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<p>One of the problems with this approach is that she will also be responsible for what is called “balance billing”. So she might end up paying much more than 50% of the bill.</p>
<p>Apprenticeprof, thanks.</p>
<p>Texaspg, </p>
<p>No. It is a coincidence. They did not grow up together. They just started playing together.</p>
<p>I clicked on the liver link. I had no idea hundreds of millions of people around the world have hepatitis B or C. And it could be so hard to diagnose. And there is a vaccine that can prevent hepatitis B. </p>
<p>[Five</a> Questions - Stanford University School of Medicine](<a href=“http://med.stanford.edu/five_questions/2006/so.html]Five”>http://med.stanford.edu/five_questions/2006/so.html)</p>
<p>Stanford is a great place. Kudos to your kids.</p>
<p>“BD - Can you get us that contract now? Minimum 40 hours at 100$ an hour”</p>
<p>I’d go for that contract myself! It sounds like she’s going to talk to more insurance agents first, though. Shouldn’t they be researching policies for free?</p>
<p>“I went to the Washington exchange site and put in my age and a Washington state zip code and looked at policies. You can search hospitals and doctors on the site. The Seattle Cancer Care Alliance is listed as being in network.”</p>
<p>I just passed that on, Cartera, thanks. She said that SCCA is very good, the best in Seattle. Annoyingly, though, a couple of days ago there was an article on the front page that said the state exchange site said that all UW hospitals and physicians were not in network…when they all are actually in network. That would really turn people off, a major screwup. Hopefully people still read the newspapers.</p>
<p>I think she should just get a policy that covers UW, SCCA, hopefully her own doctors…and if something happens where she needs the specialized, best of care (hopefully never), then pay for it out of network. Even if it costs a lot, it sounds like there is no way you can get a policy that includes out of state facilities as in network. Except, of course, if you have a group policy, which makes no sense to me…or get a two person group policy, or find a way to join a group.</p>
<p>There are multi-state plans in Washington state too. They really need to let us know exactly what that means and what it might mean. I realize the definition of multi-state does not mean there is in network coverage in other states but the memo from the OPM suggests that “may” be the case. If the Blues decided to open their networks across state lines, that would be huge.</p>
<p>"Stanford is a great place. Kudos to your kids. "</p>
<p>One is still in high school and is struggling to come up with a local awareness campaign after attending the summer camp (any high school student can apply around April). </p>
<p>“state exchange site said that all UW hospitals and physicians were not in network”</p>
<p>No one forced them to retract it? It is sheer laziness if the reporter can’t do factcheck, something a person from Maryland could do in ten minutes.</p>
<p>
“Multi-state” means that the 1 company has agreed to develop exchange plans in all 50 states (but not in year #1 --I think in 2014 the multi-state companies will be in ~30 states). It does not tell them how to structure their networks. They can have HMO’s or EPO’s that are fairly restrictive.</p>
<p>However, if an insurance company has networks in all 50 states, then it is a fairly good bet that there will be an in-network doctor you can see while traveling or when a family member is living temporarily in another state. There very likely may be some sort of advance paperwork or communication needed to set that up – like I had to do when my daughter went to college in New York. (Blue Shield of California asked for proof of enrollment, and my daughter’s college had a system where she could print off a “Verification of Enrollment” for that purpose directly from her student account. This is not a new thing or an ACA thing. I’m noticing that there are a lot of business-as-usual things about insurance that apparently people never worried about or noticed until ACA came in.)</p>
<p>I’ve already posted that I have also verified with Blue Shield of California that the Blue Card program will continue with my new Obamacare policy. (Though I don’t travel much, so it’s unlikely to be an issue for me).</p>
<p>
That’s what I was griping about yesterday – it seems that good journalism is a thing of the past, and no one does basic fact check. Yesterday it was a story published in CNN about a woman who did not have “affordable” insurance when it was easy to see that she had very reasonable options in her state. In the past media has published stories about moderate-to-low income people who are being quoted exorbitant rates for insurance when it is obvious from their reported incomes that they will qualify for large subsidies. Or stories about patients whose ongoing cancer treatment will be disrupted with a change in insurance when no one has bothered to call an insurance company spokesman to ask about their practices in such cases (I mean, it really is not a new phenomena that a person loses their insurance mid-treatment; the only thing new is that the patients now have the ability to get new insurance to take up the slack).</p>
