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My husband and I received separate letters from our primary care physician, a woman we’ve been going to for seven years. The letter told us about “an exciting new program being offered in my practice.” There will be wellness programs, “leading-edge tools” (not revealed) and technology for “individualized treatment.” She will be reducing her practice and only be servicing these customers... er, sorry, patients. And there’s an annual fee to see her now.

When he finished being mad, my husband said, “Obamacare Derangement Syndrome.”

“Guess we’ll be looking for a new doctor,” I said.

The company involved is called MDVIP. Their member physicians charge $1500 a year for patients to receive wellness care... that ACA covers.

But here’s where the rubber really meets the Obamacare road:

“As part of healthcare reform,” the letter says, “it is expected that millions of Americans will be seeking healthcare from the same number of primary care physicians....”
In other words, my doctor is hinting she’ll be swamped with millions of unwashed minorities demanding their “free” Obamacare while you, hard-working-tax-paying-white-rich-person-with-company-paid-for-insurance might have to wait a whole extra day to see the doctor if it’s just a routine check-up!
“MDVIP will help protect our doctor-patient relationship.... As a member of an MDVIP practice, you will also enjoy on-time, unhurried routine and same-day appointments....”
I’m still trying to figure out how I can get an appointment that will be “on-time” if she’s seeing people at an “unhurried” pace. The last doctor I went to who had a policy like that kept me waiting 5 hours (not kidding).

But, yes, I get it. It’s “concierge medicine”; a way to exclude the unwashed masses surely coming to her doors.

Now, I really like this lady. She kept me alive over a holiday once, so I have more than a little reason to think well of her. But I’m also on Obamacare. Heck, I was on early Obamacare (PCIP). And before that, she was giving us a cash discount on visits because we were uninsured (we dropped our insurance when the bill ran to $1800 a month for 2 healthy people with pre-existing conditions and no one would insure us for less).

Yes, I’m writing a letter to her, explaining why she isn’t my doctor any longer. I doubt she’ll care.

To say I’m pissed is an understatement. But I’m not just mad for my family. I’m angry for all the other families whose doctors are buying into this cynical, greedy program, and depriving patients of access to an ever-dwindling pool of primary care physicians. All because the doctors are sure they’ll have to treat more people than they want to see, or won’t make enough money on what ACA pays, or are just generally greedy.

Meantime, anyone know of a good doctor in Reno who isn’t Obamacare-phobic?

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Comment Preferences

      •  Concierge Medicine...fine...but let's expand the (32+ / 0-)

        Number of medical schools, the number of slots in medical school, AND produce more Nurse Practioners.

        Nurse  Practioners in particular offer a highly cost effective way to deliver primary care in a supportive patient-centered fashion.

        Having worked with many NP's, the only change I would make is a formal one year post-graduate internship, which would help them transition to INDEPENDENT Practioners.  They should be allowed to open their OWN practices in every state!

        •  I like NPs fine, but I'm not paying $1500 (15+ / 0-)

          Again, this isn't just a case of concierge medicine and maybe I'd be better off with a Nurse Practitioner (I'd be fine with that). The problem is that a) the doctor is reacting to a Heritage Foundation talking point and b) I CAN'T afford to pay $1500 a year for nothing (recall that the wellness program is covered by ACA).

        •  That's already happening (9+ / 0-)

          and has been happening for quite awhile. The number of accredited medical schools has increased more than 10% in the last 10 years. And roughly the same number are scheduled to open in the next 10 years. Both are more than twice as many as the number of new schools over the previous 20 years.

          •  Thanks for the information...do you have a source (0+ / 0-)

            for this information you can point me towards about the expansion of existing medical schools and the opening of new medical schools?

          •  There is also a program that is run under the U... (1+ / 0-)
            Recommended by:
            ScienceMom

            There is also a program that is run under the USDE called NCFMEA which assess foreign medical school accreditors based on US standards and then states whether they(the accreditors) are considered equivalent to the US assessments.

          •  This might not help much (0+ / 0-)

            Because only about 25% of medical school graduates go into primary care due to the poor pay and ever increasing number of patients one has to see per hour. And of that 25%, only about 5% of those choose to work in rural communities. Hopefully, the ACA will increase payments to primary care providers, and make primary care more attractive to new grads.

            •  Debt (3+ / 0-)

              In addition to increasing payments, the government could pressure lenders to reduce the interest on student debt and institute a forgiveness program for doctors who are willing to work in primary care, especially in underserved areas.

              •  This is IN the ACA for a number (1+ / 0-)
                Recommended by:
                twocrows1023

                of primary care specialities such as pediatrics, internal medicine and even general surgery. There are a lot of loan repayment programs, both federal and state.

                Medicaid payment to providers have been raised to equal Medicare rates.

                I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                by samddobermann on Mon Jun 23, 2014 at 05:14:46 PM PDT

                [ Parent ]

                •  Medicaid Payments (0+ / 0-)

                  Source that, please.

                  I know that when a patient has Medicare AND Medicaid...Medicaid pays zip, zero, nada.

                  For those patients, Medicaid is basically a get-out-of-jai-free card.  I have not noticed any payment increases for patients with Medicaid only.

                  But we don't have many Medicaid patients, either.  As far as I can tell PA Medicaid is paying what they have always paid.

                  When I get an EOB from Medicaid with ANY payment on it whatsoever, I am astounded.  Because 99 times out of 100 they are all no-pay - because primary insurance already paid more than Medicaid allows for the service.

            •  Rural Medical Services (2+ / 0-)

              provided much of the medical care in the rurual areas of East TN. and many of us went to them because of excellent care, and CARING.  We had a few doctors in town, but I Prefereed my Rural Health Clinic. "We could get in for emergencies, also.  They also trained Family Nurse Practitioners for the University of Tennessee and they did a great job.  They also knew all their patients, they cared, and they thought nothing of calling and checking on us if we had been sick and in to see them..  Get PC's, and peds, and midwives in there and for working for 5 years or 6, their medical school and student loan expenses would be paid off by the government....  

            •  Have You Ever Heard Of HPSA? (0+ / 0-)

              Doctors who choose to work in an HPSA (Healthcare Provider Shortage Area) recieve extra money on a quarterly basis, as a bonus, from Medicare.  One of the doctors I have as a client works in an HPSA.

          •  Then how come so many (1+ / 0-)
            Recommended by:
            reasonshouldrule

            medical students in Florida are having to go outside the state for their residencies and then they don't return.  This state is bringing in doctor after doctor, after doctor from India and China and Egypt... There are language issues, they are all specialists and are opening 'complete medical groups' ....

            Unless states and hospitals get certified to have interns and residentcy training for doctor and NP's the numbers are not going to increase.    

            Our doctor here loves the ACA; he has been pushing for it.  We know the ones who are fighting it; they are the high prices, 'god=complexed' doctors, Americans, who really don't give a damn about the masses...  I have tangled with one; my husband and my doctor walked in and realized I was talking to him.  They were both figuring I might have a stroke.  Nope I think he was considering having one.  

          •  New medical schools (5+ / 0-)

            Want a good win-win situation.

            The military offers to pay tuition in exchange for a certain number of years of service. How about the VA providing tuition to bright students for a certain number of years of service in a veteran's hospital. Not all have to be doctors. Medical practitioners, techs, physician's assistants.

            Get a medical degree, no student loans and the experience of working with veterans.

          •  Number of medical schools and successful medical (0+ / 0-)

            students needs to be increased by far more than 10% in 10 years!  Two types of people become doctors - one wants the money and respect, the other wants to help people.  The second should be favored in every way.  
            Currently medical schools and residency programs discourage students and make them think they deserve to be rich after passing through absurd memorization and work hour "hazing" traditions that do not make them better doctors.  

        •  I'd love it if I could see my dogs' vet (12+ / 0-)

          or actually, any of their vets.

          They are always far more caring and attentive than an human doctor.

          Yes, I've had some bad experiences.

          •  There are many many caring doctors...to paint ALL (2+ / 0-)
            Recommended by:
            offred, fly

            doctors with such a broad brush is simply unfair.

            •  Yeh? (1+ / 0-)
              Recommended by:
              Amycat

              Well, I searched for years back in MI and never found a decent human doctor but had no trouble finding vets who loved their patients.  The human docs didn't listen to me and gave me meds that made me worse.  I don't think the brush is too broad at all.

              Since I moved, I have the best doctor I've ever had. He's Filipino and is swamped with patients for good reason.  But it took years and a lot of strike-outs before finding him.

              Our cats have always had excellent vets, who were also fine human beings, so I'm with Catesby on this one.

              Enjoying the Age of Aquarius so far?

              by sendtheasteroid on Mon Jun 23, 2014 at 05:50:44 PM PDT

              [ Parent ]

              •  Finding a good doctor can take time, (1+ / 0-)
                Recommended by:
                sendtheasteroid

                but is well worth the effort.

                I like to think of myself as an educated consumer of medicine.  I have many chronic challenges, but try to stay on top of them.

                Where I am really fortunate is in having an excellent primary care physician.  He really cares.  Most important, he listens to me.  I call and offer suggestions, based on the considition I am addressing.  My doctor has learned, through our developing relationship, that I am more often than not, correct in my assumptions and suggestions.  As a result, we work together in finding solutions to keep me as healthy as possible.  He knows that I hate doctors and hospitals, so when I do call with a complaint, he listens to me.  I wish everyone could be as fortunate as I have been.

                •  Exactly the Doctor (0+ / 0-)

                  I've got here only he believed me from the start.  I had one in MI, who didn't believe me after YEARS of seeing her.  Yes, we're both lucky, and I feel the same about doctors and hospitals as you do, in genersl, but the doctors and hospitals here have proved to be excellent.

                  Enjoying the Age of Aquarius so far?

                  by sendtheasteroid on Tue Jun 24, 2014 at 12:45:21 PM PDT

                  [ Parent ]

        •  Sorry well actually I'm not (1+ / 0-)
          Recommended by:
          sendtheasteroid

          I've yet to meet a Nurse Practitioner who wasn't completely useless. And only one PA who was any good. But she was great. She specialized in epilepsy and after my seizures greatly increased after having meningitis I saw her more often but whenever there was something she didn't know the answer she got the doctor. She actually was a "Physicians Assistant". When I moved she gave me the name of the neurologist she worked for previously. He's been pretty good.

          •  I've have several good NPs (1+ / 0-)
            Recommended by:
            artmartin

            I saw my first NP when I lived in a small town on the Oregon Coast in the early 90's.  She was terrific.  When I moved to AZ, I saw my Primary Care doctor's NP most of the time and she was wonderful also.  The think I've always liked about them is that they take/have the time to actually talk to you and actually listen to what you're saying.  Any real problems they get the doctor in to confirm or further investigate.  Has worked great for me.  I now live in another part of AZ and don't have an NP, but luckily have a very nice older doctor who I'm very happy with.  

          •  Physician assistant - No 's' on the doc (0+ / 0-)

            I have two sisters who are PAs. I won't even bother to defend them other than to say life's a crap shoot.

            Albert So, The Original Socalled Socialist

            by Socalled Socialist on Tue Jun 24, 2014 at 04:16:08 AM PDT

            [ Parent ]

        •  NP (0+ / 0-)

          My Dr. office has 4 Physician Assistants who can write prescriptions, treat me for things, etc.  I am perfectly happy to see one of them.  When I have a "male" problem, they fully understand why I want to see the Dr.   BTW, the PAs are women

    •  I've lived in a lot of countries (24+ / 0-)

      Including the UK, but I must say Australia's system was my favorite.

      I couldn't partake in Medicare there because I wasn't a citizen, but I could walk into a storefront in a mall and buy fully private coverage, no pre-existing condition exclusions, no deductible, just by showing proof of age and address.  For $300 a month.  Doctor's visits were $20.  And none of this "maybe you are covered for a treatment, maybe you're not" nonsense.

      As soon as I came back, I had to pay close to $900 for a high deductible plan that was about as reliable as my ex-husband.

    •  We have already done that but few people are (9+ / 0-)

      aware of it.  The reason most rural areas in the heartland of the country have doctors is that they are Indian and Pakistani for the most part.  It is why medical care and usage is so high in Texas.

      In a town of 3000 the Indian doctor here has six full time workers in his office to deal with insurance claims.  I have never seen more than two in really big offices in LA.

      The population here is so dumb down and conditioned to authority that they simply do as they are told.  They all have about 10 prescriptions each, they agree to surgeries for someone they don't even know.

      I met a young girl of 21 who had been on a basketball scholarship that had had 3 ACL operations and was scheduled for a total knee replacement with a doctor who she had not met and did not know his name.

