<p>So I checked out the plans for my state, Washington. Not needing it now, but you never know in the future. No problem getting on the website and getting a quick response on the second day. Here’s what I found for my family. Cheapest bronze plan is about $9200, with 6K deductible. So to me, that means while even though routine visits are covered at low/no cost, if I actually had an issue, I would have to pay a large amount out of pocket and meet the huge deductible before they would start paying, is that right? So really, this is like a catastrophic plan that covers some preventive care.</p>
<p>The best and most expensive plan they have is a Gold plan, for about 20K. And it still has rather high copays, God forbid you go out of network. It is significantly worse than my employer provided plan (if I paid for that myself it would be about 14k). </p>
<p>I can’t see using this unless I was uninsurable through the private health insurers, or had a big subsidy. I think the open market would be much better.</p>
<p>Goldenpooch, the termination of UC medical contracts has nothing to do with ACA – Blue Shield has a long history of rate disputes with UCLA. They had a rift in 2006, in 2008, and 2012. </p>
<p>This is not a direct result of ACA. ACA does increase the pressure on insurance companies to hold down costs, obviously – and it essentially changed the negotiating landscape somewhat for the insurance companies. But if the net result of ACA is that the highest-cost hospitals lose their contracts with insurance companies in favor of those that are able to provide more cost-efficient services… then that is the program working in the way it intended.</p>
<p>Yeah, they had a dispute and UCLA was not in the network for maybe 6 months; however, they eventually worked it out. But I also could have gone to Aetna, Anthem, Cigna or Health Net, all of them included UCLA in the network. Regardless of the cost, trust me, if you get very sick, these are by far the best hospitals in the region. None of the other hospitals even come close to the level of care you get there.</p>
<p>Edit: I don’t remember any interruption of service in 2006 and 2008</p>
<p>Well, yes, that’s exactly the point of ACA. To help people who aren’t lucky enough to have good employer-paid insurance, and who aren’t healthy or well-off enough to get it on the open market.</p>
<p>
</p>
<p>calmom, if high-cost hospitals lose their contracts with insurance companies, aren’t they going to have a hard time finding customers? It seems to me that they would pretty quickly have to reduce rates, unless they want to limit themselves to patients who can pay out of pocket which would be a very small customer base indeed. Am I missing something?</p>
<p>LasMa, high-cost hospitals can still contract with employer group plans and all grandfathered insurance plans. They can decide not to contract with any exchange plan or off-exchange mirror plan with identical benefits. The reason why they would not contract with exchange plans is the same reason given by the largest outpatient provider in my community - that they would go bankrupt if they agreed to the very low reimbursement rates from the insurance companies for their exchange plans. </p>
<p>In Ca., in order for the insurance companies to keep the rates from skyrocketing (although they did go up very considerably for non-subsidized people) they narrowed the networks by negotiating very low reimbursement rates with few providers. The best teaching and research hospitals, like UCLA and Cedar Sinai, are more expensive to run, but if you’re sick I would think you would want to go there rather than a community hospital which doesn’t have the cutting edge technology, the world-renown specialists and the excellent facilities. </p>
<p>Obamacare is going to cost much more when you commence community rating and guaranteed issue for all people. The exchanges in all likelihood are going to have a much sicker and poorer population; that is not going to be cheap.</p>
<p>Well, part of the problem is that you don’t live in Los Angeles. So not only do you want a plan that includes the hospitals of your choice in your network, you want it to be an out-of-region hospital. So perhaps your first step might be to move to live within the region where those hospitals are located. </p>
<p>But the point is, the ACA doesn’t dictate what medical facilities should be included within each network. Nor does it require the companies to exclude specific doctors or facilities. </p>
<p>You wrote that you changed policies two years ago because of a premium increase. Without ACA, what would have prevented BS from similarly increasing premiums again? Or what would have prevented them from eliminating PPO’s from their policies sold on the individual market, and shifting toward an HMO and EPO model instead?</p>
<p>goldenpooch, here’s the problem with Cedar Sinai: Their prices are way out of whack. </p>
<p>Newly-released data revealed one of the dirty little secrets of American medicine: Costs vary wildly from provider to provider, even within the same city. Picking a procedure at random – gall bladder removal – this map shows that for Los Angeles County, the average hospital charge is $61,764. Cedar Sinai’s charge * for the same procedure* is $143,239. Or take prostatectomy: Average: $54K, Cedar Sinai $103K. C-section: Average $27K, Cedar Sinai $50K. It should be obvious why Blue Shield doesn’t want to include Sinai in its network. </p>
