<p>
</p>
<p>This seems perfectly reasonable to me. The law was supposed to grandfather plans in effect when the law was passed, not post-hoc plans designed to get around provisions of the law. If insurance companies wanted their plans to be grandfathered, all they had to do was not change them.</p>
<p>
</p>
<p>I can understand why specialists might be concerned about this, but as a consumer, I love the idea. Right now when a patient is admitted to the hospital, it feels like all the people who are treating that patient don’t talk to each other. One specialist orders one test and tells the patient or the family one thing, and another specialist orders another test and tells the patient and family another thing, and it just gets confusing. If the hospital only gets ONE payment, instead of all the specialists being able to do whatever they want and bill for it, then the hospital is going to make sure that the whole team communicates. And they’re going to make darn sure that the patient is well enough to go home, and has good support out of the hospital, because the hospital gets dinged if that patient gets readmitted for the same diagnosis right away.</p>
<p>Bookworm, why are you afraid of costs? Are you older? or living in one of the highest priced insurance markets? I’m in one of the highest cost areas in California – in my region, the only plans that are $1125 or above for a 60-year old are the Platinum level PPO’s (highest metal level, actuarial value of 90% coverage).</p>
<p>Bookworm, go online either to an exchange or a major insurance company in your state. I think you are going to pay less. The odds are in your favor. :)</p>
<p>“If insurance companies wanted their plans to be grandfathered, all they had to do was not change them.”</p>
<p>In my case, the insurance company didn’t change the plan, I did. Goodbye grandfather status!</p>
<p>
</p>
<p>Midlevels are care providers like nurse practitioners and physician’s assistants? I’m not so sure that non-physician care providers are bad news for physicians. There’s no reason a practitioner needs an M.D. to do a well-baby exams or stitch up a cut on a knee, and if the nurse practitioner does the routine stuff, that frees up doctors for more serious problems. In the short term, we’re not going to have more doctors, but we will have more patients.</p>
<p>So the last time I went to the doctor she was looking up symptoms online as I sat in the office. I could have done that at home. The only thing I needed her for was to write the prescription. I would like a Dr. who has encountered my problem before at some point is his or her career. I’m worried we will be losing those kind of doctors.</p>
<p>TOMORROW I’ll go on-line. I’m over 60, and got a lot of injuries from car accident 2 years ago. With current insurance, I’ve postponed colonoscopy, as don’t want to spend the $4000. I do the regulars, like mammogram, which costs between $500-900, and GYN exam and bone scan. Just a few years until Medicare. I could find I have better coverage for less, but I’m a pessimist. and a scared human.</p>
<p>I have become very skeptical of local hospitals and doctors. My 50 y.o. friend was in hospital. She has CA, and given too much fluids, ordered by N.P. Now her cardiologist says she has permanent heart damage. Since I worked in a Boston hospital for dozen years, I truly fear being sick in local area. I doubt MDs anywhere take the time to call colleagues. What the first doc writes in chart, gets copied and repeated through the record. My own office uses such a system, and can see the flaws.</p>
<p>I had a long talk with a senior ENT DO resident this past Friday. We talked about the DO training. I remarked how well trained they were with performing bread and butter procedures, how mature and professional they were, and talked about the academic side of their training. In my limited experience in my area, I would have no concern recommending the DO pathway. I went the MD path. The big difference I see is the fact that the DO residents get a lot more hands on training very early on and less of the hard core academic education I was used to. This may be due to my background. I trained at a very heavy research institution. Day one out of residency, I have observed DOs who were very good and comfortable with procedures while the MDs took several months. But the MDs had a solid understanding of the research, studies, and science behind what they were doing but lacked the comfort level in performing certain bread and butter surgeries. Again, my experience is limited to my area.</p>
<p>Bookworm, I bet you will be happy. You are who this is designed to help, I think. </p>
<p>Let us know.</p>
<p>If doctors, particularly specialists, are going to be paid less because of lower reimbursement rates or these lump sum payments, it remains to be seen if this is going to be good for patients. Under this scenario, doctors will be forced to see many more patients to sustain their income, causing a deterioration in the quality of care. I have also heard there are quite a few doctors who will retire if they cannot make a decent income. Also, the loss of independent practices might not be good thing for patients, either. </p>
<p>Anyway, neither you, CF, nor I are doctors, that’s why I am asking frugaldoctor.</p>
<p>
</p>
<p>CF, It sound more like they narrowed the rules to kick enough people off their existing plans and force them to ACA to make it viable.</p>
<p>Frugaldoctor, thanks for the reply. I appreciate all your posts. </p>
<p>Thanks.</p>
<p>
</p>
<p>This assumes that specialists’ incomes are some precious jewel that we should do everything in our power to protect. I don’t share that assumption. In short, I think specialists are overpaid. (Sorry, frugaldoctor.)</p>
<p>Bookworm – your age will determine your premium under ACA. Your medical history is irrelevant-- you will not be asked any questions whatsoever about that. Over age 60 the rates are highest – but ACA says the maximum differential in costs is 3:1 – that is in order to charge a 62 year old $1200 for a policy, they would have to charge a 20-year-old $400 for the same policy. That’s why I’m seeing those type of numbers only with the Platinum-level plans. Any plan you choose, from the lowest price Bronze, will give you basic mammogram & colonoscopy for -0- cost. </p>
<p>Sounds like you have been paying jacked up rates because of your pre-existing medical condition. I’ll bet you can find a policy you like for around $800. I’m 59 and I’ll pay $660 at most next year – but I’m going for a higher deductible Bronze because I have an emotional attachment to my HSA account.</p>
<p>“because I have an emotional attachment to my HSA account.”</p>
<p>Calmom, do you remember who bitterly opposed HSA accounts at the time they were introduced? Hint: these accounts were included in the Medicare Part D law.</p>
<p>Calmom, Do you make a final decision when fill out form? My current plan will cover me for next year (just received that letter)? Does one have time to think through choices?</p>
<p>bookworm, you have plenty of time. But you might want to look at your current plan, and see if you can find something better and/or cheaper. We suspect you can find something that is both better and cheaper. If you want to change, you can have a new plan January 1.</p>
<p>
</p>
<p>Exactly- its thumb on the scales. “Look we got way more subs than we ever anticipated. Obamacare is so popular”. Meanwhile money is just being moved from one pocket to another so it really didnt help the viability at all. </p>
<p>On the human side someone thought that was worth 10 million people opening cancellation notices.</p>
<p>Bookworm, if you apply online there are several steps. The first step is to set up a user account with user id & password. (The exchanges have managed to make this unduly complicated – so it can take more false starts than expected.)</p>
<p>Then, if you think that you might qualify for premium assistance, you have to fill out a very brief financial form and submit it for verification. </p>
<p>Then, after the financial part is approved, you can select the plan. You can take as long as you want - you have an online account that has all your info when you log in. So plenty of time to pick and choose.</p>
<p>If you submit a paper application instead, then I would expect that you would needed to mark which plan you wanted on your application.</p>