      People here are sent from doctor to doctor.  Acid reflux don't try the pill first do an endoscopy.  The regional medical center actually listed its income and expenditures to some extent.  In a population of 25,000 over 43,000 endoscopies in one year.

      I am told these doctors all go home for 30 days and they have a loop hole for which they pay no taxes to the US because of it.  They have built hospitals and palaces in India with their income.  I would really like to know if this is true.  What is true is their education was free in India and they encourage as many patients as possible in one day.  Double booking is routine and yes, to now see a specialist like orthopedics--my doctor is now swamped with
      patients from ACA.

      Medicine here has no humanity to it.  I ride a medical bus that has many on dialysis etc.  These patients are in and out of local hospitals and smell very bad from yards away.  Apparently, bed baths and skin care is a thing of the past.  It is rackem and stackem.

      I learned nursing as primary care 4 to 1 ratio and total patient care as an integrated human being.  The only way we choose to do the things we do is by deciding to make medicine a commodity.  Prior to 1980 most hospitals and insurance health policies were essentially non profits.  That is why people did not complain so much because they could afford to see a doctor.

      In 1990 in San Antonio I could see an excellent doctor for 35 dollars they now bill more than ten times that for a 15 min office visit.

      Much of this is because if you are an American physician with all its attendant accountabilities why should you make less than a 25 year old stock broker?

      •  Hippocrates would be fuming. (3+ / 0-)

        "First do no harm" indeed.

        Another example of an industry that, when forced to deal with government 'regulation', first resist it tooth and nail, and then turn around and take advantage of all of the loopholes.  See exhibit A in regards to auto liability insurance, exhibit B for healthcare.

        The Rich and Spoiled 1%'ers are making the Biker Gang 1%'ers look a lot better than they used to.

        by dcnblues on Mon Jun 23, 2014 at 02:34:02 PM PDT

        [ Parent ]

      •  21 is too young for total knee replacement! (4+ / 0-)

        I have had two, one each knee, and even though I needed it at age 40, they made me wait till my mid to late 50's to have one.  They only can do 2 in a life time and they last anywhere from 10 to 20 years max.  The more active you are, the more pounding you give them, such as a basketball player would do, the faster they wear out.  I hope the girl didn't get one.  I know how painful it is to live for years with bad knees, but total knee replacement is a big deal, and there are things you can't do afterwards without causing damage to them, like arobics, very vigourous dancing, or running, anything that pounds on the knee.  Swimming is acceptable, as is biking.  In fact both are recomended.  

        •  Actually, you're providing "old school" knee (0+ / 0-)

          replacement advice.  As a result, you're providing a great deal of obviously very well-intentioned but highly inaccurate information simply based on your past experience.

          I mean, yup, I was told the same darned things back when I was "young".  But times have changed...DRASTICALLY.

          That unwelcome advice to wait from when you were 40 and actually needed the implant and to suffer until your mid-late 50s?  Not any more.  Indeed, they've learned that such advice actually causes harm to other parts of the body!  If this were today and you were 40 now?  You'd get your knee replacements.

          And that old 10-20 years max replacement lifetime thing that we were told?  Not true any more!  The implant designs, the materials used, the surgical procedures, etc. have changed dramatically.  Patients used to be fitted to the implant.  Now the types of implants are fitted to our own personal anatomy.  Most replacements now will last at least 25 years...and more and more are lasting 30-40 years!!!

          Also, that "they can only do 2 in a lifetime" claim isn't quite accurate anymore either.  You see, unlike the 'good old days', when it had to be completely replaced...and there was a really lousy success rate...most revisions now don't need a full replacement...just a "part" replacement.  Kinda like a car :-)  And that can be done multiple times.  

          But, even if it is only two in a lifetime, if they each last 30 years, then that 21 year old girl...if she had her knee replaced now, then again 30 years from now...she would be 81 years old when her replacement "failed" a second time!!
          So it sure sounds to me like we shouldn't advise against early replacements any more just because of what it was like when we went through it...don't you think??

          Plus the recovery rate is infinitely faster than it used to be :-)  I remember the months and months and months it took when I had mine done 20 years ago (by the way, my replacements are still in perfect shape!)  It now takes only WEEKS!!  Amazing!!!  

          I hope your knees are doing as well as mine!!!

      •  Exactly. Some, too many Doctors are the (2+ / 0-)

        generator of the high costs of care. You should be concerned because they are raking in money that comes from your taxes and your premiums.

        This is Texas which has removed any liability for errors, malpractice and even assault and battery from doctors in the state.

        You are not a patient; not even a customer or consumer: you are a profit center.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Mon Jun 23, 2014 at 05:25:55 PM PDT

        [ Parent ]

    •  australia can probably do that (4+ / 0-)

      stronger federal system

      but, perhaps the Feds could allow in several thousand doctors from other countries and have them stiff out the federal systems VA, DoD, Indian Health,  Public clinics.

      hey if a Doctor wants to come to the  US and work for 3 years in the federal sector, i'd let them get citizenship

    •  Let's see how much millionaire doctors (1+ / 0-)
      Recommended by:
      mwm341

      love the global economy when they find themselves competing with doctors from India and China.

      Just another underemployed IT professional computer geek.

      by RhodeIslandAspie on Sun Jun 22, 2014 at 06:04:52 AM PDT

      [ Parent ]

    •  Similar in Canada... (2+ / 0-)
      Recommended by:
      GrannyG, ram27

      Universal health insurance was first introduced in the rural prairie province of Saskatchewan.  When the local "establishment" doctors resisted the provincial government went and recruited well-trained physicians from England and Scotland -- promising them a higher standard of living in Canada.

      Saskatchewan became the model for the rest of Canada, and one-by-one the other provincial governments had to promise medicare in order to win elections (or go down to defeat for not doing so). [Canadian provincial elections are not synchronized as in the USA -- most provincial governments  can go at any time in any year, with a maximum four or five year term.]

    •  Hey! (0+ / 0-)

      My doctor is Chinese here in Sacramento, California, but that was my choosing.

    •  Immigrant Docs (1+ / 0-)
      Recommended by:
      silverfoxcruiser

      Exactly. Cuba exports doctors all over the hemisphere. Maybe we could get some, while we send young Americans to the Cuban medical school.

  •  Doctors are great people, and so are ditch diggers (23+ / 0-)

    and fast food workers.

    Docs like making money, they are human. Your doc isn't the first one to be pissed off and she won't be the last. They'll just have to learn to deal with it. Many of the cost containment measures in the ACA have yet to take effect, when they do the doctor as business person selling extra procedures and tests might well become a thing of the past.

    I like physicians from India, wish we had a few hundred thousand more.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Sat Jun 21, 2014 at 02:13:59 PM PDT

  •  I understand your frustration ... (22+ / 0-)

    ... but ...

    I also understand that an individual physician might prefer to practice medicine on their own terms -- and not by maintaining a revolving-door for 60 patients a day. And even at the cost of alienating a significant number of her/his current patients.

    If we ever end up with a single-payer system here, these are the docs who will maintain their concierge practices for the wealthy few who are willing to pay top dollar for their services.

    I'm not making a value judgment on this; private practices exist (as far as I know) in all places where medicine is state-run or otherwise socialized for the majority of the population.

    "This whole's thing's a business plan for arms dealers! ........ Son ... of ... a ... bitch!"

    by Powell on Sat Jun 21, 2014 at 02:21:39 PM PDT

    •  Exactly (1+ / 0-)
      Recommended by:
      ScienceMom

      In Australia they have private health insurance and state Medicare. Everyone has coverage through Medicare, but most private insurance companies have hospitals and doctors who only see their patients. And if you can afford it, you are expected to buy private coverage otherwise you pay a tax. That helps reduce the burden and the wait times at the Medicare based hospitals.  

    •  As well (0+ / 0-)

      many doctors are just tired of having to deal with ANY insurance companies at all.

      I can see how it would be tempting if some sales human comes into your office promising a solution where you get to spend all of your working hours helping patients instead of dashing between rushed patient consults so you can get back to filling out the insurance paperwork, with the hope you'll eventually get paid so you can in turn make payroll for your staff who themselves are dedicated solely to fighting with the insurance companies about that paperwork.

      •  THAT Is Where People Like Me Come In (0+ / 0-)

        I told my doctor client, when I first started working with him....

        YOUR job is to be in the examining room, and seeing patients and making them better.

        It is MY job to make sure you get paid for doing it!

        He likes that concept.

    •  Just try to FIND it!!!! (0+ / 0-)

      I live in a very rural area--surprisingly to the rest of the US Upstate NY closer to Canada IS highly rural.  

      We have ONE medical office anywheres close by--this is OWNED by a hospital I would NOT take my dog to--I would still have a LEG if I had been taken elsewhere.

      But---even driving an HOUR one way to a different area you find that THOSE practices are owned by hospitals.  Some you might like some not so much.  These hospitals are COMPETING to try and buy as MANY MD's and practices as they can for the income stream.

      This means that any specialized care WILL come from THEIR MD's--keeping it in the family---and if you DARE to opt to go to some one DIFFERENT--woe to you. They act like spoiled children and don't want to co-operate or send info etc.

      To get any kind of specialized care outside a few MD's --like dermatology (and I am not talking "Cosmetic Dermatology" here; Endocrinology; certain surgeons; neurology---you HAVE to leave their systems and go to a larger major area--for me this is an HOUR AND A HALF ONE WAY.  That is the closest but not the best.  High risk pregnancy?  Off to Albany or out of state!

      The "Local Docs" are---well--I like some of the Docs but I HATE the office staff.  Pretty much obstruct all communications and requests.  Getting a message TO the Docs--could take so long you could die.

      And I don't have ACA coverage.  I have what used to be considered the creme de la creme of insurance. Employee sponsored.    Now this might pay for things--and it might not.  The percentages of WHAT they will pay FOR is decreasing;  the fights to get them to pay ANYTHING is increasing; they will "approve" operations but NOT the follow up re-hab or after care.  Sent me home one DAY after a leg amputation with NO follow up care;  no means of access to my HOUSE; if I wanted re-hab I would have had to be able to complete a certain number of HOURS per day or I would have had to PAY for the ENTIRE stay out of pocket yet no one could TELL me exactly WHAT I would have to DO or pay---then they decided I HAD to have ramps at my home or I could not be RELEASED from the hospital! After this they REFUSED to pay for a prosthetic leg.

      Can you wonder WHY we get a bit frustrated here?  And we just had our beloved GP move out of the area.  We now have an NP who seems very nice and has a sense of humor but GETTING to communicate with her is---difficult.  Something I must bring up.  But--she does listen and try and work WITH us.  

      We just NEED more of--everyone in health care.  More MD's More NP's more RN's---and we need to NOT have them worried for YEARS over student loans. This cannot dictate WHERE they practice.

      •  Actually... (0+ / 0-)

        There is a WORSE area.

        And it falls into not getting your re-hab and aftercare paid...as you mention.

        If you are listed as OUTPATIENT...forget aftercare and re-hab.  Not happening.  Insurance won't pay it.

        And here's the rub...you're an OUTPATIENT now....if you're admitted to the hospital and released three days or less later.

        Used to be...Admit = Inpatinet.

        Not anymore.

        And THAT is probably why you're having trouble getting re-hab and aftercare paid for.

        I'm a medical biller/coder and deal with insurance comapnies all day long, take my word for it, this is probably what is happening to you!

        You're being listed as OUTPATIENT.

  •  Both you and your conceirge doctor have to start (44+ / 0-)

    thinking outside of the box. The future of American medicine - and cost containment - lies in the use of Nurse Practitioners. It is well established that about 75% of patients in a doctors office can most adequately be served by a Nurse Practitioner. Yes, in some cases a referral should be made to a MD, just as MD general practitioners now refer to specialists; but the overwhelming number of cases can very successfully be handled by a Nurse Practitioner.

    If this increased use of NPs is followed, you will receive professional medical care, wait shorter times at appointments and watch while the waiting room of concierge doctors empties out.

  •  Having trouble finding doctors as well (23+ / 0-)

    My primary care doctor who I have been seeing for a couple of years and paying cash isn't taking Obamacare. The receptionist said "That's the only plan we don't take!"

    I had to see an ENT and there were none under my plan in a city that has plenty of them. The only ones on the plan locally were pediatric ENTs. I had to drive roughly 60 miles to find one.  I have a car but I'm thinking about those who don't like the elderly or disabled. How would they manage?

    When I got to the doctor's office I looked down at my file when I checked in and at the bottom it said in bold "pre-existing condition" I had never seen this doctor before and I had just developed this condition so I'm guessing it was a code for Obamacare.

