<p>One of the parents on another thread mentioned that JH is asking for full payment upfront for a tumor treatment because her health share is not accepted. She is looking into alternatives since it requires 2 months of local stay and JH is convenient.</p>
<p>Hayden, where do you get your insurance? Does it have very narrow networks or is it a HMO. Are you paying for the insurance or is it mostly subsidized by an employer or the taxpayer? Are their hospitals and/or many doctors in your region you can’t go to? Has the premium increased by 80% starting Jan 1. I always like to know if posters are eating their own cooking. It’s so easy to tell others to suck it up when you don’t have to experience what others have to live with.</p>
<p>“Furthermore, if you require the most advanced types of care but your plan doesn’t have practitioners capable of providing it, you are typically allowed to go out of network.”</p>
<p>Do you know how hospitalization costs are billed when you go out of network?</p>
<p>Ok… I signed up today for 2014. Anthem Blue Cross equivalent of a bronze plan. 1371 a month… 4 people.
It is a ppo plan. There are multi state plans… More expensive and the Anthem person said since my son is going to have employer coverage in 2 months… Forget the multi state plan. Since that was my thought, that was easy. </p>
<p>For the 3rd time, I asked Anthem if UCSF was in my network. And for the third time the answer was, “YES”.</p>
<p>My network is quite good.</p>
<p>I also find it amusing that because a poster has some anecdotal stories of poor care at teaching facilities that somehow justifies limiting my choices. I think I can figure out what is best for me without the help of ACA or its supporters.</p>
<p>“There are multi state plans.” </p>
<p>With Anthem? Which ones?</p>
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</p>
<p>In most states, it is not administered by insurance companies. Arkansas just got a waiver from the federal government to have their Medicaid program administered by private insurers. Iowa has also applied for such a waiver, but I can’t find any information about whether they’ve gotten an answer.</p>
<p>GP, The plans are too expensive for you.</p>
<p>You also said you can handle choosing your insurance yourself. I agree with you.</p>
<p>Here’s the U of M list of plans covered: [Which</a> Marketplace & Medicaid Expansion insurance plans does UMHS accept? | University of Michigan Health System](<a href=“http://www.uofmhealth.org/ACAplans]Which”>Which ACA Marketplace Plans does UMHS Accept? | Michigan Medicine)</p>
<p>This is 2 months old and I know because I’m working on a project related to this that the list is expanding. I think it’s up to about 70 of 101 of plans now. The ones that are not participating are insurance companies that haven’t participated in the past- well before the ACA (Humana HMOs, Total Healthcare USA, etc). </p>
<p>Yes, obviously it’s just a data point but it’s the largest network in MI so it’s what’s relevant to us Michiganders. It’s also one of the top-rated systems in the world and somehow they are still managing to partner with most of the plans.</p>
<p>GP, you’re upset, repeatedly, at great length, that private companies are not offering you the insurance product you want to buy, even though no law prevents them from offering that product if they choose to.</p>
<p>How much more would you be willing to pay for the product you say you want than the product you are being offered? What do you think is keeping the insurance companies from offering you the product at a price you would be willing to pay?</p>
<p>BD, earlier, someone else made the comment about some here being smug, not you. I understand your concerns about how this will/won’t work for you. But I also can’t help but see where some “drop a gauntlet,” making statements others are challenged to oppose, clarify or correct. I don’t see that as " automatically [reacting] to defend that this was all happening anyways, you people just had it so good before, it’s okay because (fill in the blank.)" That feels like another gauntlet. </p>
<p>But if she has to move from a state of the art medical facility, where she’s been working with people who know her health needs well, and are on the cutting edge of research…she may lose far more than the nicely paneled waiting room. She might lose her life. Do we know this is what will happen? My exchange and insurer explained the ways doctors will/can make a case for approval of a facility that better serves this patient, if that is what is needed.</p>
<p>Maybe not in your state. But why are some projecting this- and across the country? Or maybe you just mean in WA or GP means under his/her plan- if there are state by state exceptions, all the more reason to complain, in-state.</p>
<p>“It’s so easy to tell others to suck it up when you don’t have to experience what others have to live with.” And yet, look at how one’s own experiences were used to extrapolate for the whole country. </p>
<p>It’s not hard to google, find a little more info, corroborate, before proclaiming. That’s my head scratcher. That’s all.</p>
<p>dstark, which means you don’t know.</p>
<p>Is Medicaid administered via insurance companies also?
