<p>(It’s quite possible that the NY Times article focused heavily on Cal Pacific precisely because the information is available online – it certainly would make it easier for a journalist to fact check an article).</p>
<p>As you can see it would not be an easy task to do detailed price comparisons. It would be one thing if there were flat fees for all procedures – but the gotcha might be in the numerous items tacked on - no one is going to think in advance to compare prices on rubber tubing and tylenol.</p>
<p>I do have to say this: Sutter didn’t create its own hospitals – it has bought up existing hospitals throughout the state. Most of these hospitals had already established reputations as being among the best in their respective communities-- “best” does not necessarily mean “most expensive” – but it put Sutter in a powerful market position. I mean, if you buy the best hospital in town it makes it relatively easy to jack up prices – the consumer demand is already there, and because the prices are largely hidden from view, the changes in fees and charging policies are not going to provoke outrage in the short term. </p>
<p>Under the current system, the insurance companies really are the only entities that have an understanding off the prices being charges and their overall impact on cost of care. So they are the market drivers-- that is, the insurance companies function as the agents of consumers in doing comparison shopping. If they don’t take a hard stance, no one will.</p>
<p>So I don’t think there’s much of an alternative right now: you either get a narrowed network or skyrocketing premiums.</p>
<p>The insurance companies are operating under the very narrow constraints of the ACA law. They are not free agents. The law is driving up costs and the insurance companies are trying to figure out ways to reduce these costs</p>
<p>I will trade half of your so-called essential benefits for having greater choice of providers.</p>
<p>I don’t know if 5K is bad or not. Or more precisely, warranted or not.</p>
<p>I guess, at the time, I was a bit shocked at how expensive it was, since the procedure itself was very quick. It’s not like they opened her up. The incision was very small. Most of the time was spent on filling out forms, waiting for my daughter to wake up and waiting for her to calm down. She got so irate that the nurses got scared and asked us if we ever saw that kind of behavior before (unfortunately we did).</p>
<p>Price transparency is good. Since switching to high deductible plan, I became more conscientious about spending health care dollars, even though I put maximum allowable by law into my HSA every year. So, I always have enough money to meet my deductible. For example, gone are the days of going to a doctor’s office if I suspect ear infection or strep throat - it is Target clinic now. In the past, I would not think twice about scheduling an appointment for this or even going to an expensive urgent care clinic during office hours because it was more convenient for me.</p>
<p>A word about ambulatory care centers aka surgicenters: many, if not all surgicenters are owned by the doctors that staff them (some are chains and corporately owned). They’re usually for-profit. They can charge lower rates because 1) they only have to provide the services they choose to provide; 2) they have much lower staffing costs as they don’t have to staff for 24/7; 3) they don’t have ER’s which are incredibly expensive; and 4) they don’t have to accept non-paying patients. </p>
<p>The reverse of each of those points applies to hospitals, even the for-profit hospitals.</p>
<p>“Because you have to live in Los Angeles and they also have the narrowest network of all the insurers.”</p>
<p>Ok. </p>
<p>So, if I were you, and having the ability to go to Ceders was so important - I would either start a fund just dedicated to the pay for whatever hospitalization I might want to have done at Ceders. This might involve cutting back on other expenses - but I would start building a nest egg. The other thing I might do is look for a job with employer subsidized insurance that has a plan which covers Ceders. I understand that you own your own businesses, but if Ceders is that important to you - you should consider alternatives such as these.</p>
<p>A word about doctors and your choice of hospital: you can go to any hospital in your network but you can only receive care from your physician if your doctor is on staff there. In other words, a doctor can’t decide on his/her own which hospitals they’ll practice at. They must apply for privileges at the hospital and go through the hospital’s credentialing process. </p>
<p>[A side comment: this is why the various laws requiring abortion physicians to have admitting privileges at a hospital is a way of eliminating legal abortions: abortions doctors cannot meet credentialing requirements. I say this as an explanatory comment, not to be political. I hope I succeeded.]</p>
<p>At any given time, your hospital and or your physician may be in your network, but they are separately negotiated.</p>
The law doesn’t drive up costs – it simply prevents insurance companies from discriminating against people based on previous health care status). So what the law does is force insurers to address the real costs of health care in a meaningful way, rather than simply solving the problem by refusing to insure anyone who is actually likely to use their services. </p>