    The doctor confirmed my suspicions of what was wrong with me and sent me on my way with an info packet I could have just as easily gotten off the internet, no follow up visit, no referral for further treatment which is not uncommon. On my bill it read that my condition was "unidentified" even though she specifically told me what condition I had.

    I bought the platinum plan and was expecting platinum service but that's not happening in any way, shape, or form.

    I have to admit that I didn't realize that ACA enrollees would be segregated into their own standalone plan. Sure makes it easier to weed us out. Hopefully more doctors will sign on but until then I'm not very happy with my insurance so far.

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

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

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

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

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

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

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

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

          [ Parent ]

          •  No (5+ / 0-)

            A major insurance company, maybe the biggest.

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

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

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

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

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

              [ Parent ]

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

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

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

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

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

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

                  up our asses.

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

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

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

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

                  [ Parent ]

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

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

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

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

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

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

                      [ Parent ]

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

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

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

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

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

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

                        I am become Man, the destroyer of worlds

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

                        [ Parent ]

                        •  If there is (0+ / 0-)

                          one of these:

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

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

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

                          [ Parent ]

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

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

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

                      Ask questions before you buy.  You can change companies.

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

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

                        Congressional elections have consequences!

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

                        [ Parent ]

                  •  Exactly. (28+ / 0-)

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

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

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

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

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

                      [ Parent ]

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

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

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

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

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

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

                        [ Parent ]

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

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

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

                          •  Technically yes (0+ / 0-)

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

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

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

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

                            [ Parent ]

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

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

                            Congressional elections have consequences!

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

                            [ Parent ]

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

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

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

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

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

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

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

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

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

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

                          [ Parent ]

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

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

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

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

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

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

                      by annan on Sat Jun 21, 2014 at 08:21:44 PM PDT

                      [ Parent ]

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

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

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

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

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

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

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

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

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

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

                    Just another faggity fag socialist fuckstick homosinner!

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

                    [ Parent ]

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

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

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

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

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

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

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

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

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

                      [ Parent ]

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

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

                      WTF? Are we all that confused?

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

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

                      [ Parent ]

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

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

                        Just another faggity fag socialist fuckstick homosinner!

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

                        [ Parent ]

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

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

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

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

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

                          [ Parent ]

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

                          But it's more than that.

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

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

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

                          Not so with Out Of Network.

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

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

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

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

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

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

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

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

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

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

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

                •  New Coverages (0+ / 0-)

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

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

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

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

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

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

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

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

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

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

                  Congressional elections have consequences!

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

                  [ Parent ]

      •  Yes its private insurance (3+ / 0-)
        Recommended by:
        NinetyWt, Rogneid, terabytes

        bought through the ACA, better known as Obamacare.

        •  So the doctor's office took offense to (8+ / 0-)

          a plan from a national insurance company?  Whoa.  That's harsh.  I wonder how they knew it was purchased through the ACA.  

          •  I don't know but they do (1+ / 0-)
            Recommended by:
            Rogneid

            Why else would they have put "pre-existing conditon" in bold at the bottom of my file on my first visit?

            •  There's a missing piece to this story (5+ / 0-)

              "You don't know", but "they do"??

              I wonder how they knew it was purchased through the ACA.  
              So do I. Your response about "pre-existing condition" makes no sense in the context of taking coverage from a private insurance company that happened to be purchased through the ACA exchange.

              There are doctors whose practices won't honor certain insurers or insurance groups--but that's been going on long before the ACA. So, which insurance company are you with now?

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

              by lunachickie on Sat Jun 21, 2014 at 03:09:52 PM PDT

              [ Parent ]

              •  It might be possible - in places where only (2+ / 0-)
                Recommended by:
                lunachickie, annan

                one or two insurers offered plans - that a plan could be identified as one sold on the ACA.  Seems like a lot of trouble to go to, though.

                •  Well that's just it (0+ / 0-)

                  in an area like that, there are probably plenty of people with insurance from a company, where some utilize the company on their own, and some because they used the exchange.
                   

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

                  by lunachickie on Sat Jun 21, 2014 at 03:16:52 PM PDT

                  [ Parent ]

                •  It probably has to do with reimbursement rates. (3+ / 0-)
                  Recommended by:
                  Quasimodal, Catte Nappe, annan

                  If a plan, regardless of the company providing it, reimburses at Medicaid rates, it's easily identifiable as an ACA plan.

                  "Two things are infinite: the universe and human stupidity, and I am not sure about the universe." -- Albert Einstein

                  by Neuroptimalian on Sat Jun 21, 2014 at 03:55:54 PM PDT

                  [ Parent ]

                  •  That may be why doctors don't like it (2+ / 0-)
                    Recommended by:
                    terabytes, Neuroptimalian

                    After many calls to find an ENT I asked a receptionist why the doctors didn't accept this plan and she said in essence that it wasn't a good deal for them but didn't go injto specifics. I don't know if there is any way to change that.

                    •  That is the insurance company's decision. (1+ / 0-)
                      Recommended by:
                      worldlotus

                      Because the pool of newly insured under these plans was unknown at the time the prices for care and policies were developed, the insurance bean counters did their best to anticipate what costs would be.

                      An established company with a known pool can better judge the costs AND negotiate with physicians to provide routine care at lower prices.

                      The CBO estimate was 7 million. The delayed roll out decreased it to 6. The final was 8. The estimates are many people who didn't sign up the first year will do so this year for '15. There will be a similar push to get folks to sign up, including the younger ones.  

                      The insurance companies are now crunching their numbers of enrollees, payments, costs, and adjusting the payments and plan costs for '15.  The expectation, given what is happening in healthcare, is the costs will be able to go down - possibly increasing provider payments too.

                      What may well be contributing to this is the shortage of doctors and all other levels of health care. The GOP house was very on top of throwing cogs in the ACA wheel. One was not to fund the Healthcare Workforce Committee which was to address the shortages.

                      I know from physicians I've worked with that they are not members of the AMA because one of it's goals is to keep the numbers of med school grads down to keep MD salaries up. Add the problem of higher ed loans and you have a lot of grads who go on to higher paid specialties.

                      The  pre-existing condition issue is weird. Denying coverage for them was an insurance practice that the ACA did away with. The playing field was leveled so they all have to comply. The doctor's office may differentiate between new diagnosis and pre-existing for a new patient because there can be a significant difference in time for the appt. They are paid according to the reality so as far as I am concerned it was a clerical error by whoever puts their new patient charts together.

                      Did you point out the error to correct it?  Docs and staff make mistakes. I once had a doc put my menopause date as the date of a hysterectomy.  Lousy historian, I corrected it when I got my copy.

                      Until we get single payor, the health care system is going to be a maze. Ask all the questions you can think of. Share info with whoever might be able to resolve it. The insurance company might want to know you are having trouble getting doctors to take their patients. They do have to keep up some level of customer satisfaction or you might change your policy to a company with better ratings.

                      "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

                      by Ginny in CO on Sat Jun 21, 2014 at 05:36:40 PM PDT

                      [ Parent ]

                      •  You have a link to that (2+ / 0-)
                        Recommended by:
                        Overseas, Neuroptimalian
                        The expectation, given what is happening in healthcare, is the costs will be able to go down - possibly increasing provider payments too.
                        Here we were just told we're getting a 13.1% increase in July following on the heals of a 7%+ increase last january which followed a 11% increase in 1/13 which followed on the heels of increase year after year.
                        Until we get single payor, the health care system is going to be a maze.
                        Gonna need a lot more docs
                        •  Costs going down or up doesn't (0+ / 0-)

                          apply everywhere. The prices set by each company and in a specific region will change depending on how accurate the initial price/cost estimates were. One of the improvements I have seen cited (several places, didn't bookmark) is the increases are smaller, some significantly than in the years before.

                          This is on rates for people who had been getting their insurance through employment, depending on negotiations between employers, ins cos and providers. So when talking about the increases and decreases, you have to keep in mind for this 1st year or 2 that the ACA exchange policies are in a subset until the adjusters have more data to work with.

                          Haven't a specific link. The expectation was what the ACA was based on, using insurance company practices and results from MA and other places. I suspect McCarter and Clawson covered it, Brainwrap or others also. I also check Think Progress a lot and get email from some associations.

                          "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

                          by Ginny in CO on Sun Jun 22, 2014 at 12:51:50 PM PDT

                          [ Parent ]

              •  I'd rather not say (0+ / 0-)

                But its one of the biggest. Not sure I follow what you're saying about it making no sense. Why would they put "pre-existing condition" on my file on my first visit when they don't know what my condition is, if any?

                •  It's simple (6+ / 0-)

                  if your insurer is really big, then plenty of others have it. And not all of them bought through the exchange.

                  So if your doctor says "We don't take that insurance" because of where you purchased it--but they take that same insurance from someone who purchased it outside the exchange--they're asking for trouble, no matter what they wrote on the front of your file.

                  I suspect we'll see lawsuits over this kind of thing. Big time.

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

                  by lunachickie on Sat Jun 21, 2014 at 03:23:10 PM PDT

                  [ Parent ]

                •  What State Are You In? n/t (0+ / 0-)
                  •  Florida n/t (1+ / 0-)
                    Recommended by:
                    majcmb1
                    •  Well 4 Large Insurers Are Already Being Sued In FL (7+ / 0-)

                      The case doesn't involve what you describe but if they'll gouge in one area, they'll gouge in another.

                      Instead of paying a flat $10 co-pay at the pharmacy, the plans require patients to pay 40 to 50 percent of the cost of their drug, which could run into the thousands of dollars, according to the complaint which health experts say could have national implications.

                      The groups also alleged that the plans charged high up-front costs and require unwieldy prior authorizations. The complaint, filed with the Office for Civil Rights at the Department of Health and Human Services, asks the agency to investigate the Florida plans offered by CoventryOne, Cigna, Humana and Preferred Medical and require the insurance companies to take corrective actions if necessary.

                      Federal health officials said they are reviewing the complaint.

                      As I'm sure you know, FL's governor and legislature opposed the ACA.

                      http://kff.org/...

                      Wherever state government got involved and supported the reform (not FL), the networks are better and the programs over all are working better. If you ask me, Floridians need better legislators and a new governor.

                      •  I Forgot The Link To That Blockquote... (1+ / 0-)
                        Recommended by:
                        Quasimodal
                      •  Florida is horrible (6+ / 0-)

                        I still cannot figure out why anyone would vote for someone who was tried for Medicaid fraud - let alone make this goniff governor!

                      •  As a Floridian, I agree. We need a new governor! (0+ / 0-)

                        And new legislators.  I personally don't need the ACA, I am on medicare and tricare for life, but in the past I have delt with insurance companies, especially while working as a teacher assistant.  I had a couple of doctors over that time who stopped taking the insurance we had in the school system because they weren't paying them for claims.  We had a teacher assistant at our school who had stomach cancer, had surgery, and when she had been home a week, got a call from the doctors office demanding imediate payment!  She was upset, called the school board about it, and they were livid.  They called the doctor's office, the insurance company, and chewed them out for calling a sick woman about a bill she shouldn't have to pay!  The next year the board got a different insurance company to provide us with insurance, and the problem went away.  This was in the 80's.  This kind of problem with insurance has been going on for decades.  Some companies are very slow to reinburse, or reinburse doctors too little for the doctor to afford to use them.  I  had a very good doctor I liked who I had to stop seeing because his office stopped taking the school systems insurance.  They had just had too many problems with them.  

                  •  I'm betting it's one (1+ / 0-)
                    Recommended by:
                    Quasimodal

                    that didn't offer the Medicaid expansion.

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

                    by lunachickie on Sat Jun 21, 2014 at 03:29:39 PM PDT

                    [ Parent ]

                •  For the possible medical records about your ills? (0+ / 0-)

                  That seems the most likely reason to me.

                •  Your pre-existing condition (3+ / 0-)
                  Recommended by:
                  Ginny in CO, odlid, worldlotus

                  That probably came from the referring doc. It may have merely signalled that you had already been seen elsewhere, and were not walking in off the street cold; but had been referred for specific consult or specialist attention.

                  “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 Jun 21, 2014 at 04:25:58 PM PDT

                  [ Parent ]

              •  Many ACA plans (7+ / 0-)

                come with easily identifiable markings on the insurance card (quite common in CA).

                Also, many ACA plans are only offered though the exchanges, and can be identified as ACA by Plan ID. (Office managers would particularly adroit at finding this out; knowing insurance plans inside-out is their job.)

                So in many cases, maybe even the majority, its possible to find out if a plan was purchased through an "Obamacare exchange".