<p>Sky-high prices like this are one of the biggest drivers of our health care crisis. calmom is correct that if we are ever to get costs under control, high-cost providers must be excluded from networks as Blue Shield has done. Otherwise, they distort the entire system, pushing up costs for everyone. Most of us are satisfied with our li’l ole “community” hospitals, and don’t wish to pay for your desire to go to a world-renowned hospital with cutting-edge technologies. If you prefer a wildly expensive hospital, that’s your privilege, but you can’t expect that you won’t have to pay more for it.</p>
<p>If you want to blame someone, ACA didn’t ask Sinai to charge more than twice the average for that gall bladder surgery. Neither did Blue Shield. The problem lies with the provider.</p>
I think that’s the general idea: one way for BS to leverage its bargaining power is to pull its business. But keep in mind that the individual market is different than the employer market – it may well be that UCLA figures that it will have plenty of patients who are have employer based insurance. </p>
<p>UCLA and Cedars Sinai are also both located in areas where there are a lot of wealthy people around. So maybe they feel that they are already being shortchanged by the insurance companies and that they would rather cater to a different market.</p>
<p>“Well, yes, that’s exactly the point of ACA. To help people who aren’t lucky enough to have good employer-paid insurance, and who aren’t healthy or well-off enough to get it on the open market.”</p>
<p>Well, I am neither of the two examples you cited. I had a non-grandfathered plan and I am being forced to go to an exchange or off-exchange identical plan against my will.</p>
The insurance plan with the highest satisfaction rate in California is Kaiser. I never could get a particularly competitive plan with Kaiser on the individual market, and I think it would be a tough transition for me at age 59 to move from the model of care that I have been used to for my whole life. But I definitely am considering that option now. It has also occurred to me that getting all my care in one location might actually be something of an advantage, rather than have to go one place for my doctor, another place for the lab, a different place for the mammogram, somewhere else for the bone density scan, somewhere else for the colonoscopy-- never mind what I would have to do if I actually was diagnosed with a serious illness.</p>
<p>First of all , all exchange and off-exchange (so far) plans, including LA, do not have Cedar Sinai or UCLA in the network, so it wouldn’t have made a difference if I lived there. All I am asking is to have a choice so I can elect to pay the money to have the providers of my choosing. </p>
<p>I am almost paying double for my insurance with lesser benefits and without my preferred providers and somehow I am benefiting from this new law. I don’t get it?</p>
<p>You also had a non-guaranteed plan. Blue Shield has always written its policies on an annual renewal basis – there was nothing to stop them from raising rates, making changes to its network. or notifying you that it was discontinuing your plan and you would have to choose another. </p>
<p>The only time I ever remember my insurance company increasing rather than reducing or limiting various benefits was after ACA came in, when they started offering preventive care for free rather than requiring a copay. Not that it makes a huge difference – but up until then its been a fairly steady pattern of rate increases and notices that various benefits are being withdrawn. For example, 2 years ago my plan had a prescription drug plan for generics, without a need to meet the deductible – I’d go in and every prescription would be $10. Sometime in the interim they took it away, to my utter surprise when I went to fill a prescription for antibiotics this past summer.</p>
<p>That’s the point Calmom - what is good for you (Kaiser), may be unattractive to me. All I want is the choice. I am not asking anyone else to pay for me.</p>
<p>Yeah, but my rate never increased by over $5,000 a year before Obamacare. Also, I have had insurance in the individual market for 25 years in ca. and I have never experienced these type of sweeping changes</p>
<p>Calmom, if you don’t qualify for a subsidy, how much is your rate going up? You are saying if your preferred providers are not included, you will go to an HMO where you will have no ability to choose your doctor. I don’t understand why you are happy with this, unless you think you are getting a huge subsidy.</p>
<p>Goldenpooch, maybe she’s happy because her kids can now stay on her policy until age 26. Or maybe she likes the peace of mind that if she ever does lose a lot of income, she can still get insurance. Or maybe it’s because she knows she’ll never run into a lifetime cap, or she’ll never get booted out if she gets sick. Or maybe she likes the fact that she can now leave her insurance company if they treat her badly. Or maybe it’s knowing that insurers must spend most of the premiums they collect on actual healthcare instead of lavish executive compensation. </p>