<p>dstark, how do you know that UCSF is covered? They’re in San Francisco, a region with only an EPO network.</p>
<p>Calmom, thanks for the referral. I don’t have enough posts to PM you.</p>
<p>Edit: I appreciate the help, but I still don’t agree with you about this law. :)</p>
<p>Well… Anthem told me earlier. I will double check that too.</p>
<p>I am pretty sure my network extends beyond my region with a ppo. My son was covered in NY this year. Anthem talks about its broad coverage as a selling point.</p>
<p>dstark, I hope that agent is correct because it would be a deal breaker for me if I couldn’t choose a provider in the LA network.</p>
<p>Edit: Make sure you ask if it extends to an EPO region.</p>
<p>dstark, also ask the agent tomorrow if Anthem is going to keep the Blue Card program. This program allows you to see any provider outside of CA that is in a Blue Cross/Blue Shield network. I think this would answer the question you have regarding your son.</p>
<p>Ok.</p>
<p>GP, If it is a deal breaker, you shouldnt rely in me.</p>
<p>Here is Anthem’s no. For customer service 1-800-333-0912.</p>
<p>I try not to call Blue Shield/Anthem agents, not good for my blood pressure. I’ll let you go first.</p>
<p>
That seems to work with many major providers (such has hospitals and large group practices) – but not so well with the individual practitioners in the community who seem to be clueless. My guess is that many of them are fence-sitting because they don’t yet have a sense of how many of their patients will be impacted by the change. The advance PR about ACA emphasised the uninsured who were being brought in – to a doctor with a busy practice, that might sound like a new group of patients they don’t need to take on. They may not have been aware that existing, privately insured patients are losing their old policies and being shifted onto the new framework.</p>
<p>
Sutter is a for-profit network that is very good at delivering medical care and also very good at advertising its services but also unwilling to agree to the low-ball pricing terms set by Anthem, which is also a for-profit entity. In other words, it’s not profitable for Sutter to agree to Anthem’s reimbursement rate, and it’s not profitable for Anthem to agree to pay Sutter’s prices. </p>
<p>So as far as I can tell, the insurance companies are going to cut out Sutter if they can get away with it. (“Get away” means that they may not be able to do that in areas where Sutter is the only game in town). However, in my community where a Sutter-affiliated hospital is clearly dominant, I think Sutter is also what is driving up insurance rates. So yes, where I live Blue Shield covers the Sutter-owned hospital and Anthem does not, but for the low end Bronze premiums, Blue Shield’s premiums are also $50 higher than Anthems. It’s a pretty good bet that Sutter is the major piece of the puzzle that accounts for that differential. The math might be different in areas where a UC medical facility is dominant and is covered by Anthem but not Blue Shield.</p>
<p>
At least they can’t use your high blood pressure as an excuse to jack up your rates any more. ;)</p>
<p>I guess with the individual insurance market being small, Anthem and Sutter can live without each other in some markets. I have a hard time believing Anthem and Cal Pacific dont have a deal in the employer based health care market.</p>
<p>Edit… I did see a doctor who works at Cal Pacifc on the Anthem list.</p>
<p>I don’t see how Anthem can manage in SF without Cal Pacific either, but I think that there are some issues that may be ironed out only over time. That may be a big factor in Anthem’s decision to go EPO rather than PPO – I think the EPO’s also have a tiered system where they can offer their insured’s different copay or co-insurance rates, depending on which provider is chosen.</p>
<p>[A</a> Stage-4 Gallblader Cancer Survivor Says: I Am One of ObamaCare’s Losers - WSJ.com](<a href=“http://online.wsj.com/news/articles/SB10001424052702304527504579171710423780446]A”>A Stage-4 Gallblader Cancer Survivor Says: I Am One of ObamaCare's Losers - WSJ)</p>
<p>Pertinent to the problems of ACA. This cancer patient was being seen at both UCSD and Stanford. Now they aren’t both on the same plan. So the patient has to choose one or the other.</p>
<p>Well, I’m sure there’s some reason that is good, Tatin. Someone will rationalize it.</p>
<p>Tatin, that is very interesting article. Obviously, the poor gentleman lives in San Diego and cannot go to Stanford because his Anthem EPO plan won’t allow him to go to facilities that are in regions with PPO networks. I don’t understand, however, how he could go to Stanford but not UCSD. The only thing I can come up with is that he could choose to go with a Blue Shield PPO network that would allow him to go to Stanford.</p>
<p>I found this statement ominous: “UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO” This seems to imply that hospitals in EPO regions will not take patients from regions with PPO networks. That would disqualify UCSF for dstark and UCLA for me.</p>
<p>Interesting case. It sounds like the primary issue seems to be open coverage across state and across the country?</p>
<p>texaspg, actually the issue is that it doesn’t allow it across county lines.</p>
<p>So Covered California does not have a single plan which would allow coverage outside county or State?</p>
<p>My company offers United Healthcare in Texas and California. So only way to get such coverage is get employer based coverage?</p>
<p>So this guy would have to move to Santa Clara County to be seen at Stanford? What do the people in Mono or Lassen County do?</p>
<p>I saw that article, too. Wondering what to make of it. What happens if you have a family plan, but adult kids go to college in a different zip code and county than where you live within the state?</p>