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

                by nosleep4u on Sat Jun 21, 2014 at 04:27:34 PM PDT

                [ Parent ]

                •  Shoulda read your comment first. (1+ / 0-)
                  Recommended by:
                  annan

                  I just said substantially the same thing, but with a healthy seasoning of anger.  It just seems stupid to me to expect that the doctor's office would not know it was bought on the exchange.

                  I am become Man, the destroyer of worlds

                  by tle on Sat Jun 21, 2014 at 06:32:35 PM PDT

                  [ Parent ]

              •  They know because any insurance purchased (4+ / 0-)

                through the exchange is branded as an exchange plan when verified. And not all exchange plans participate in the same networks as other products offered by the insurance company.

              •  They knew because of the plan. (1+ / 0-)
                Recommended by:
                annan

                Insurance companies sold plans that were sold almost solely through the exchange.  The one I bought, through BCBS, is not a BCBS plan.  BCBS employees instantly knew it was through the exchange, and dumped me to a different company, with some extremely overworked people, and a phone line that was a straw for a fire hose of callers.

                When you go to a doctor, they'll want to see your insurance card.  Do you seriously think they won't have the info as to whether it's an "exchange plan"?

                I am become Man, the destroyer of worlds

                by tle on Sat Jun 21, 2014 at 06:27:41 PM PDT

                [ Parent ]

          •  Doctor offices, hospitals, testing centers etc ... (1+ / 0-)
            Recommended by:
            VClib

            Doctor offices, hospitals, testing centers etc always call your insurance to verify your coverage before you are seen, if at all possible unless an emergency or late at night. They get your group ID number/plan ID number and call to find out if you have met deductible and/or owe a co pay for your visit. They also verify their particular contract rates for their own reinbursment for the visit and/or rates for any known tests or procedures that may be required for that visit (if they happen to know ahead of time...like you are coming in for a leg injury so X-rays might be required).

            Anyway, this is how they know it's Obamacare. They can tell with the ID numbers to that particular plan from BCBS or whoever. One patient might have a certain plan from BCBS that they got with their employer and that plan is not one on the exchanges and they will pay X amount of dollars for an office visit or an X Ray and my deductible might be 500 bucks and will also have a unique ID number to my plan. The BCBS plan in my state off of the exchanges will also have an ID number and might pay more or less for the same office visit or X ray and the patient with the exchange plan co pay might be higher or lower etc. This is how they know....when they call and verify all of this.

            •  Bailey, this is how every well managed physician's (2+ / 0-)
              Recommended by:
              worldlotus, Bailey2001

              office operates. They will know everything about the insurance product you have, verify directly with the insurance company that are covered, and all the specifics about what you owe and what your insurance product will reimburse them, and what they won't, before you arrive for your appointment.

              "let's talk about that" uid 92953

              by VClib on Sat Jun 21, 2014 at 06:50:56 PM PDT

              [ Parent ]

    •  How do they know you got it through Obamacare? (8+ / 0-)

      Seem to me since the coverage is by insurance companies, there would be n difference.  How dis this explained?

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

      by DRo on Sat Jun 21, 2014 at 02:49:58 PM PDT

      [ Parent ]

    •  Obamacare Set Up An Exchange That Lets (8+ / 0-)

      eligible people buy policies offered by private insurance companies. Aetna, Anthem, and Blue Cross, et al. now all issue ACA-compliant bronze, silver, and platinum policies but no one anywhere can buy any kind of policy from "Obamacare."

      Depending on your state's level of support for the ACA, you may have only a few options with narrow networks but that should change and expand in 2015.
      Insurers flocking to ObamaCare

      Any practitioner that's submitting bogus bills, should be reported to the insurance company and to the state insurance commissioner.

      Since discrimination based on pre-existing conditions is now illegal for all U.S. policies, what sense does it make for the doctor to not officially diagnose and treat the condition you say s/he verbally diagnosed?

      Maybe you left some important details out but, other than the narrow network, your story doesn't make much sense.

      •  As Pluto said upthread (1+ / 0-)
        Recommended by:
        terabytes

        Doctors can identify who bought it through the ACA website, better known as Obamacare. I don't know why my doctor wrote that down, or wrote that " I had a pre-existing condition before ever examining me but she did. Not making this up and not leaving anything out. I take no pleasure in sharing my experience.

        •  Then you're better off without that doctor (3+ / 0-)

          that's for damned sure. Expect to see them on a court docket at some point, because what they are doing is discriminatory, unless there's a provision of the ACA that allows for such nonsense.

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

          by lunachickie on Sat Jun 21, 2014 at 03:24:49 PM PDT

          [ Parent ]

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

            My doctor told me that I couldn't get a refill for a prescription for my prostate until I came in for a checkup, and doesn't even give me an prostrate exam when I get there.  

            •  Meant to say my primary care physician (1+ / 0-)
              Recommended by:
              lunachickie

              Not my ENT, which I don't plan on seeing again either.

            •  They don't need to do a prostate exam (3+ / 0-)
              Recommended by:
              Quasimodal, VClib, Cassandra Waites

              What they are doing is making sure that your general health is in good enough shape to continue using the medication, without any indication of adverse side effects. Blood work might provide all they need to know, or even just a check-in sort of check up answering questions.

              “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 Jun 21, 2014 at 04:38:53 PM PDT

              [ Parent ]

              •  Thanks Catte Nappe (1+ / 0-)
                Recommended by:
                Catte Nappe

                but no blood work had done before getting the refill. The nurse took my blood pressure and that was it. No questions at all about my prostate.

                I had also gone for a sports injury which she didn't know about when I was told that I had to come in for a checkup. maybe my BP was all that was needed but it would have been nice for the doctor to be more thorough.

                I told the doctor of some health concerns since my last visit and I got an indifferent "yeah yeah" every few seconds. Ugh.

              •  I have Hashimotos (1+ / 0-)
                Recommended by:
                yoduuuh do or do not

                Low thyroid function.  And I have had it for decades.  And my prescription has not changed in all that time.  

                And yet, doctors insist on me a) coming into their office, then b) sending me to a lab, every three months in order to continue my prescription.

                a) That is ridiculous given my history, and

                b) I remember when doctors used to draw blood in their office and send it to the lab.  Now you have to take time off to sit around and wait for two appointments.

                •  Interesting (0+ / 0-)

                  Obviously there are many different approaches. My doc has a representative from the lab in the office, who does all the blood draws, and runs many of the tests on site.

                  “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 Jun 21, 2014 at 05:54:56 PM PDT

                  [ Parent ]

                •  I have Hashimotos and I get my blood tested (2+ / 0-)
                  Recommended by:
                  annan, RN that thinks

                  once a year at my physical. It hasn't changed in years so my doctor said we can move it to every two years unless I start feeling exhausted, etc.

                  It sure seems like your doctor is overtesting you.

                  President Obama at Madison Rally 9/28/2010 - "Change is not a spectator sport."

                  by askew on Sat Jun 21, 2014 at 07:26:23 PM PDT

                  [ Parent ]

            •  Well theres your ANSWER (0+ / 0-)

              If you went TO that MD for a PRE EXISTING CONDITION relating to ANY part of your body-in this case your PROSTATE---that IS the "Pre-Existing Condition".

              This was NOT a new diagnoses JUST made by this MD.  

              Unless YOU did not TELL the MD you had been seen at some point--and been medicated FOR--this condition--it WAS the pre-existing condition.

              IF you feel that this NEW MD should have done a PSA or a physical exam---and they did NOT or did not set you up for this---well turn around and LEAVE.

              I suspect--from family experiences here---you went to a Urologist and had to TELL them in advance why you needed to see them--or your GP's office HAD to tell them WHY.

              And of course they are NOT going to give you an automatic refill of an RX that they did NOT prescribe.  

              That would be a basis for a mal-practice suit waiting to happen.  

              I used to work in an MD office and we got this sort of thing ALL the time.  I also (irony alert here) used to work in a mail order pharmacy call fulfillment center and we got these calls ALL the time--I had a bottle of XYZ that Doctor ABC gave me before he died 5 years ago and I don't understand WHY you won't just refill it!!!!

              But there IS your answer--you HAD a pre-existing condition ergo the "Pre-Existing" condition note on your chart.

        •  I'm Not Saying You're Making It Up. The ACA (0+ / 0-)

          has been deliberately distorted for 4 years by the defenders of the status quo and even many doctors appear to be confused about its requirements.

          But unless you or the insurance company told this new doctor that you purchased your policy over the exchange, the doctor has no access to that information.

          Even the federal website didn't ask applicants whether they had pre-existing conditions so what you describe seems pointless on the insurer's and the doctor's behalf.

          Financially, the insurer will have to spend 80-85% of all collected premiums on health care, so why would the insurer set up a system that might lead to less health care for its customers? Similarly, why would the doctor charge for a single office visit and pass up fees for treating a verbally diagnosed condition?

          •  "the doctor has no access to that information" (7+ / 0-)

            Not true.

            Firstly, start with this: many plans offered on the exchanges are offered only through the exchanges.

            Many insurance cards from ACA-only plans come with easily identifiable markings on the insurance card. This is quite common in CA.

            Further, even if teh card looks vanilla, many ACA-only plans can be identified as such by Plan ID. Office managers would particularly adroit at finding this out; knowing insurance plans inside-out is their job.

            So in many cases, maybe even the majority, its possible to find out if a plan was purchased through an ACA exchange.

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

            by nosleep4u on Sat Jun 21, 2014 at 04:34:49 PM PDT

            [ Parent ]

          •  simple answer (1+ / 0-)
            Recommended by:
            JayRaye
            Financially, the insurer will have to spend 80-85% of all collected premiums on health care, so why would the insurer set up a system that might lead to less health care for its customers?
            Because the law wasn't written by Mother Theresa…it was written by and for the FOR PROFIT health insurance industry.

            As they say, the devil's in the details. There are a lot of details in 2,800 pages that no one bothered to read.

            See that road kill back there? That's single payer the Obama Bus ran over.

          •  The do know once the call to verify your plan a... (0+ / 0-)

            The do know once the call to verify your plan and have an ID for that plan. See my comment about this procedure.

          •  As far as a doctor finding you have a preexisting (0+ / 0-)

            condition, there are probably enough records available to the doctor to find that out.  I have found some docs don't want to take patients with certain problems.  Also, there are alot of bad docs out there, who are in it for the money, care less about the patients.  I have had a few.  I have had just a few good ones, two really great ones.  My current doc and the one I used to have about 14 years ago who I think worked herself to death are the great ones.  I pray everyday that I don't ever lose the one I have, as it is hard to find the great ones.  I have several preexisting conditions, have had disabling conditions since age 19 and I am now 59.  I have been to too many specialist to count and to quite a few GP's.  I have seen docs who knew they didn't know about my conditions and admitted it, and docs who tried to fake it.  I have educated myself, found I sometimes understand more than docs do.  

        •  I would not take a random internet poster ... (0+ / 0-)

          as holy writ.

          It would be amazing if all the hundreds of insurance companies with different plans could agree on a "coding" for Obamacare.

          Still -- would need more confirmation than a single post.

        •  Say whaat? (0+ / 0-)
          Doctors can identify who bought it through the ACA website
          I don't think so. That's protected information.

          What they can know is that something called the Aetna Platinum Premium Individual Plan is one that Aetna marketed only through the exchange, and that Aetna has offered them the lowest possible reimbursement rates for it. Your anger needs to go the insurance company that is selling you a plan that has worse terms than the one they offer to the big employers buying group 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 Jun 21, 2014 at 04:34:28 PM PDT

          [ Parent ]

          •  No, they can. (5+ / 0-)

            Check my other comments.

            Sometimes its even obvious on the insurance card.

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

            by nosleep4u on Sat Jun 21, 2014 at 04:37:31 PM PDT

            [ Parent ]

            •  Nope (1+ / 0-)
              Recommended by:
              VClib

              Unless you can post a pic of a card that says "this customer bought his plan on the Obamacare exchange"

              What's "obvious" to them is what I just posted - the name of the plan is one that has "negotiated" unfavorable reimbursement rates with them. They don't know or care if you bought it on the exchange or through a broker, they don't know or care if you are getting subsidies or paying it all out of your own pocket. They do care if that particular insurer and/or that particular plan are not willing to pay them enough to make it worth their while. Or in many cases they don't even have the option to accept it, because the insurance company has not allowed them to accept that plan.

              “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 Jun 21, 2014 at 04:45:26 PM PDT

              [ Parent ]

              •  Covered Califoria cards have their own logo. (1+ / 0-)
                Recommended by:
                terabytes

                This has been discussed repeatedly here on DKos.

