013 at 09:13:16 PM PDT

      [ Parent ]

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