<p>For whatever reason, the new Blue Cross ACA-approved network provider list is different from the current Blue Cross provider list in NH. Hospitals in major population centers of Nashua, Portsmouth, and the state state capital, Concord, are not in the new network – as is my local hospital.</p>
<p>Anyway, rather than administer two networks, Blue Cross is going to switch all their plans (both exchange and private) to the new ACA network. They can’t (or at least aren’t) forcing this change for existing plans until the renewal dates, so 2014 will be a transition year.</p>
<p>I can’t explain it. It makes my head hurt. I like my current plan and my current network providers. I wish I could keep it. Fortunately, my doc (who I got when I moved here 18 months ago) is on the new provider list. However, the hospital that he uses is not… Sigh… Fortunately, I’ve only been to the hospital once in my entire life and the big Manchester hospital (regional trauma center) is only 7 miles and 12 minutes further away, so I guess that’s not the end of the world.</p>
<p>Yes, same providers. Our medical group sent out a letter stating they would not be participating in the lowest level (might even be the bronze plans) BCBSNC plans, but the one we are in is considered to be “Silver” and we can keep our doctors.</p>
<p>Talked to my insurance guy. He’s coming in next week, but has pretty much corroborated my assessment that in our particular case we should proceed as planned and dump group in favor of increasing employee pay because we simply cannot match the assistance the single-wage-family-of-four-earner will get in terms of scaled deductible and lower OOP max will get on the exchange…and he suspects our existing group plan is converting to platinum.</p>
<p>The employee in question came over to me yesterday and thanked me for being a conscientious employer I have to thank you all on this thread for helping me get my arms around this thing enough to devise a plan of action!</p>
<p>Simple. The more expensive hospitals were not chosen by Blue to be in their new ACA-Exchange Plan. (It’s what I’ve been saying on cc for years: we either ration health care by dollars or now, under ACA, by service availability; it’s just basic health care economics.)</p>
<p>It’s an interesting kind of rationing. We’re not rationing the service-- everyone gets gall bladder surgeries and knee replacements and well-baby checkups. We’re “rationing” the service as provided by expensive providers.</p>
<p>So you might have to end up driving an hour to save $20,000 on a surgical procedure. This cost-savings measure does not bother me as much as it might. Most people would drive an hour to save $20,000 if they were the ones writing the checks.</p>
<p>My S had jaw surgery that was not covered by our insurance. We flew to another state to save $20,000 (haha, nice example used above).We also got a better surgeon than one we could find locally.</p>
<p>GP: I had not heard about the changes to what defines a ‘group’. If husband and wife businesses are excluded then another whole round of cancellations will be going out next year. Ugh.</p>
<p>Regarding what qualifies a small business for a group plan…</p>
<p>The BS Medical Loss Ration Survey asked whether this was a business owned wholly by a husband and wife (which - depending on the definition of ‘owned’ it may or may not be). It then asked if the business covers anyone other EMPLOYEES under it’s medical health insurance plan - currently it does not. The business is and LLC, we own stock in this business and are also employed by this business. We are the only stock holders. So, not sure how this figures into the group qualification issue since we do not take W2 wages, but instead receive K1 distributions (or not - depending on circumstances). </p>
<p>Also, one kiddle is a CPA in the making and already handles many of the books. We could drop her as a covered dependent and make her an employee with W2. Then the business would have a covered employee other and H and I…wonder if that is a work around…</p>
<p>At this point, won’t everyone who has been cancelled hold off on doing anything until Dec. 1? There is going to be some ‘fix’, people just don’t know what it is yet. With everything in limbo, it’s best to just wait.</p>
<p>The problem arises if people end up uninsured between the cancellation and sign up. </p>
<p>People keep acting as if the only concern is the fine for the mandate. The real concern, IMHO, is people being left uncovered. It’s not as if things won’t happen to people just because they couldn’t sign up on the website.</p>
<p>^^ This answers a lot of the confusion I had in understanding the cancellations vs non-cancellations/extensions.</p>
<p>“Neither state nor federal law requires such cancellations, Jones said, and existing policies offer benefits that include a broader network of medical providers and lower costs for consumers whose incomes are too high to be eligible for premium subsidies. New policies must meet the requirements of the federal health care law, but Janice Rocco, deputy commissioner of health care reform and policy, said in a telephone interview that old policies can continue into 2014 even if they fall short.”</p>
I have to thank you all on this thread for helping me get my arms around this thing enough to devise a plan of action!</p>