                And apparently, you didn't bother reading my other comments on this. But continue on uninformed if you like.

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

                by nosleep4u on Sat Jun 21, 2014 at 04:53:13 PM PDT

                [ Parent ]

              •  For a complete explanation of how and why (3+ / 0-)
                Recommended by:
                Catte Nappe, VClib, terabytes

                providers know for one carrier, Anthem BC in California, see here.

                Covered California logo is included on Anthem Blue Cross ID cards, as required by the California state Exchange.
                The presence of the Covered California logo indicates that the health plan was purchased on the Exchange.
                You're right about subsidies, but not about whether the policy was purchased on or off the exchange.
              •  Plan ID will be unique and identify it very qui... (0+ / 0-)

                Plan ID will be unique and identify it very quickly.

                •  What does it matter? (0+ / 0-)

                  If the Dr. Has approved the plans from the insurance company, as he/she does with all the plans they accept, who cares how it was purchased?  It may have lower reimbursements than others or it may not.  I know lots of plans that were issued long before the ACA that many Dr's didn't accept for low reimbursements.  Not every person who purchased through the exchanges gets a subsidy and why should that matter to the Dr. anyway?  As one poster said before, now all insurance plans except a few grandfathered plans are ACA plans because they must comply with the requirements.  It really is about the insurance and the plans they issue more than the ACA.  The ACA just makes sure everyone can purchase insurance and as time goes on, a lot of the issues will be resolved.  If we are lucky, it will all be single payer soon enough anyway.  Medicare for all......it really is time for Insurance companies to stop deciding who gets what from their Dr.  Lets all scream about that form of rationing for a change.  It's been going on for years and years.      

                  •  No that is not true. A doctor who accepts some (0+ / 0-)

                    BCBS plans does not have to accept all BCBS plans. I have run into this myself with my own insurance.  

                    I have a son who has severe medical issues and needs constant care.  We have good insurance with my husband's employer and it is BCBS but there have been times  that my son needed a test or procedure and we have contacted a facility that can do the test/procedure and asked do you take BCBS? The answer is usually yes but they then need my policy and group ID and tell me they will get back with me to let me know if they take ours. Most of the time they do but we have had times were they indeed do not take ours.  Why?  Our policy only covers 50% of outside procedures if it's a stand alone and  not afflilated with a hospital (and some particular test they allow only if he is an inpatient versus out patient status).  We generally will pay the rest when this happens and then appeal to our insurnace company if that test is one that is a lot cheaper than going to a hospital or our local ones referred us out because they themselves don't do it.  We almost always get out money back and everything else about our insurance has been great for us.  However, some places just don't take our policy because they are a stand alone unit and know this about our policy once they call to verify.   I guess they don't want the hassle of billing someone even if we tell them up front that we will cover it.  

                    So, yes, a doctor/hospital/testing center can pick and choose which insurance they take and even accept certain policies of the same company and deny others....and, yes, it can be soley related to how much they are getting paid upfront.  

    •  What's that mean? "not taking Obamacare" (0+ / 0-)

      There is no such plan as "Obamacare".  Your plan would be BCBS or Cigna, or Aetna or some such. Your doc has no reason to know or care one way or another whether you have subsidies under  Obamacare. That makes no sense.

      “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 Jun 21, 2014 at 04:19:46 PM PDT

      [ Parent ]

    •  "Pre-existing condition" may have been to (1+ / 0-)
      Recommended by:
      Quasimodal

      identify you as someone who is newly insured because no insurance was available to you before due to a pre-existing condition (wouldn't have to be related to what you went to the ENT for). I'd suspect this if you were going with a referral or records sent from your primary care doctor, which isn't clear from your post. If not, I'm not sure where they'd get the info. They can certainly tell if you're on an exchange plan, but I don't think they can tell if you're getting a subsidy, or for how much.

      The "pre-existing condition" category of patient, especially those who've been getting care and paying cash, is more attractive to doctors than patients who are newly insured because they could not afford insurance before the ACA and its subsidies. Definitely not saying that's a good thing, just that in your case it may have operated in your favor.

    •  Since MDs are licensed (0+ / 0-)

      by the state, I would report this  to the Medical Board of your state. It sounds unethical for openers and also subpar for the standard of medical care expected from licensed physicians in ANY state. Even Red states.

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

      by cagernant on Sat Jun 21, 2014 at 05:41:24 PM PDT

      [ Parent ]

    •  Insurance companies planned this (0+ / 0-)

      When you're on your own, even if the coverage is mandated, there are loopholes. And if these nasty companies can find the loopholes they will. Our new plan wouldn't take the Physician's assistant that works in the office of a doctor ON THEIR PLAN. Insurance companies need to go!

    •  Platinum doesn't mean better care (0+ / 0-)

      It means your co-pay is lower for covered services and instead of having the insurance company pay 70% and you pay 30% as with the Silver, on the Platinum it's 80%/20%.
      Still it sounds to me that this doctor's office was out of bounds and I'd take it up with the insurance company if they say that doctor is on their plan.

      I am on a Medicare Advantage Plan and I have all the same problems that people have with ACA, and still think it's the best deal I've ever had.  I grew up in a military family, born in a military hospital, and married a military man.  Only ever had military medicine until I was 40 and got divorced.  The joke used to be if you went to sick call you were going to have problems, but once you got to a specialist the care was excellent.  However, we women used to say if you had your pelvic exam/pap smear scheduled  and when you went in the doctor's office he had a model of a foot on his desk, instead of a uterus, you were going to have a problem.  However,when I need treatment for infertility, my Navy doctor in San Diego in 1968 was rated #2 in the nation for infertility care and my care was excellent.  Some doctors are, and always have been, better than others in both care, manner, and skills.  Some are greedy, some are just not good at empathy, but I think most do the best they can.

      My  42 year old son has a pre-existing condition and after he lost his job he had been without care for a year before the PCIP part of ACA started.  He started getting good care and now that PCIP has morphed into regular ACA and he is back working, he is still getting good care.  

      I walked into one doctor's office in Scottsdale 5 years ago who had a sign on his front desk that said he "didn't take Medicaid" and I never went back after that appointment.  I'm not on Medicaid, but I refuse to see a doctor who's only in it for the money and won't see a patient who needs help just because he might not get paid as much. If they don't care enough to take a few "low pay" patients, they don't have the right heart to be a doctor as far as I'm concerned.  Of course, now with ACA they are paying the same as Medicare for Medicaid patients so I would have hoped that problem went away, but apparently the greed is still going strong with some.  I would have had the same reaction as you did to your doctor's refusal to take ACA insurance.  Thankfully, few of them are like that.  

  •  A fairly good argument for immigration (3+ / 0-)
    Recommended by:
    fly, ban nock, Rogneid

    Frankly, at least in the city, I've been happier with a higher proportion of non-US-native health providers than US ones.  My sense is that it's a money motivation issue; a larger proportion of US-born folks getting into healthcare are "in it for the money" than non-US ones, and you see that when you go into rural areas where medical pay is merely qualification-appropriate as opposed to lucrative, and then the national and cultural background doesn't matter; a high proportion of them are good across the board.

    Bear in mind that this is an Upper-Midwest-based experience, rural and urban; your mileage may vary elsewhere.

    •  Give Free Medical School (8+ / 0-)

      has been a thought of mine for some time. We need doctors, and it's almost impossible for kids bearing the crushing amount of debt they graduate with to do anything but maximize their dollars-out on their practice. I'm not against folks from outside the US practicing here. But I'd like not to exclude those who were born here and want to practice.

      •  a friend borrowed for med school. He earns ten (4+ / 0-)
        Recommended by:
        Pluto, Rogneid, terabytes, worldlotus

        times what he borrowed in one year now.

        Yes med school costs a lot. Some specialties also pay a lot.

        How about if all state schools are at very low cost for everyone. Right now the poor and lower middle class are excluded from University based on lack of funds.

        “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

        by ban nock on Sat Jun 21, 2014 at 03:01:55 PM PDT

        [ Parent ]

        •  the problem (7+ / 0-)

          with high medical school costs is it encourages graduates to choose high-paying specialties, rather than primary care.

          Fewer primary care physicians and more specialists = higher medical costs.  

          Only in America.

          There is no snooze button on a cat who wants breakfast.

          by puzzled on Sat Jun 21, 2014 at 04:32:16 PM PDT

          [ Parent ]

          •  good point (1+ / 0-)
            Recommended by:
            puzzled

            that's why my friend chose his specialty.

            “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

            by ban nock on Sun Jun 22, 2014 at 11:40:18 AM PDT

            [ Parent ]

            •  Thats all fine n good but--- (0+ / 0-)

              Thats all fine n good for that specialty.  Which surely will NOT be coming to MY rural area anytime soon.

              Is this a doctor to treat diabetes?  WE don't HAVE any of them.  We don't HAVE any neurologists.  We don't HAVE any dermatologists--medical OR cosmetic.  We don't HAVE pediatric specialists of ANY kind.

              Need any of these?  Need a General Surgeon?  Need an orthopedist?

              Prepare to travel an HOUR one way for ANY of these and most not worth the trip---so onwards to an HOUR AND A HALF ONE WAY Drive plus wait time and multi appointments for ANY of these plus pretty much ANY other "specialized" care.

              Or you can travel---like I do---four HOURS one way for the kidney specialists I was FLOWN into that saved my life;  I make the time for this because they ARE that good.  

              And no we DON'T have kidney MD's that know what they are doing---if I had WAITED in the ER til the NEXT DAY as the "Local" Urologist guy wanted me to do I would be DEAD.  

              And that was one of the "Specialists" at the hour one way  away hospital.  Treating--or not!!!! kidney sepsis over the PHONE.  Refused to come TO the ER to see me---wanted me to sit there for 16 further hours.  And the hospital that EMPLOYE'S him was apparently FINE with my dying before then.  

              What does your friend specialize IN and is he rural or metro?

  •  Yeah, I think I got that letter (2+ / 0-)
    Recommended by:
    Rogneid, Simian

    I take a more sanguine view of the situation.  We want everyone to have enough food to eat, but we don’t guarantee the poor they can dine at the finest restaurants.  We want everyone to have a roof over his head, but we don’t guarantee the poor they can live in a mansion.  By the same token, the rich should be able to buy better health care than the rest of us.  One thing I did not like about the Clinton Health Care Plan was that it provided for a 16-year prison sentence for those who tried to go to a doctor and pay cash for better or quicker service.  It is never a good idea to tell the rich their money is no good.

    By allowing doctors to make more money by charging the rich more, more people will be encouraged to become doctors, which will help lower costs in the long run. If we insist that everyone get exactly the same quality of care, that quality will inexorably decline.

    •  Logical fallacy here: (12+ / 0-)
      By allowing doctors to make more money by charging the rich more, more people will be encouraged to become doctors, which will help lower costs in the long run.
      More people will be encouraged to become concierge doctors, or to choose highly remunerative and low-risk specialties like dermatology. That will do exactly nothing to lower costs for people who can't pay for boutique medical care.

      I don't think we can abolish that kind of medicine, but let's not pretend it benefits anyone except the rich people paying for it, and the doctors practicing it.

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

      by sidnora on Sat Jun 21, 2014 at 03:06:24 PM PDT

      [ Parent ]

      •  Even Worse (5+ / 0-)

        The supply of doctors so limited -- and will remain so because of the difficulty becoming one (in capitalist lingo: the barriers to entry into the profession are high, effectively excluding competition) -- drawing them off to the higher paying gig will further constrain supply to everyone else.  Only in fantasy land does significant additional supply materialize.

      •  Logical fallacies and misinformation (4+ / 0-)

        …throughout. In the US -- as noted by the UN -- there is no basic human right in the US for affordable food or shelter or health care.

        ... we don’t guarantee the poor they can dine at the finest restaurants… we don’t guarantee the poor they can live in a mansion.
        •  we don't guarantee (7+ / 0-)

          the poor they can live.

          So Dickensian of us.

          There is no snooze button on a cat who wants breakfast.

          by puzzled on Sat Jun 21, 2014 at 04:33:37 PM PDT

          [ Parent ]

          •  Oh they can LIVE---- (0+ / 0-)

            Only if they don't bother the REST of us with their silly complaints like--I am hungry or thirsty (we rate far down on the worlds scale of clean drinking water and access to same!)  and I don't have any place to live not even under a bridge and I have no place for  my kids to go and I have this sore--

            AS long as THOSE things don't disturb US we are FINE with the poor.