Wiki: “Each state administers its own Medicaid program, establishes their own eligibility standards, determines the scope and types of services they will cover, and sets the rate of payment. Benefits vary from state to state, and because someone qualifies for Medicaid in one state, it does not mean they will qualify in another. The federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.”</p>
<p>In CA, MediCal “is jointly administered by the California Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS), with many services implemented at the local level mainly by the counties of California.”</p>
<p>Some states may choose to farm out some tasks to insurers.</p>
<p>I know what it was for me. ;)</p>
<p>LF, because it is happening across the country. I have read hundreds of articles about narrow networks excluding hospitals and doctors all over the country. Do you have some data to indicate this isn’t happening or is it what you would like to believe.</p>
<p>A doctor’s working hours are limited. The overhead is high. </p>
<p>If they can do it, doctors will fill their schedules with patients whose insurance will pay the most. With Medicaid paying only $20 for an office visit, no wonder the number of doctors who take Medicaid patients is dwindling.</p>
<p>But it isn’t happening the same way in all states, GP. If you look, you will see that. Eg, I am not in MI, but looked at some details for that state (actually, looking for Romani’s Medicaid threshold.)</p>
<p>There are many web sites that take a pointed stand, only lead one to believe this happens this way and in all cases. Look at how often calmom (and others) has referred this thread directly to the laws or agency explanations.</p>
<p>People here have misquoted stats, gone on their old experiences-- in some cases, not even pursued info with their exchange or the insurer. </p>
<p>And, the network can exclude a facility or one of its highly specialized docs-- and still have a process to approve YOUR use, based on your case. When Seattle Children’s came up, it was referred to in that article…“non-unique” versus medically appropriate.</p>
<p>Tatin, can you back that up? You know how docs schedule?</p>
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<p>Well, we have the numbers. Nationally, 16% of the population doesn’t have health insurance, meaning neither group nor individual coverage (including state and federally operated high-risk pools), nor Medicare, nor Medicaid, nor any state program. Among adults aged 19-64, the figure is 21%; we tend to take better care of the young and the old. Obviously, these aren’t all people excluded from the individual market by pre-existing conditions, but a large fraction of them are; most estimates are about 1 in 8 uninsured were “medically uninsurable” pre-ACA.</p>
<p>[Health</a> Insurance Coverage of the Total Population | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/other/state-indicator/total-population/]Health”>Health Insurance Coverage of the Total Population | KFF)</p>
<p>[Health</a> Insurance Coverage of Adults 19-64 | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/other/state-indicator/adults-19-64/]Health”>http://kff.org/other/state-indicator/adults-19-64/)</p>
<p>We’ve been over this ground on high-risk pools already. You keep flogging an argument that’s been soundly rebutted, as if working off someone’s shopworn talking points. Most high-risk pools, including the transitional federal PCIP which was intended only as a temporary stopgap until the ACA exchanges got off the ground, were not well marketed and were woefully underfunded. Congress provided only $5 billion total for PCIP, which was intended to be a 3.5 year program covering 400,000 people, a small fraction of the uninsured with pre-existing conditions. HHS closed the program to new enrollments when they realized that the 100,000 people already enrolled were costing far more than anticipated and would burn through what was left of the $5 billion before the exchanges got off the ground. </p>
<p>Same was true of most of the state high-risk pools: nice idea, but if you don’t adequately fund it, don’t aggressively market it, and stop taking new enrollments, it’s going to leave an awful lot of people uncovered. Even Minnesota, which by all accounts operated the biggest and most successful high-risk pool in the nation (with more than 26,000 subscribers, it dwarfed California’s 6,000-member high risk pool, despite Minnesota having roughly one-seventh the population of California), didn’t aggressively market the availability of its high-risk pool because every new subscriber added potentially very large costs to a financially wobbly system. Large as it is relative to other states, Minnesota’s high-risk pool reaches only 7% of the state’s uninsured; most state high-risk pools reached around 1% of the uninsured due to stringent eligibility requirements, enrollment caps, high premiums, limited coverage, or some combination of these. And the best estimates I’ve seen say Minnesota’s high-risk pool probably reaches only about half of state residents excluded from the individual market by pre-existing conditions.</p>
<p>There’s no reason to think Minnesotans are sicker than the national average; in fact, health surveys seem to indicate the opposite. Nor is there any reason to think a higher percentage of Minnesotans were denied coverage due to pre-existing conditions; again, probably just the opposite, since a higher percentage of Minnesotans have employer-sponsored insurance (57% v. 49% nationally), and far fewer Minnesotans are uninsured (9% v. 16% nationally). Yet tiny Minnesota, with just 1.7% of the nation’s population, manages to cover more people in its high-risk pool than any other state. </p>
<p>If other states had high-risk pools proportionately as large as Minnesota’s relative to their populations, we’d have about 1.5 million people enrolled in high-risk pools nationally. If I’m right that Minnesota’s high-risk pool is serving only half the need, you’d need to double that to estimate 3 million medically uninsurable (pre-ACA). And then when you factor in that Minnesota has just slightly over half the national rate of uninsured, you’d have to roughly double it again and assume that approximately 5 to 6 million people nationally were medically uninsurable pre-ACA. Which is pretty close to the back-of-the-envelope calculation you’d get by dividing the estimated number of uninsured nationally (about 45 million) by 8 (using widely cited estimates that one-eighth of the uninsured were medically uninsurable pre-ACA).</p>
<p>And of course, LF, the supporters haven’t misquoted stats and haven’t let their political biases influence their objectivity.</p>
<p>[Millions</a> are about to get health insurance. Will they get care? | MSNBC](<a href=“http://www.msnbc.com/msnbc/doctor-gap-next-hurdle-health-care]Millions”>Millions are about to get health insurance. Will they get care?)</p>
<p>In the future, nurse practicioners will replace primary care physicians. The article says that there’s no difference in outcomes in 80-90% of cases, particularly when the visit consists of monitoring blood pressure, weight and other very routine matters. </p>
<p>But even if the states loosen the requirments for NPs and the other roadblocks mentioned in the article, there will still be a shortage of physicians in primary care. (I would argue more so when medical students seeing the niche being filled by NPs).</p>