<p>If someone buys into an HMO that shows no out of network info, does that mean you’re only insured while using network providers? If someone has an HMO, travels out of state to visit someone and has a heart attack, are you all saying that person is not insured for the visit to the out of state hospital?</p>
<p>jbsmom – I’m just saying that what they offer generally (on paper) does not preclude what they may offer when you make a special application. When my daughter was living in NY with an individual California-issued policy, we had to submit paperwork to the insurance company. But once the paperwork was filed, then it was noted that she fit within the “temporarily living in NY category” and all was fine. This wasn’t something printed anywhere that I could find it on my policy – I called up an agent, explained the situation, and asked.</p>
<p>People move. People travel. And it’s fairly common for 26 year olds to live in different states than their parents. So I don’t think that means that a New Jersey insurance company is going to be telling parents that they need to fly their daughter home from Stanford if she needs medical care. I think they will handle it the same way they handled it for my daughter – you’ll fill out some sort of form and they will keep it on record. If you are on an EPO and your daughter is living halfway across the country, they’ll temporarily enroll her in their equivalent EPO in that neck of the woods. </p>
<p>Again, this is not the stuff they print on the front page of the brochure. This is the stuff you find out by calling up an agent and asking.</p>
<p>Absolutely. The cliff between 400% of poverty and 401% of poverty is quite simply a legislative mistake. It needs to be fixed in some way, because we don’t want to incentivize people to earn less money.</p>
<p>I have read threads here from people who had to sign up for coverage from their college because the college said the family’s insurance was inadequate in their far-from-home location.</p>
<p>teriwtt, how terrible. This young woman will be able to buy insurance based on her age, not her injuries, because of the ACA. So at least the parents won’t have to spend millions. So that’s something. I hope she has good insurance for 2013. </p>
<p>My thoughts are with her, as are my hopes for her complete recovery. I hate to hear about yet another cyclist hit by a car.</p>
<p>That’s what I hope, too. Her dad has a solid big corporate job which I’m sure pays very well, with I’m sure excellent benefits, and I’m sure they’ll reach their out-of-pocket maximum very quickly. Assuming that they still have a lifetime maximum this year, though, I hope they don’t reach that and cut her off. That would be tragic.</p>
<p>Terriwit: If the driver was at fault, hope he had a large auto policy that will pay up. It’s terrible to read about a young life so terribly damaged.</p>
<p>Very sorry to hear about your friend’s daughter teriwtt. I know a lot of kids take bikes to UT but not sure how bike friendly the campus might be. </p>
<p>A parent told me a couple of years ago that he did not believe his daughter’s bike was ever moved from the chained spot after almost 6-7 months on campus because students just don’t seem to use them.</p>
<p>For the record, I’m not sure "shut out"is the best way to describe doctors not in the exchange in California. Several months ago I was urged to “not miss out” on the opportunity to accept something like 25 percent, 50 percent, and 75 percent of my already discounted rates. No mention was made of ACA, but I suspected that was the plan. It looks like I may have “missed out”, along with all the other psychiatists nearby. An e I sound too self serving, it’ts not the rates for “medication visits” that are off putting (even though they appear to be below the rates of other medical specialities for the same cpt codes), it’s the rates for “therapy”.</p>
<p>The tragic story of Terriwits friend brought to mind a story about a local girl and brings us back to the original subject. This girl developed a very rare form of cancer. It went undiagnosed for a period of time UNTIL she went to UCLA, where it was surgically excised in a marathon surgery and then treated with experimental type chemo. She is still alive. </p>
<p>With hospitals like UCLA out of the picture on the exchange, little community hospitals simply aren’t equipped to handle difficult, rare, conditions like this. It would be malpractice for them to even try. </p>
<p>It’s nice to have insurance for small things like broken arms. But when you really need insurance for the major, life-threatening stuff, you need to go to a teaching hospital like UCLA. </p>
<p>A small network of basic community hospitals simply won’t help.</p>
<p>Both H and I took our bikes to UT, but that was many, many eons ago, and we used them after we moved off campus in our junior and senior years. But I’m sure campus has changed since then!</p>
<p>I’m guessing that whether they use them or not depends on their class schedule and distance between buildings for classes. I remember, even after declaring my major and having most of my classes in one building, the shuttle bus often could not get me to the other side of campus in time for classes in other buildings if I only had ten minutes. So I would ride my bike those days. </p>
<p>That being said, after looking through this mom’s Facebook page, I saw that she posted a link to a website for RoadID, which is an ID system for bicyclists to use when they are out, in case they are in an accident and are knocked unconscious (my H has one, too), and said that both her daughter and husband used this product; so I’m guessing that the daughter was more than a recreational rider if she uses RoadID.</p>
<p>Another girl who my kids went to high school with developed severe headaches at age 20. Again, undiagnosed for months. Our little community hospital sent her to USC because they recognized it was likely a brain tumor and they did not have the type of neurosurgeons and staff prepared to do an excision of the tumor. </p>
<p>Most community hospitals do not have, for example, NICUs for the smallest preemies. They aren’t tertiary care centers. </p>
<p>The list for the hospitals on the exchange hasn’t come out yet. But if it’s inadequate, then the insurance on the exchange is buying a pig in a poke.</p>
<p>Calmom, I do have a friendly question for you. Do you think there will be any way to purchase a policy on or off the exchange in Ca. and have access to the network still available to grandfather plans? I keep racking my brain trying to think of a way, but so far I can’t figure it out. It seems like Anthem may offer such a plan but we won’t know until they announce it. There must be someway; I just wish I knew what is was. You seem to know more about the Ca. marketplace than anyone on this thread, so I am hoping you may have some ideas.</p>
<p>You might want to go to a teaching hospital for something rare. But rare conditions are, well, rare. Most major, life-threatening stuff is run-of-the-mill: heart disease, cancer. If people need to go to teaching hospitals for run-of-the-mill stuff, then why do community hospitals even exist?</p>
<p>You don’t go to teaching hospitals for easily treatable things like broken arms. But when you really need healthcare for brain tumors, premie babies, rare cancers in a child, transplants, you don’t want to go to a hospital that doesn’t have that kind of expertise. </p>
<p>If the networks don’t include those hospitals for referrals when needed then the insurance isn’t very good at all.</p>