            After all another guy will come along to clean OUR pool and weed OUR garden and build OUR mansion and provide care for OUR kids and wash OUR car and dig OUR ditches and pick OUR vegetables and sweep OUR floors---

            A different and usually browner "guy".  

            They can't ALL have been deported.  A lot of them simply die.  

            We none of us--even "American Indians"-- came here "LEGALLY".  I know MY ancestors did NOT.  Oh they might have had papers on a boat--but they were not asked to meet the same criteria as todays immigrants legal or not.

            Was this a GOOD THING?  Well lets see--genocide in Ireland (See:: Potato Famine)  Economic collapse in Germany.  Economic collapse and class system in England.  War in Spain drove them to France and then to NYC.  In my husbands case fishing boats brought them--the almighty cod.    

            Did they do menial work?  Some did and some had professions.  All rose with the USA's rising economy--sadly driven by even MORE wars.  

            That was the Old School way to "boost"  your economy.

            Remains to be seen what the New School way is.

            Did they have great health care?  Judging from what they died of--not really.  But--they surely would have had it much WORSE in a country at war.  

            Dickens had it right--we don't mind the poor---as long as they remain INVISIBLE.

      •  It is only a fallacy when viewed narrowly (0+ / 0-)

        What I had in mind was that concierge medicine would be something for doctors to look forward to as they built up a practice.  In the meantime, they will serve those of us who cannot afford concierge medicine, while they dream of the day they can take it easy treating fewer patients for more money.  Hope is a great way to get people to work hard.

    •  OMG, this is so wrong. (12+ / 0-)

      Health care is not a luxury that should come in tiers. Everyone deserves the best.

      Other countries manage to pay their doctors decent (but not obscene) salaries and still provide high level care to all.

      Tracy B Ann - technically that is my signature. I scroll with my middle finger.

      by ZenTrainer on Sat Jun 21, 2014 at 03:18:13 PM PDT

      [ Parent ]

      •  What we have here is a values problem (10+ / 0-)

        When we place a higher value on the pursuit of money than on any other value--this is what apparently passes for "freedom" in our world--this is what you get: the casual acceptance of class warfare at the most basic level of society. Are there no workhouses?

      •  Does everyone deserve the best? (2+ / 0-)
        Recommended by:
        Justanothernyer, peregrine kate

        Do you think everyone deserves the best food?  The best housing?  The best legal representation?  The best education?

        Perhaps you do.  I admit that I like the mixed system we have here in the United States, neither purely socialist nor purely capitalist:  we provide a basic minimum of the necessities for the poor, while allowing luxury and magnificence for the rich.

        Theoretically, a mixed system is a mess.  In practice, the results are pretty good.

        •  One in four US children go to bed hungry (8+ / 0-)

          …every night because they have no food.

          You have no perspective on human rights.

          •  Some very odd reactions to this diary (4+ / 0-)

            My point was to see if anyone else had the same experience. Most are reacting as if this is just okey-dokey. I'm sure once your primary care physician with whom you've built up a relationship tells you, "Up yours unless you pay me more," you just won't get it.

            •  Happened to a good friend of mine, her doctor (3+ / 0-)

              went concierge, but she did it a few years ago before the ACA was even introduced. My friend eventually paid the annual fee because the doctor is really very good.

              The physician in this case went concierge because of the difficulty in filing insurance claims for multiple carriers all with different restrictions and requirements. She now accepts all of the insurance that she did before, but she charges a $500 annual fee. That fee includes 24 hour call back, same day email/text communication and speedy appointments.

              •  Again, this dr is motivated by a RW talking point (6+ / 0-)
                “As part of healthcare reform,” the letter says, “it is expected that millions of Americans will be seeking healthcare from the same number of primary care physicians....”
                And my doctor wants me to pay 3x what your friend does. I can't afford $1500 + insurance + whatever insurance doesn't cover. Oh, and the "wellness plan" the dr. is touting is covered by ACA. I shouldn't have to pay extra just to see this woman.
              •  My doctor in CA went the conceirge route too (3+ / 0-)

                At the time I was making a handsome Silicon Valley salary but I took one look at the "retainer" and just told her there was no way I was coming along for the fleecing.

                I think she was surprised but I never heard a peep from the office again, so they must have had some takers.

              •  I have numerous friends who have concierge (1+ / 0-)
                Recommended by:
                Susan from 29

                physicians, but none of them take insurance of any kind. The physicians are happy to provide a statement of services and if they can get their insurance company to pay something, good for them. Payment is due in full before you leave the office. The typical office visit is 60 minutes and patients are seen one at a time. Most make house calls.

                "let's talk about that" uid 92953

                by VClib on Sat Jun 21, 2014 at 06:37:29 PM PDT

                [ Parent ]

            •  Well, I think it sucks but it's her right. All my (0+ / 0-)

              doctors are Democrats. I'm pretty picky when I shop around for them. I've had my primary care physician for 20 years now. I know her well enough to know that she has never made $100,000 a year in her life and that she supports single pay health care.

              Tracy B Ann - technically that is my signature. I scroll with my middle finger.

              by ZenTrainer on Sun Jun 22, 2014 at 07:44:36 AM PDT

              [ Parent ]

              •  Sounds like mine (0+ / 0-)

                Mine left a big practice where the primary goal was money to open her own small practice where her primary goal is caring for her patients.  She and an NP have a great office now.  The biggest change she made is now instead of going to all the local hospitals herself she uses Hospitalist to see her patients who are admitted to the hospital, freeing her up to see more in clinic patients.  She is an internist and she gets daily updates from the Drs at the hospital on her patients and also approves the treatments.  Seems to be working because it was normal to wait a week for an appointment or longer and now I can see her or the NP in a day or even the same day.  Last time she just sat and visited with me for nearly an hour going over all my test results.  She mentioned that her government patients, Medicare, etc had only a couple of forms she had to fill out and much less paperwork than private carriers. After 30 years of practice,  She is an advocate for single payer.

        •  It's not hamburger helper vs. lobster! (2+ / 0-)
          Recommended by:
          peregrine kate, ZenTrainer

          It's who's going to do your kid's surgery or how and when dad's cancer is treated or how you're put back together after the accident, and that can mean the difference between life and death or whether you make a full recovery or end up crippled. Then again, let 'em die seems to be a Republican value.

        •  I take it you are not one of the poor. (2+ / 0-)
          Recommended by:
          peregrine kate, worldlotus

          For health, education and legal representation I think it ought to be across the board "best for everyone". Equal.

          Tracy B Ann - technically that is my signature. I scroll with my middle finger.

          by ZenTrainer on Sat Jun 21, 2014 at 08:51:09 PM PDT

          [ Parent ]

        •  Short answer: yes. (1+ / 0-)
          Recommended by:
          ZenTrainer

          Because without the best being available, the whole fabric of society eventually unravels.
          See The Spirit Level.
          I'd say more, but I prefer to step AFK to avoid making potentially bannable statements.

          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 Jun 21, 2014 at 09:19:54 PM PDT

          [ Parent ]

      •  ZenT - even in systems with very effective single (1+ / 0-)
        Recommended by:
        disinterested spectator

        payer programs, like the NHS in the UK, there is a separate private pay system for people who don't choose to access their healthcare through the NHS. The same is true for every single payer system in the G8.

        "let's talk about that" uid 92953

        by VClib on Sat Jun 21, 2014 at 06:32:59 PM PDT

        [ Parent ]

      •  Agree about quality of care but not the rest (0+ / 0-)

        My business requires constant, sometimes unpredictable travel. If I stay home, I'm not making money.

        Scheduling regular haircuts is a major challenge - and scheduling anything health-related eats up hours of time before I even get to the doctors office.

        Fortunately I'm healthy so it's all preventative care.  I try to take care of everything at once, but the best I've been able to do, by scheduling months in advance, is to take two weeks away from client work.

        So it is totally worth it for me to pay extra so that I can schedule on short notice, get all my labs, etc done at once and generally avoid multiple appointments as much as I can.

        I already use this option for dental care.  I go to a high end dentist who can get me in quickly for a cleaning when I'm in town, and doesn't mind rescheduling when things change on short notice.

        For my partner and I, concierge medicine is an option that we can afford, that meets our needs and that we are willing to pay for.   Our primary care doctors don't use that model today but when we relocate next year, we are explicitly going to look for that kind of practice.

        In most other countries with national health services, there is a private option for those who can pay more, and for whom the extra payments make sense.

        This is not to diminish the real problems that low income people have with accessing quality care, but I don't see how it relates.

        Even if the entire 1% paid for concierge service (and many of them are too cheap to pay for it) I just don't see how that would take up so much capacity that it would make a significant impact on access to care.  

        We have bigger problems to solve. The high cost of med school and massive debt drives graduating students to high income specialties and away from primary care. A dysfunctional insurance system reimburses specialists at a much higher rate.  Below-cost reimbursements for Medicaid patients make it essentially charity care. Reimbursement imbalances between rural and urban care centers has weakened the medical system in rural areas.

        Plus we will be paying for years both in money and lost capacity for our country's stubborn refusal to cover preventative care for chronic illnesses, like asthma and diabetes.

        Obamacare fixed that, except in the Medicaid refusenik states, but it's too late for a lot of people who are now a lot sicker than they needed to be.

        I agree that everyone should have access to high quality medical care - but I still want the ability to use my money to save time, and I don't see why that's a problem for anyone else.  

        If you have real data to show that I'm wrong let me have it.

        "He not busy being born is busy dying" -- Bob Dylan

        by Kascade Kat on Sun Jun 22, 2014 at 11:34:30 AM PDT

        [ Parent ]

  •  I have health care (17+ / 0-)

    insurance for the first time since 2001.  I go to a Wellness Clinic in our town.  They anticipated the new influx a few years ago so have been doubling the building and have excellent staff.  What they can't do -- they refer out.  Every doctor, nurse, technician I've dealt with takes time to talk, listen and advise.

    So -- yeah, your former doctor can go do her premium non-care shite without you and probably a bunch of others.

    " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Sat Jun 21, 2014 at 02:30:40 PM PDT

  •  If I want a concierge (10+ / 0-)

    I'll move to Paris.

    It's the Supreme Court, stupid!

    by Radiowalla on Sat Jun 21, 2014 at 02:32:53 PM PDT

  •  My PCP started down that same road. (10+ / 0-)

    To his credit he changed his mind and backed out of the deal. I didn't want to change doctors but I sure couldn't afford his new fee structure.

    And this all happened while G.W. was still president.

    Everyone has a plan till they get punched in the mouth - Mike Tyson

    by hnichols on Sat Jun 21, 2014 at 02:34:54 PM PDT

  •  money is going to stop this trend (7+ / 0-)


    the only health care providers who 'don't take Obamacare' also will not be taking other insurance either.  Cash plans and cash only patients will cause a limit to these practices, and they'll eventually become the minority.

    "Kossacks are held to a higher standard. Like Hebrew National hot dogs." - blueaardvark

    by louisev on Sat Jun 21, 2014 at 02:59:48 PM PDT

    •  I was thinking maybe (0+ / 0-)

      that was the missing piece and that the person who told Quasimodal "that's the only plan we don't take" was full of shit.

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

      by lunachickie on Sat Jun 21, 2014 at 03:20:40 PM PDT

      [ Parent ]

      •  I believe you are right (3+ / 0-)

        about the person who claims being denied use of his/her insurance plan because it was purchased through the exchange and seeing pre-existing condition stamped on the medical file. That person is a plant. Very obvious.

        You go to a new doctor, the new doctor wants copies of all your old medical records or has you sign a form to retrieve them from the previous doctor. That person is full of it.

        And that person refuses to identify the "BIG" Insurance Company. If this person is in Florida, it is Blue Cross or Humana.

        And ten years ago my old Oral Surgeon became a cash only practitioner much to my surprise when I came in for a consult and received a 20k estimate for work. Needless to say, I walked out and never went back to him again. ACA has absolutely nothing to do with the greed of a certain segment of Doctors that focus on their bottom line by catering exclusively to the wealthy.

        And to the wealthy jerk above that believes the wealthy are entitled to better health care than everyone else, the Constitution guarantees the right to life and associated happiness and I submit this includes the right to equal access to health care for everyone. The lack of compassion is what is killing this country.

    •  Why not? (0+ / 0-)

      "the only health care providers who 'don't take Obamacare' also will not be taking other insurance either"

      Why would doctors turn down being in a non-Ocare insurance plan that pays adequate rates? Doctors cannot be forced into Obamacare networks.

      Yet.

