<p>Emilybee, with all due respect, checking on your doctor is not a reasonable method for determining if the network is sufficient or identical to what people with group coverage have. You need to check to see if some of the prestigious research-oriented hospitals are included. I would check to see which doctors and hospitals are not included. From what I have read, the list is extensive.</p>
<p>Bay, check the network for your current group plan and what is available if you lose your group coverage.</p>
<p>“Nothing is certain at this point, but there is a very good chance we will be moving off an employer plan next year. We will have the COBRA option, but who knows how much that will cost, and whether it will be any better than an exchange plan. Our current coverage is pretty bad, $3,600 deductible per person which we have never used, not much better than the exchange plans in that regard, and costs us about the same.”</p>
<p>:)</p>
<p>Thanks for the advice. The only thing I care much about is the hospital. We rarely go to the doctor (knock wood), so I don’t really care if my current doc I use for check-ups is on it. We have a very nice hospital near us that I would prefer to use if needed. I assume that if a hospital is in the network, then doctors who have privileges there are also included?</p>
<p>You know, some of this is just plain different for those of us in areas where we routinely cross state lines. We’ve got OOS hospitals covered as in-network. And doc/pharm at, say, Dana Farber. (I have no way today to predict a specific doc name and check, if we have a future need for DF.) Also two hospitals at D2’s college location. All the logical hospitals in my area are also Tier 1, if I go with that sort of plan.</p>
<p>Also, this keep-your-doc issue is probably less relevant to younger people who don’t have something chronic.</p>
<p>No, you cannot assume a doc is in-network because the facility is. Put another way, sure you can assume, but you should check.</p>
<p>Bay, are you sure this one hospital could take care of all your needs if god forbid you should need very specialized care? Is this a local community hospital?</p>
<p>Bay, the answer is no. </p>
<p>[Out-of-Network</a> Docs at In-Network Hospitals - FairHealth Educational Site](<a href=“http://www.fairhealthconsumer.org/reimbursementseries/whybill.aspx]Out-of-Network”>http://www.fairhealthconsumer.org/reimbursementseries/whybill.aspx)</p>
<p>GP- a very good point. In my area, they consolidated certain services at certain hospitals. So, cardiac surgery may be handled at one- while “name-it” is centered at another. It only took us a few minutes to get the difference and both primary hospitals will manage ER, but at a point, a transfer can be needed. The ambulance guys know the difference. So, right, a favorite should be explored further.</p>
<p>“Emilybee, with all due respect, checking on your doctor is not a reasonable method for determining if the network is sufficient or identical to what people with group coverage have. You need to check to see if some of the prestigious research-oriented hospitals are included. I would check to see which doctors and hospitals are not included. From what I have read, the list is extensive.”</p>
<p>There are perfectly good hospitals in my area. I do not care if I cannot go to SK or Dana Farber. I would not base my insurance decision on a worse case scenario. And if my doctors weren’t covered on any plan, I would get new doctors. I’m not married to them! </p>
<p>There is a large teaching hospital where I live and another very large non teaching hospital (also a comm. hosp.) Every doctor is my area has admitting privileges at both the major hospitals. </p>
<p>I actually prefer going to the community hospital - especially their ER.</p>
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<p>No, I am not sure. I am quite ignorant in that regard, actually. I am somewhat of a fatalist (like interestedad). I was presented with one option for employer coverage, so that is what I have. I will be presented with limited options for individual coverage, so I will just have to go with one of those. I will look at whether this nice hospital is in network (not optimistic, actually), and figure it out when the time comes. There isn’t much I can do about any of it at the moment. But thanks for the important ideas to keep in mind.</p>
<p>“I would not base my insurance decision on a worse case scenario.”</p>
<p>This is exactly how I look at insurance, whether it’s home owners, long term care, auto, earthquake or umbrella liability.</p>
<p>“I would not base my insurance decision on a worse case scenario.”</p>
<p>That’s fascinating since the only reason I would ever have insurance is a worst case scenario. And the law. Interesting.</p>
<p>The worst case test does apply to my family, though. </p>
<p>I also think anyone should re-check what the rep of their hospitals really is. You often don’t know what’s decent or better til you’re in the situation. We have one that has always had a crappy rep, the one that takes the shootings and drunk dry-outs. In fact, my experience there was superlative. </p>
<p>Again, if we want to obsess a bit, we need to sweat through some of the research. If someone really doesn’t care, never does use much med attention, then maybe you choose another way.</p>
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<p>Make that three of us, because that is the only thing I look at, too.</p>
<p>What is a worst case scenario? </p>
<p>A life threatening illness?</p>
<p>A gall bladder removal can be pretty expensive. What about a torn acl?</p>
<p>dstark, if you didn’t know about this, you may like it. Can put in your zip. <a href=“Healthcare Bluebook – Your Guide to Fair Pricing for Healthcare Services”>Healthcare Bluebook – Your Guide to Fair Pricing for Healthcare Services;
<p>For me, worst case is anything inpatient</p>
<p>Anything bigger than a few tests and a 4-figure treatment plan. Before that I’m okay with paying cash and with most of these deductibles that’s pretty much what happens, anyway. But that’s just me.</p>
<p>My bigger concern is getting appts. in a timely fashion with a doctor who knows what they are doing. I really hate it when they look up symptoms online as you sit in the exam room. I’ve already done that a few times by then and am tempted to help but that would be rude. LOL!</p>
<p>Lookingforward, I thought you were one of the more informed posters starting with the first ACA thread. I am not surprised you knew about that site. I did not know about it but I like it. I played with it a tiny bit. I like it. Cool find. I am going to play with it more later. I am going to save that link. Thanks.</p>
<p>Bay and flossy, I was expecting open heart surgery or brain surgery. 
Ok. Interesting.</p>
<p>Worst case for me is having some type of rare disease for which the only treatment/doctors available are only found at an SK/DF/Mayo, etc, etc., etc. </p>
<p>Most illnesses can be treated without going to one to the best hospitals in the world. And even if you go to the best, that doesn’t guarantee anything. My neighbor, who was only 55, just died after battling month cancer for two years. All his surgeries and treatments were at SK. It was an awful two years. </p>
<p>If I get diagnosed with something which only can be treated at one of them - I’ll just take out my bucket list and do as much of it as I can before I croak. </p>
<p>I am not going to live forever.</p>