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<p>FYI -
[AbbVie</a> Releases First of Six Phase III Results from Investigational All-Oral, Interferon-Free, 12-week Regimen, Showing 96 Percent SVR12 in Genotype 1 Hepatitis C Patients New to Therapy - Nov 18, 2013](<a href=“http://abbvie.mediaroom.com/2013-11-18-AbbVie-Releases-First-of-Six-Phase-III-Results-from-Investigational-All-Oral-Interferon-Free-12-week-Regimen-Showing-96-Percent-SVR12-in-Genotype-1-Hepatitis-C-Patients-New-to-Therapy]AbbVie”>AbbVie Releases First of Six Phase III Results from Investigational All-Oral, Interferon-Free, 12-week Regimen, Showing 96 Percent SVR12 in Genotype 1 Hepatitis C Patients New to Therapy - Nov 18, 2013)</p>
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<p>I happen to have two friends that currently have hepatitis C. From what I understand, current treatments not only have lower success rates, but there’s a high rate of discontinuation due to the severe side effects of those drugs. This potential of this new drug is HUGE.</p>
<p>calmom - You understand how out of network works. </p>
<p>Since BDs friend seems to be well off without financial constraints, what exactly would she need to do if she wants to enroll in Washington and be able to go to Sloan? </p>
<p>How much more would she need to spend to go out of network if she needed something major?</p>
<p>[Insurance</a> FAQs](<a href=“Insurance FAQs”>Insurance FAQs)</p>
<p>This is what the OPM will say about multi-state plans. They say that a “few” have a nationwide network. Not sure how you can find out which ones.</p>
<p>Out-of-network is not an affordable option unless the hospital is willing to waive the balance billing charge. Any amounts above the in-network allowable charges are the responsibility of the insured. At a hospital like Sloan, it would be enormous.</p>
<p>Apprenticeprof is absolutely correct to be worried about the sufficiency of her policy’s network. If you get cancer you may not be able to go to a specialized cancer hospital if the hospital is not included in the network. I would urge all posters to focus on this aspect of their insurance policy. You may regret it if you don’t.</p>
<p>The network problems are also my number one concern. H and D have chronic and genetic conditions that have previously left them uninsurable if we didn’t have insurance through H’s employer. He hates his job. We live in a rural area in a rustbelt state–not exactly a hotbed of economic growth. He has stayed for one reason only–the insurance.</p>
<p>We would strongly like to see health insurance decoupled from employment and had hopes this might do it. My state has 3 insurance companies on the exchange, with very narrow networks. Both H & D have their specialists in our state capital where the state flagship med school is. There is NO way local family GPs offer the level and quality of care they need with their diseases. My mom also went there for her breast cancer 10 years ago. Our state’s high risk pool is also dissolving 12/31/13.</p>
<p>So…I guess we’re still in the same position regarding health insurance, although I think employers will also go to narrower and narrower bands in the network. I worry about D’s future health insurance as smaller employers will just drop health insurance. Her condition is too rare–many GPs have never seen it except for a page in med school. She will not get the care she needs if she’s not at a major med center. I’m not even asking for a fancy one like some of you are discussing–just acceptance at the only one in the state!</p>
<p>
She would have to read her insurance policy and talk to a company agent or benefits coordinator.</p>
<p>Cartera,</p>
<p>By definition, a multistate insurer must have a network in every state in which they do business. I mean, they can’t be selling insurance in New Jersey and expecting their NJ customers to see doctors in Arizona. </p>
<p>Because they have committed to selling insurance in all 50 states, they will have an existing network in each state where they are currently doing business and be in the process of setting up networks the remaining states.</p>
<p>Sryrstress, sounds like you have a lot on your plate. I wish you the best.</p>
<p>I wonder if there are clauses in policies where if you cant get adequate treatment in network, you can go out of network for the cost of in network care?</p>
<p>Otherwise, some people with rare conditions are not really insured.</p>
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<p>Have you talked to a benefits coordinator for the insurance companies who sell on the exchange?</p>
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<p>As far as I know, there is a federal law that says that. It’s called the Patient Protection and Affordable Care Act. </p>