  •  I've got Kaiser, same day appointments for things (9+ / 0-)

    that need immediate attention. Plenty of docs.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Sat Jun 21, 2014 at 03:03:18 PM PDT

  •  I think the diarist is confused (1+ / 0-)
    Recommended by:
    Justanothernyer

    and having worked front desk in small medical clinics, with a six week temp shift in Jan/Feb this spring, I've dealt with these sorts of issues (insurance and clinic paperwork) a lot.

    I doubt sincerely the letter had anything to do with the ACA/Obamacare. Much more likely, from what diarist wrote, that Dr. joined a healthcare co-op which doesn't take insurance at all. These are becoming more common. A group of MDs work together in a location/clinic. Each patient pays a yearly "membership fee" AND a fee when being seen at the clinic. Any services which might be covered by insurance are the responsibility of the patient to apply for reimbursement from their insurance by sending a copy of the bill and proof they paid it.

    Which USED to be how all family doctors in the U.S. practiced, up until the 1970s.

    The "pre-existing" notation on the paperwork may have been part of the 'tell me about your health now' questionnaire which gives the doctor a heads-up on what you may already be getting treatment/medication for. Again, nothing to do with the ACA/Obamacare.


    "I like paying taxes...with them, I buy Civilization"

    by Angie in WA State on Sat Jun 21, 2014 at 03:34:38 PM PDT

  •  Obamacare still does not address the issue (1+ / 0-)
    Recommended by:
    terabytes

    how to decrease costs by much. I am on good terms with my HR people and our premium kept getting jacked up and we are moving from BCBS to Cigna with less great benefits.

    One thing they need to increase is the number of medical students in the system. Not every specialty of medicine requires the same kind of insane hours. All the current system does is limit the pool of potential medical students to those who are good test takers. Increase that pool and filter them later on. It is amazing that is not easy to get into med school and yet, I see dumbasses practicing medicine who are not half as bright as their nurses. You want to do more filtering - do it at the residency level and keep monitoring doctors who lose their way. We have easy ways to sue doctors but no easy way to really remove bad doctors from the system.

  •  Good for you Grumpy, good for you (4+ / 0-)

    you have class along with an outstanding degree of knowledge on a damn dog whistle.  You betcha there are other doctors who would love to see you and there will be more coming into the pipeline real soon.  Maybe it is a good thing that your old doctor is against all of this as it will make it much easier for her to just move out of the way for the next batch of providers.  Thanks for your diary.

  •  Typical. (1+ / 0-)
    Recommended by:
    GrumpyDem

    Republican docs have been feeding bullshit like this to their patients, same with insurance companies, and it's all a plot to get people angry about Obamacare.

    I mean, where do you think all this bullshit from the right is coming from?

    30, white male, TX-07 (current), TN-09 (born), TN-08 (where parents live now)

    by TDDVandy on Sat Jun 21, 2014 at 04:02:11 PM PDT

  •  She may care if a majority of her (2+ / 0-)
    Recommended by:
    GrumpyDem, worldlotus

    patients write that same letter.  Doctors on retainer.  And I thought we've seen it all.

    The GOP will destroy anything they can't own.

    by AnnieR on Sat Jun 21, 2014 at 04:07:42 PM PDT

  •  It isn't necessarily greed. Or ACA aversion. (2+ / 0-)
    Recommended by:
    Justanothernyer, VClib

    Concierge medicine is a different way of practicing that has some pluses for the doc, and some minuses.  This post gives a fairly well balanced view:
    http://www.thehappymd.com/...

    My husband and I are in one that has for years been more like the first model they describe. We are seen by a nurse practitioner. I've never even met my primary care doc of record, my husband has maybe seen him twice. My prior doc took early retirement some years ago. She could see that the only way to make a go of it was going to be the kind of model our current doc has. Had the concierge model been as popular as it is now becoming, I think she'd have gone that route instead, so she could have the slower pace and the ongoing personal relationships.

    “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 Jun 21, 2014 at 04:11:16 PM PDT

    •  Yes, this is specifically about "Obamacare" (0+ / 0-)

      The letter specifically references a Heritage Foundation talking point. It's being used both the scare the patient and because the doctor herself is being made to be scared of impending low-paying hordes.

      And if you have never seen your primary care doctor, you are in a really bad practice. Just sayin'.

      •  Why? (0+ / 0-)
        And if you have never seen your primary care doctor, you are in a really bad practice.
        He ain't that special. My NP is doing just fine by me.

        “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 Jun 21, 2014 at 04:48:54 PM PDT

        [ Parent ]

      •  It does? (0+ / 0-)
        The letter specifically references a Heritage Foundation talking point.

        “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 Jun 21, 2014 at 04:54:31 PM PDT

        [ Parent ]

        •  I'm pretty sure I wrote this diary (3+ / 0-)

          but apparently it's a Rorschach test and people are reading lots of other things into it. Please see above, but if that's too difficult, please see it here:

          “As part of healthcare reform,” the letter says, “it is expected that millions of Americans will be seeking healthcare from the same number of primary care physicians....”
          If you don't know the RW talking point about how there will be health care scarcity because all the unwashed "free" insured people are going to swarm a limited number of doctors... where the heck have you been for 4 years?
          •  That's not exactly a "talking point" (3+ / 0-)
            Recommended by:
            Villanova Rhodes, odlid, askew

            It is a fact. More people will now be able to seek healthcare. It is a known issue that initially there will be a squeeze because of the numbers of primary care physicians who are ready to meet the demand. The RW solution to that problem is to not provide coverage to keep demand low. The liberal answer is to explore ways to better meet the demand. The article I linked pointed out two ways providers may go to do that.

            “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 Jun 21, 2014 at 05:46:42 PM PDT

            [ Parent ]

  •  As you note, the ACA is simply an excuse (1+ / 0-)
    Recommended by:
    Betty Pinson

    but I think not for the reasons you suggest.  A few years pre ACA my internist sent a detailed survey to find out whether enough of his patients would be interested in a "boutique" medical care.  It was in essence the same thing you've written about here.  I burned him as apparently did most of his patients, and the subject died quickly.  It had to do with greed as you note rather than any excess of demand.  (I also think he overestimated the emotional attachment of his patients.)  This kind of thing goes around frequently with varying explanations for its appropriateness.  The ACA merely provides a new excuse to attempt to gouge.

    Good on ya.

  •  I don't think the ACA covers the range of welln... (0+ / 0-)

    I don't think the ACA covers the range of wellness tests that are performed during the annual physical. I tried this and it was far beyond what I expected on that front. Having said that, I am generally disappointed with the physician.

  •  I would think you'd ask (0+ / 0-)

    what the pre-existing condition remark was about.

  •  I was referred to a doctor with the same (0+ / 0-)

    scheme.

    I passed on it. And you're right... its concierge medicine.

    KOS: "Mocking partisans focusing on elections? Even less reason to be on Daily Kos."

    by fcvaguy on Sun Jun 22, 2014 at 02:33:54 AM PDT

  •  Ironically (0+ / 0-)

    This is the sort of method that [most] NHS General Practitioners (primary care physicians) are paid in England. A typical location may have several doctors, a nurse practitioner  or trained phlebotomist and provision for several types of "clinics" like those for pregnant women, diet advice etc.

    There is however usually a lead G.P. or several partners who, are the nominal payees so I'll refer to the "practice" rather than individual doctors, some of who may be salaried. The practice received a "capitation" amount based on the number of patients registered with them. The amount per patient is varied according the age profile and the practice's location (poorer areas may have patients requiring more care for example and inner city locations obviously cost more).

    In addition there are some target-meeting payments, like reaching a certain percentage of vulnerable patients having annual flu innoculation, tied into a "payment by result" system that also covers secondary health care like minor operations that would otherwise take place in hospitals. (The system is complex but there is an interesting paper on the different systems in use worldwide published by the King's Fund in 2012 .pdf)

    Note though what the GPs do not get is a capitation payment and then additional payments for their basic job of treating minor illnesses and referring to specialists if necessary.

    "Come to Sochi, visit the gay clubs and play with the bears" - NOT a Russian advertising slogan.

    by Lib Dem FoP on Sun Jun 22, 2014 at 05:43:16 AM PDT

  •  I wouldn't be pissed. (1+ / 0-)
    Recommended by:
    Wendy Slammo

    I do see this as a organic business development. If you want to be in the healthcare elite, pay my fee. These doctors hope to limit the number of patients while maintaining their top line. Wish her well, tell her you don't feel her increased service is worth the increased price and move on. I wonder if her practice will survive. You could put up a poll. I'd vote no.

    "I dreamed I saw Joe Hill last night..."

    by Killer on Sun Jun 22, 2014 at 05:44:43 AM PDT

  •  We have been using MDVIP for years (0+ / 0-)

    This in not something new. In fact, if you have a chronic disease, like my wife does, MDVIP comes in handy. Sure, there is an additional fee for it, but, my doctor is at my wife's beck and call. He is instantly available 24 hours a day, no waiting for appointments, and he spends at least an hour with her when she visits. He also helps coordinate the many doctors and specialists my wife has to see in order to deal with her condition. Sure, it may seem like a pretentious luxury to someone who is not chronically ill, but it does serve its purpose. It would be great if everyone could get this kind of service for free, but you all know that is not the case. I am as much a progressive as anyone on this site. However, I care about my wife and I want her to get the best attention she can for her condition. Unfortunately, I have to pay for that. I realize that in reality, our healthcare system sucks. If it didn't, I would not need to pay for this MDVIP service, nor would it even exist.  

  •  MDVIP = vintage HMO (0+ / 0-)

    This doctor's description of her MDVIP plan is old wine in a new bottle.  It sounds like the classic vintage HMOs to come out in the mid 1980s.  The subscriber or an employer would pay a set fee per member per year and you were to get the royalty treatment for patient care, no office costs or deductibles, and no waiting.  But the doctor got to decide what care you needed and whether you got to go to a specialty doctor, or not.  Then they started marking member files as "non payor" which purportedly was a reminder not to charge the member for the office visit.  Problem is as time went on, non payor meant something entirely different  when a member came in for an OV.  To maximize profit, the OV was to be as short as possible and render as little service as reasonably necessary.  It didn't take people longer than a plan year or so to realize they would never want that kind of health care plan!

  •  Please -- post a copy of your letter... (0+ / 0-)

    ... to your doctor on Kos as a follow-up.  And her response to you, if there is one.

    This new approach sounds like a turnkey package that's been put together by a group of swarmy "medical-practice consultants" with a background inventing clever mortgages on wall street.  They  go from doctor to doctor flogging the model... and the package includes everything from staff training to software to the words in the letter you received in the mail.  ONE WORD: Carpetbaggers.

  •  Reno? Not sure. (0+ / 0-)

    (I'm east of you in Sacramento) Have you looked into Kaiser Permanente? I know they are a tad pricey but when I went in for my Endarterectomy, I paid nothing. Not a penny. My poor wife spent two months there with two abdominal surgeries and again, not one cent. I went in today for a free Pnumonia inoculation. I am covered by her retirement, so lucky, lucky, me.
    But I also have Medicare I pay $200 a month for virtually nothing. Good luck to you.

  •  Dropping doctor (0+ / 0-)

    Good for you! We had a doctor we loved. Wonderful man, but he left private practice to teach at a med. school. Then the hunt began. My spouse has found a good one, I'm still hunting. Do any of the young trainees stay awake during class anymore? And if we have a shortage of drs. we need to look into making med. school a bit more affordable to our students. Maybe some of these high dollar folks could chip in a bit to help out a new one. Don't say you don't have it. And everyone in this country should be able to receive medical care, not just the upper 1%.

  •  "Fired my Doctor" (1+ / 0-)
    Recommended by:
    belinda ridgewood

    Sounds like a greedy "get rich quick program" for the doctors. She will have plenty of time to see whoever wants to buy into her joke. I am afraid of how many people are really ignorant and will pay this. And I know a lot of who I used to think were intelligent, but...

    So say she does have 100 patients pay this. A $150,000 base salary and how many really see their doctor more than 2x a year unless having health issues? She will be able to afford a bit more golf and not touch her bottom line.

    I too am on "Obamacare" (OHIO Medicaid).  I have to think long and hard now about whether I will will continue to go to my current doctor or return to my previous one now that I have "insurance". Before I came here I had a doctor I loved but couldn't afford the cost of my medications much less the doctor for my pre-existing conditions after losing my job and insurance.

    Like I said, I will think long and hard. I am afraid of that old adage, "you can't go home".

    I dreaded the kind of medical care I couldn't even afford at the clinic I found. Cost is according to your income. My $12K cost me $30 per office visit w/labs included. I had expected to have to have longer wait times even with appointments like most clinics had in the past but these doctors did not give a cut rate service to match the min amount we paid. I even got in same day a couple of times. Add to that Prescription discounts they helped me to get, often 90% of the previous costs.

