<p>bclintock, that was a long answer but you didn’t answer the question. How many SICK people got the shaft who did not have group/individual insurance or Medicaid/Medicare. Meaning how many with preexisting conditions were denied insurance who were willing to pay the premiums like the rest of us and who had no other options. Not how many uninsured are there in US. </p>
<p>Also, at least in CA, it was well documented how surprised govt officials were at the low enrollment numbers for PCIP. It took way longer than projected to get to the meager number before shutting it down. Where was the tremendous pent up demand?</p>
<p>GP, you can PM me for details of what insurance we buy and why, but that decision only pertains to one family in one state, so I really don’t think it’s helpful - or interesting - to go through it all here. </p>
<p>I will offer that my husband had cancer which is now in remission. We had to change doctors a couple times during that period. The bad news is that cancer is very prevalent. The good news is that because it’s so prevalent there are lots of doctors who do a great job treating it. </p>
<p>I will make a few comments on pricing. We live in a suburban / metropolitan area, so it’s severely over-bedded. That means there is a lot of competition and rates reflect that. If you look across the country as a whole, you’ll notice that major impacts on rates include the number of hospitals of similar size in the same general area (two excellent hospitals in the same city may offer better quality at lower cost than a lesser facility with fewer competing facilities in the same catchment basin), and available patient dollars. If you have Hollywood on your doorstep, you will bring Botox docs on staff and charge accordingly. Similar decisions affect pricing in other areas. </p>
<p>There are almost always providers we can’t access because our insurer doesn’t accept them. We have changed physicians and change hospitals from year to year, although we have to change physicians more frequently than we have to change hospitals. We constantly get letters saying the insurer du jour is severing their relationship with this provider or that one, then get another letter 6 months later saying they kissed and made up, so we can go to them again. It’s tiresome, but it’s been going on for years. </p>
<p>I don’t mean to sound like I want people to “suck it up” in a cavalier way. If I did, I apologize.</p>
<p>The article that TatinG posted is worth a read. Don’t be put off by the title, “Millions are about to get health insurance. Will they care?” The title doesn’t appear to have anything to do with the content, which discusses the primary care doctor shortage and how nurse practitioners might fill in some of the gaps.</p>
<p>Journalists who write articles don’t get to choose the title.</p>
<p>GP, I a not a blind supporter. I feel for Busdriver. But I also go freaking look for the primary info. Anyone can.</p>
<p>Eg, the comment that docs are reimbursed at $20 and won’t schedule those patieints–in fact, what I am coming across shows Medicaid payments will increase, to Medicare levels. Yes, it is complicated to follow. But do-able.</p>
<p>In 2013, most states will have to increase their 2012 Medicaid fees to comply with the requirement to pay qualified physicians at least Medicare rates for ACA primary care services. On average, primary care fees will increase by 73 percent, but the magnitude of the increase will vary by state (Figure 3). Since states administer, the report examines which are currently lowest in this ratio and will need to increase the most.</p>
<p>“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>Okay, maybe it is a gauntlet. I was thinking of it more as a generalization, not meant towards you. The only way one could think the ACA was all good (or all bad), is if one is coming from a purely ideological viewpoint, which I know you aren’t. There are a few, just a few on this forum that appear to have that ideology, one way or another.</p>
<p>“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>Great. One has a doctor and facility that is serving their needs, and perhaps there is a plethora of ways in which one can beg to the insurance company to keep them. To filter through the insurance company bureaucracy for months, awaiting someone to get around to approving their doctors and facility…when the odds are, unless you have something very unusual, the answer will be it’s out of network, go suck it. Anybody who has dealt with an insurance company on just one issue knows what a PITA it is to attempt to try to get them to do anything non standard. Or even something standard that they need to correct. It’s like a brainless monolithic entity, that just consumes and can’t be reasoned with…but don’t get me started. </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>I am complaining about my state issues. I can’t speak to specifics of other’s states, though I’m learning enough about the problems in CA to commiserate.</p>
<p>I’ve seen the nurse practitioners 3 times over the course of the last two weeks and nothing she has done so far couldn’t have been done by my internist. I think they would both have ended up in the same place - not knowing what is wrong with me. So, it’s now onto the gynecologist, to see if he can figure out what is going on and if not, to the urologist. </p>
<p>I’ve been on 3 different meds since the beginning of my symptoms and had 5 urine samples taken and tested. Then today they did blood work. </p>
<p>What concerns me the most is what would someone in my situation do if they have no insurance? I don’t think many poor or even lower SES people would be able to pay the cost of just my “treatment” so far.</p>
<p>Based on the Minnesota experience where premiums in the state’s high-risk pool were capped at 125% of the highest rate in the individual market, I’d estimate that at least half of the 5 to 6 million medically uninsurable (pre-ACA) were willing to pay for coverage if it was available. What we don’t know is how many of the medically uninsurable in Minnesota who didn’t sign up for the state’s high-risk pool made that choice on the basis of cost–i.e., they couldn’t or wouldn’t pay the premiums–and how many simply didn’t know that option was available to them, since it wasn’t well marketed. That’s why I say “at least” half. With better marketing, the figure could be higher.</p>
<p>By the way, all these figures exclude people covered by Medicare, Medicaid, or other government programs. No doubt some people tried to buy insurance on the individual market, were rejected, then went onto Medicaid or waited until they were eligible for Medicare. But they’re all counted among the insured. Pre-ACA, 30% of all the insured in the U.S. were on Medicare, Medicaid, or some other government program, usually some kind of state supplement to Medicaid.</p>
<p>GP, the numbers are good. That is one reason I support ACA.