<p>The federal law can’t protect against “balance billing” but it does require that the insurers pay for necessary health costs that can’t be met in-network.</p>
<p>I think insurance companies do have to provide somebody that can treat your daughter, sryrstress for in network rates. </p>
<p>[Fight</a> for Your Rights: Getting Insurance to Pay for Your Treatment](<a href=“http://www.wsps.info/index.php?option=com_content&view=article&id=94%3Afight-for-your-rights-getting-insurance-to-pay-for-your-treatment&catid=0%3A&Itemid=64]Fight”>http://www.wsps.info/index.php?option=com_content&view=article&id=94%3Afight-for-your-rights-getting-insurance-to-pay-for-your-treatment&catid=0%3A&Itemid=64)</p>
<p>Number 4.</p>
<p>[10</a> Things Health Insurers Won’t Say - MarketWatch](<a href=“http://www.marketwatch.com/story/10-things-your-health-insurance-company-wont-say-1299280540906]10”>http://www.marketwatch.com/story/10-things-your-health-insurance-company-wont-say-1299280540906)</p>
<p>"4.“We will pay out-of-network expenses.”</p>
<p>Yes, there are times when insurance companies will completely cover care even if it’s provided by an out-of-network provider. That typically occurs when a plan covers the treatment but an in-network provider – often a specialist – is not available close to home or when there’s an emergency and you have to get care at an out-of-network hospital. If you know ahead that you’re going to an out-of-network provider because no one is available in your community, get the insurance company’s permission in writing, says Helen Darling, president of the National Business Group on Health, a nonprofit association of large employers. That way, months later if the insurer disputes the claim, there’s proof of the agreement."</p>
<p>“As far as I know, there is a federal law that says that. It’s called the Patient Protection and Affordable Care Act”</p>
<p>Ok…I do kind of remember. Being 57 kind of sucks memory wise. :)</p>
<p>I want more than this. I agree. I think it is out there somewhere. I would like to see the actual part of the law that deals with sryrstress’s issue.</p>
<p>[ER</a> Access & Doctor Choice | HHS.gov/healthcare](<a href=“http://www.hhs.gov/healthcare/rights/drchoice/index.html]ER”>About the ACA | HHS.gov)</p>
<p>This is good but it doesnt necessarily help people like sryrstress.</p>
<p>“Access to out-of-network emergency room services: In the past, some health plans would limit payment for emergency room services provided outside of a plan’s preselected network of emergency health care providers. Or they would require you to get your plan’s prior approval for emergency care at hospitals outside its networks. This could mean financial hardship if you get sick or injured while away from home. The new rules prevent health plans from requiring higher copayments or co-insurance for out-of-network emergency room services. The new rules also prohibit health plans from requiring you to get prior approval before
seeking emergency room services from a provider or hospital outside your plan’s network.”</p>
<p>Thank you for your kind words. Right now, their conditions are well managed, but I want to keep them that way. At this time, we are still covered under H’s insurance and as far as I am aware, the specialists are still in-network. Last week his plant moved 20% to Mexico…we shall see. I feel very fortunate they have had the great doctors and care they have. Either one could easily be dead or undiagnosed.</p>
<p>When I said, “We are still in the same position…” I meant he must still remain at the same job in order to keep adequate health insurance and that leaving and using the exchange is not really an option.</p>
<p>Thank you for pointing out the clarification on out-of-network etc and getting the insurance to agree in writing. That is easy to say and much, much more difficult in practice. I spend soooo many hours fighting insurance now on claims. I don’t even want to think about getting those things accomplished in an out-of-network situation and I’m a good hoop jumper. </p>
<p>For 13 years, her monthly meds were >$9000. I spent a YEAR fighting BCBS Kansas City over 12 months of a med they had <em>Pre-approved</em>…in writing. A letter fed-ex’d to the President’s desk got me a call and the beginning of resolution 5 minutes after it was delivered.</p>
<p>"Thank you for pointing out the clarification on out-of-network etc and getting the insurance to agree in writing. That is easy to say and much, much more difficult in practice. I spend soooo many hours fighting insurance now on claims. I don’t even want to think about getting those things accomplished in an out-of-network situation and I’m a good hoop jumper. </p>
<p>I agree. That is why I actually want to see what is written in the law. </p>
<p>For 13 years, her monthly meds were >$9000. I spent a YEAR fighting BCBS Kansas City over 12 months of a med they had <em>Pre-approved</em>…in writing. A letter fed-ex’d to the President’s desk got me a call and the beginning of resolution 5 minutes after it was delivered.</p>
<p>Sounds like hell. I am glad the med situation worked out.</p>