<p>Your problem isn’t with the law. Your problem is that you want a guarantee that someone else (your insurance company) will pay for expensive procedures at whatever facility you choose. </p>
<p>The reason that Cedars has been dropped is quite simply: it costs too damn much. You recognize that it costs far too much for you to pay on your own, but somehow you can’t get the point that it costs too much for the insurance company to finance thousands of patients for tens of thousands of procedures at Cedars – you want the benefit but I don’t think that you would want to pay the premium cost, if Anthem or Blue Shield or any other company set up a policy to cover those.</p>
<p>Emily, you got to be kidding me!!! Is this what it has come to: the supporters of this law telling me to work for someone else. That would be like me telling the subsidized people to get higher paying jobs if you want Cadillac insurance with all the so-called essential benefits. </p>
<p>BTW, my problem is not just Cedars, although you choose to fixate on that. I can name a number of facilities and doctors I want in my network. If it was just one hospital I could probably live with that.</p>
<p>No, it is the law which has driven up costs. I don’t want all your so-called essential benefits, so stop trying to force them down my throat. And there is no need to provide every benefit under the sun for people who are feasting on other taxpayers to pay for their insurance. In Ca. the number of people with preexisting condition who were denied insurance and had no other option is relatively small. It is probably less than 1% of the legal population. </p>
<p>The supporters of this law just love forcing their values on everyone else because it makes them feel good or ameliorates their guilty conscience, although most of them have no intention of living within the same restraints they want placed on others.</p>
<p>“Is this what it has come to: the supporters of this law telling me to work for someone else. That would be like me telling the subsidized people to get higher paying jobs if you want Cadillac insurance with all the so-called essential benefits.”</p>
<p>As long as you are insistent that you have Ceders as an option, then yes. </p>
<p>I have heard many, many times, the argument that those who cannot afford insurance because they are too poor, or afford to buy food for their families because they are too poor, or who want to be paid more than minimum wage, should get a better paying job, so. </p>
<p>So, if you want Ceders so much and/or a better network, get a job with an employer whose plan covers what you want. Or self insure.</p>
<p>“I don’t want all your so-called essential benefits, so stop trying to force them down my throat. And there is no need to provide every benefit under the sun for people who are feasting on other taxpayers to pay for their insurance.”’</p>
<p>You don’t have to have one. You can self insure.</p>
<p>Hayden: the hospital privileges issue was one of the problems addressed in the article about narrow networks in Seattle. The doctors might be in network, but the hospitals where they had admitting privileges were not.</p>
<p>GP: they took a sledgehammer to kill a mosquito.</p>
<p>Emily, guess what…I am not going take the provocative bait and get into a ridiculous argument with you. Obviously, you can tell how I feel about some of your suggestions, although it is useful to understand exactly how the supporters of this law think. I can safely say that we will probably never reconcile our views. BTW, can I ask how old you are?</p>
<p>dstark, in case you are still interested I haven’t given up trying to find out what is going on with Anthem and their networks. I will let you know when I get a definitive answer.</p>
<p>“Obviously, you can tell how I feel about some of your suggestions, although it is useful to understand exactly how the supporters of this law think.”</p>
<p>Well then I guess you will just have to be content to whine about something which you cannot have, unless you are willing to make certain changes. </p>
<p>I don’t think there is anything wrong with the suggestions I made as those things seem to be the only things which would satisfy your need for the network you want to use. </p>
<p>You do realize, that the networks, hospitals and doctors are not going to change, no matter how much you stomp your feet. </p>
<p>It makes sense that large employers aren’t planning big changes. Their rates shouldn’t skyrocket, since the reason that some private insurance premiums rose sharply don’t apply to employer-supplied insurance. Large employers already were covering most of the “essential benefits”-- certainly they were already covering maternity-- and they already had a varied non-cherrypicked risk pool.</p>
<p>GP: You have 100% freedom to go to whatever doctor or hospital you want, and to pay directly out of pocket.</p>
<p>The purpose of insurance is to create the opportunity for pooled risk – the idea is that the vast majority of insurance buyers will pay more in premiums than the cost of their care, which will provide a fund that can subsidize the care for the members of the pool who do have high costs. So if you want insurance, you have to play by the group rules – that’s the nature of the game.</p>
<p>Every buyer of insurance receives the same potential benefit – that “taxpayer” money will directly benefit YOU if and when you incur high medical costs.</p>