    Maybe now more people can have access to these great doctors now that we have "Obamacare".

    (Capital Park Family Health Centers in case you are in the central Ohio area.)

  •  MDVIP (2+ / 0-)
    Recommended by:
    Johnld777, belinda ridgewood

    I, too, have been faced with my physician of 20 years giving me the ultimatum that I must join his MDVIP practice at an annual fee $1,650 or lose him as my doctor.  For this, I would receive same day appointments, longer appointments, lifestyle counseling and numerous tests.  I am not in need of these benefits.

    My daughter who a salaried ER physician at the UCSF medical school (among the top  medical schools in the US) had defined such a practice as "boutique medicine" which benefits the physician financially, makes the patient "feel important" and allows for unnecessary tests.

    I will be choosing a new physician.

    Marylou
    Portland, Oregon

  •  Easily Predicted (0+ / 0-)

    Sadly I knew the Insurance companies would never really go along with the ACA no matter what they said. All of them have been doing their very best to screw people over so they blame ObamaCare and perhaps get it repealed and go back to the days when they could nilly willy screw people over. Although I'm insured through my retirement plan just for drill I called my insurance company acting like I was on the exchange and I got nothing but hours on hold, misinformation and treated like I was on welfare. No doubt we as the American people have to stay strong, demand our rights and never let these scum go back to the days of rejecting people, caping benefits and telling our Doctor's how to treat us!!

  •  HEALTHCARE (0+ / 0-)

    I worked for 20 years as a school bus driver during that time I had wonderful health insurance but had a very debilitating disease.  I saw my pcp often to the tune of 100's of thousands of dollars.  After the 20 years of great health insurance I lost my battle to keep working and lost my coverage and had to go on disability, even though my disease was listed as a reason to receive compensation I had to retain a lawyer and it took 2 years of fighting to get it, on top of attorney fee's , while I lived on my credit cards.  During these 2 years I applied for a medical assistance  card, I was no longer treated the same way by the staff at my Dr's office even after all the money myself and my children had paid to them via my insurance. The b12 shots that I was never even billed for they billed medicare for $80.00.  I have decided not to take 6 of the prescriptions that I was on and I won't go to the Dr's but once a year weather or not I need to.  I am not giving those money hungry hypocrites one more penny of the money I worked for all of my life.  I'll die first.

  •  Now when I think of doctors I wonder (0+ / 0-)

    how many Med School graduates are the rapists that George Will is so concerned about them having their lives ruined?

    I'll bet they can ruin a LOT of lives in medical practice.

  •  GREEDY PHYSICANS (0+ / 0-)

    Had same experience before Obamacare = Greedy Physician tried to Bill me $2,OOO just for a chance to see her!

  •  Find a Doctor who's good and NOT A $@*@ Republican (0+ / 0-)

    I am SURE it's not just "garden-variety greed" that's motivating your otherwise competent M.D.  I will JUST BET she is a Gated Community, Self-Satisfied, Conceptually-DRUNK Republican, who is determined to make fair health care for all FAIL, because it doesn't fit her ignorant, pre-conceived Republican Ideology.  Screw them all.

  •  Or... there could be other reasons... (0+ / 0-)

    Here's a thought: your doctor works for an HMO, is in fact contracted to that HMO for however many years. It's not too much of a stretch to suggest that the insurance company that insures your former physician for liability (easily the largest single bill any doctor would have to pay) is also owned by the company that employs her. What if these "changes" are mandated by her employers because their tracking methodology shows that Obamacare patients are more likely to file malpractice or wrongful death lawsuits?

    Or another possibility, one even grimmer: her employers might hold the note on her student loans (not unheard-of) and have threatened to raise the interest on it or even call it due if she doesn't cooperate.

    I point this out because too often I hear or see the phrase "greedy doctors." Hello, doctors don't go into medicine to become fabulously wealthy (although some do and those are usually the ones who make ghastly mistakes and are sued), even anesthesiologists. On average, a doctor fresh out of his/her residency has a student loan debt of close to a million dollars. Not a real good motivation to become a healer, is it? But it's a different kind of motivation if your employer tells you bluntly that it's the only way you'll be able to work off your student loans while you're employed by an HMO that practices "concierge medicine."

    I offer you two possibilities why your former physician rolled over and spread her legs for her employers "new policies". I may be way off the mark. But if you want to call names in this skirmish, please try to avoid painting all doctors (you used the phrase "the doctors are sure" and other similar phrases implying that ALL doctors are at heart greedy and selfish) with the same brush. It's not fair and it's not accurate. If we slip over the side into wild speculation and frenzied accusations, we become as bad as our adversaries.

  •  OK, I Get Where You're Coming From (0+ / 0-)

    But PLEASE...don't refer to doctors as "greedy."  Especially considering the doctor in question even gave you discounted/free care, by your own admission...when you CHOSE to drop your insurance coverage, because you could not afford it.

    Thanks to Obamacare, now you CAN afford it.

    You will find a good doctor who will take your new insurance.

    But it bothers me when people call doctors "greedy."  I am a medical biller/coder by trade and own my own company.  I bill doctors according to a percentage of actual collected funds.  This means, by the way...every time THEY discount you...I also get paid less!

    I am right there alongside the doctor, taking a cut in my pay to give YOU a break!  I never complain or say a word about it...except when I...or the doctors I serve are called "greedy."  That gets my fur up.

    Go to medical scool.  Spend twelve years in education and internship before you get to turn your first buck.  Emerge from that with a quarter-million in student debt.

    By this time, they are thirty years old.  How much money did YOU make by the time you were thirty?  You doctor made zip by that time.

    And many doctor DO give discounted, and even free service based on financial need...my own doctor clients do it.  Technically, they are not really SUPPOSED to, I might add...however, there is a loophole which allows doctors to do this when the doctor determines there is a "financial hardship" - and nothing is actually set to determine just what constutes a "financial hardship."

    If you think doctors are so greedy...consider what it takes to become a doctor.  Consider the investment of time and money.  consider the dedication to ongoing education for life...this is required by law...and is a good idea, anyway, to keep doctors up to date with the latest treatments and technologies.

    People like ME exist in order to help my doctor clients navigate the morass of bureaucratic bullshit that they have to navigate, legally, in this country with our bass-ackward healthcare system!

    Because if THEY had to do it themselves...they wouldn't have time to treat you...or give you proper attention and care.

    Basically, it is my doctor's job to be in the examining room, the operating room, the hospital....making you well.  It is MY job to make sure he is getting paid for doing so...and that he is following all the various rules and regulations - which constantly change, I might add!!  - and which require ME to also commit to a lifetime of staying current and continuing education.

    There's more than you think to being a doctor.  So don;'t call them greedy.  If you want to know who I think are greedy it is rock stars, sports stars and movie stars.

    •  Discount for payment (0+ / 0-)

      This past week I was on vacation and had to be seen in a Hospital Attached "Urgent Care" office.  I was surprised that my $45 co-pay was DISCOUNTED to a $31 co-pay BECAUSE I was ABLE to pay this at the time of service.  

      I mentioned this to my MD when I got back and saw her and SHE was shocked.

      And YES this was in the US!  

      This doesn't mean I will never see another bill from this altho since I just needed an Rx this might be my entire bill.

      Compare this to an ER in Arizona where they REFUSED to see me UNLESS I could pony up $100 that very instant--and NO this was NOT a "Private" hospital.

      Makes my head spin--One Payer ONe Set Of Rules--

      Why are we so FAR from this solution???

      •  One Payer, One Set Of Rules (0+ / 0-)

        Will never happen in this country, because of the for-profit health insurance companies.

        The problem comes in when they are so focused on the profit that they don't give a damn about care...or worse, make questionable decisions about care, based on cost.

        I am a medical biller/coder by trade and own my own company.  I know medical terminology...I have to, to know correct context as so forth.  But I don't claim to be a doctor.  I don't have the education for that!

        Yet, beaureacrats at health insurance companies do claim they know better than your doctor...and that they can diagnose you from a distance better than your doctor can up close.

        This is when they make a decision based, not on what is in YOUR best insterest, but rather what is in the best interest of their bottom line.

        If we are going to continue to allow for-profit insurance comanies to operate in America...and I see no way of getting rid of them, really...then there has to be an established oversight board where you can appeal these decisions - and that board should be impartial, on a state level, and make the process easy for the person who is appealing a decision with which they do not agree.

        Of course, such would likely increase MY workload, as I would likely be prevailed upon to file this sort of supporting documentation for the purpose of these appeals.  Likely such a thing would just become one more aspect of my job.

        At least we billers and coders DO HAVE an established means of appeal when claims we file are denied.  It is different for each Payer, but there is an established procedure.  Patients should have this same avenue available to them.

  •  Most likely she would have done this (0+ / 0-)

    anyway, regardless whether the ACA passed or not.  You don't have to look hard to find a sizeable percentage of the health care industry focused on maximizing profit.  My mother got a similar letter from her doctor four or five years ago.  

  •  Great ideas (0+ / 0-)

    expressed here. NP's and PA's do one hell of a job especially at the preventative level which frees the MD's to do their work. Makes great sense, and accreditation needs to be considered by the Medical schools to accommodate those who are will to serve the general public - most of us are in that category. Greedy MD's with their God complex and two MZB's and pretty mistress living in a high rise away from his family, well these guys will never change. What needs to changed is how our horrible Congress perceives the country that they are sworn to protect and maintain for ALL Americans, not just the 1% and this is the aim of the GOP - screw the rest of the 98% or 99%.

  •  How about Carson City? (0+ / 0-)

    Great revelation.  Thanks for posting.  Not trolling for any particular providers but if you don't like what alternatives Reno has to offer, you might inquire with Carson Medical Group across from the OLD hospital.  We all probably need to "network" and share experiences as the medical landscape is likely to be changing, and as you illustrated, some patients may be looking for a "better fit."

  •  There's at least two sides to every story. (0+ / 0-)

    Perhaps your doctor is trying to get or stay wealthy. Perhaps by accepting exchange plan reimbursements they would be forced out of business. There are doctors who care more about money than patients, and doctors who care more about patients than money--but they need money in order to sustain their practices. I've written a diary about the ACA in California that I haven't posted yet. I'm still trying to find out what, if anything, is being done to facilitate providers taking exchange plans. I heard a rumor that a class action lawsuit is being filed against Blue Cross and Blue Shield for including all CA physicians and hospitals on their exchange plans without negotiating the much reduced rates for exchange plans with them. Surprise! Doctors were tricked, then opted out, exchange plan consumers can't find doctors. For six months now, CA buyers of PPO exchange plans can't find doctors/clinics that take the plans. So essentially we've been paying these premiums and still have no access to health care. The health insurance companies reduced the exchange reimbursement to lower than Medicaid reimbursement, and so almost all the doctors in my county have opted out.

    •  The Solution To This Problem Is (0+ / 0-)

      And I come at this from the perspective of a medical biller/coder...who deals with insurance companies all day long...

      You make it LAW that ACA follows the standard CMS rate table in their area for re-imbursement.  They are not allowed to reimburse at rates lower than Medicare.

      If the reimbursement rates were based on the CMS standard rates for their area...doctors would have no problem accepting the plans.

      Insurance companies....IF THEY MUST...can make up this difference in either of three ways:

      1. Higher premiums (within the limits of the law)
      2. Higher co-pays
      3. Higher deductibles (again, within the limits of the law)

      The problem, as I see it, with ACA...and this will get addressed eventually...is that there is no requirement for doctors to accept the plans...nor any requirement for a minimum reimbursement rate for the insurance companies.

      If one was to tie accepting Medicare assignment to also accepting ACA plans...AND ACA plans were required by law to reimburse at the level dictated by the CMS standard rates for their area...this would solve the problem.

  •  Servicing? That's what bulls do to cows (0+ / 0-)

    "She will be reducing her practice and only be servicing these customers... er, sorry, patients"

    I grew up in the country, and the term "servicing" means, well, sex.  Somehow, over the years, "serving" has come to be replaced with "servicing".

    So if you find people seem a bit undone when that term is used, now you'll know why.

    And why not just go back to"serve" - a perfectly useful word that won't bring a blush to anyone's cheeks - the ones on our faces.

  •  Jerks with degrees (0+ / 0-)

    My wife has been going to a podiatrist as part of her employer-based insurance for years: he suddenly asked her if she had 'that Obamacare'. It's the same damn insurance she's had for YEARS. She has put me under oath not to say anything to him when I take her next, and that's the only thing keeping me from asking him, 'do you have them brains?'

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