We have gone over PCIP before and obviously you arent paying attention. This is from the PCIP website.
Do you see any reasons why people couldnt sign up?</p>
<p>To sign up you must </p>
<p>Have a pre-existing condition
Be a U.S. citizen, or live in the U.S. legally
Have been without health coverage for the last 6 months</p>
<p>You are NOT eligible for PCIP coverage if:</p>
<p>You have other insurance coverage, even if it doesn’t cover your medical condition
You’re enrolled in a state high risk pool
You have Medicare, Medicaid, CHIP, VA or TRICARE coverage
You have job-based coverage, including COBRA, or continuation of coverage, even if it’s about to end</p>
<p>“GP, I a not a blind supporter. I feel for Busdriver. But I also go freaking look for the primary info. Anyone can.”</p>
<p>Thanks, lookingforward, for the kindness, but whatever are you talking about? Perhaps you’re thinking about someone else?</p>
<p>At this time, none of this affects me. I have comprehensive coverage, that is inexpensive (for me and my company), and a wide network of providers. In fact, I’ve never had any facility or doctor ever tell me they were out of network. I am a fortunate person with union negotiated, group coverage. It’s most everyone else in this scheme who sounds like they are getting screwed. But just because I’m not, doesn’t mean it doesn’t bother me.</p>
<p>“There are almost always providers we can’t access because our insurer doesn’t accept them. We have changed physicians and change hospitals from year to year, although we have to change physicians more frequently than we have to change hospitals. We constantly get letters saying the insurer du jour is severing their relationship with this provider or that one, then get another letter 6 months later saying they kissed and made up, so we can go to them again. It’s tiresome, but it’s been going on for years.”</p>
<p>That really stinks that you’ve had to go through that, along with the health worries. Seems like the last thing you want to worry about is who is going to insure you, or who you will be allowed to see. That is ridiculous.</p>
<p>That is the group I wonder about. If someone has a serious medical need, but cannot get insurance coverage due to a pre-existing condition, are they simply getting no medical care at all? Because if they went to a doctor just one time and paid cash for the visit, or walked into a free or charitable clinic, one would think the doctor’s office would have the knowledge and courtesy to inform them about the existence of a high risk pool that would help them. It seems negligent on the part of the doctor not to do so.</p>
<p>dstark- plus the issue that the appropriate sub list of people now on social services rosters, who may qualify for PCIP, has to be produced, culled from the larger pool, in order to inform them. </p>
<p>GP, there are analyses of PCIP that discuss that this is more than someone being “poor” by one determination. A clinic doc is not a sole determiner. </p>
<p>BD, I meant the long discussion abut how your rates would have gone up- maybe that’s the original thread. It was sobering. I like the way you do consider other points, at times.</p>
<p>Btw, there’s a lot a lot about all this that raises my analytical hackles. The guy who buys that cheapo policy may still be left with a high deductible. Understanding my own choices has been hard enough.</p>
<p>dstark, so today is the first day the provider search tool on Anthem’s website has worked. I couldn’t find UCLA. I would advise you to use the tool to see if UCSF or Stanford is included in your network. You can search for all hospitals within 100 miles of your zip code.</p>
<p>Haha, dstark, I depleted it in case someone thought I was serious.</p>
<p>Reminder, for the heck of it: nearly everyone on my side of town preferred hospital X. There’s Y, equi-distant, but on the other side of town, which was where they took the troublemakers. Everyone complained about Y. </p>
<p>Lo, times changed, the two decided to streamline and we can no longer use X for certain needs. Lo again, an experience with Y drove home the point that medical care is not some snapshot, it’s always evolving, programs and procedures change, can get better. In fact, the experience with Y was excellent. No need to feel emotionally linked to X.</p>
<p>And, my doc will retire in a few years. OMG, he won’t be available to me. I believe I will find another as good. Oh, my other docs now are also good- which is reassuring. What says a change is a automatic drop in quality?</p>
<p>BD, with all due respect, it is not at all clear or obvious, which is typical of the format. That’s why a lot of posters use emoticons – a little winky is one way to get the message across.</p>
<p>dstark, you may be happy with your network but you still have no idea if UCSF is in it. I just called my agent and spoke with a supervisor at Anthem and they both admitted that they are not sure if providers in an EPO region are available to subscribers in a PPO region. They are going to get back to me with the definitive answer (in writing).</p>
<p>I know you don’t like to take advice from me (I’ll include you with my son) but you are taking a huge gamble signing up for a 2014 Anthem plan and including your kid in NY. If he/she needs to be hospitalized in the first two months in 2014, you may have a medical bill which will knock your socks off. For the agent to cavalierly tell you not to worry is gross incompetence on his part.</p>
<p>BTW, I checked to see if there were any Anthem plans that will cover you for non-emergency care out of state with in network rates. The answer is NO. Your Anthem agent is full of *****.</p>
So, it’s now onto the gynecologist, to see if he can figure out what is going on and if not, to the urologist. </p>
is one way to get the message across.</p>