<p>I am in the business and have taken the ACA courses in several states. I can confirm that the answers to our questions have not yet been determined in many cases. Physicians and hospitals have not finished negotiating, no one quite knows which providers will be allowed.
I called several popular providers, they are still figuring things out and still training staff.
GP mentioned not trusting agents, we’ll, GP, I dont trust any of the people I have spoke to at state or federal toll free sites. I know when the personal on the other end of the phone is reading a script, these people are new, partially trained, and playing catch up.
In my experience, company pricing is the same whether you use an agent or not. The agent is there to help you, to point out the answers to questions you don’t even know to ask.</p>
<p>So the two moms, Cal and Some, are both saying what I suspected, that the provider lists are incomplete both as to doctors and as to hospitals.</p>
<p>Thanks, Hayden!
The chemo I’m on is daily oral stuff, which I will take for the rest of my life, so the $100+k/year for it is ongoing. Was diagnosed at age 41 – so if I ever switch plans, our insurer will be darned happy. 
I still wrestle with the cost of keeping me alive vs. how much health care that $$ could provide for others. I also wrestle with the knowledge that DH is pretty much tied to his current employer because of my medical expenses (which, even with great insurance, are still very significant).</p>
<p>I used to work for a major benefits consulting company and part of the company specialized in reinsurance – and you can bet that health care was part of that practice.</p>
<p>post #167
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<p>The bodily injury part of your auto insurance is there to pay money to OTHER PEOPLE who are injured by your car. It will not pay a cent to you. </p>
<p>The fact that YOU are insured does not mean that you can count on the person you’ve just run over being insured. So YOU will still get sued. Plus your auto liability covers all sorts of medical and incidental expenses that are not included within medical costs. Things like lost wages, or pain and suffering. My old Blue Shield health plan covered chiropractors, but the new ones under the health exchange don’t. I guarantee you, on the low end of claims, accident victims will still be running up chiropractic bills. (People go to the chiropractor when the x-rays show that there is nothing broken but they still have terrible aches and pains in their backs and necks). </p>
<p>The part of your car insurance that pays medical expenses for YOU and YOUR passengers is called “Major Medical”. You can drop that if you want, but if you read your policy you’ll see that the limits of that coverage tend to be pretty modest. If you buy a high deductible Bronze plan on the exchange, you might be glad you had that Major Medical to reimburse you the out of pocket costs that fell under your deductible. Or to see that chiropractor.</p>
<p>Lung transplants are about $1M, I’ve been told and many multiple anti-rejections and other medications that successful transplants have to take for the rest of their lives. It all adds up quickly. </p>
<p>Medications are increasingly expensive. When patients have multiple conditions or are taking many medications.</p>
<p>In July, my husband dropped a paring knife on his foot and severed a tendon. Befor surgery, he needed a dose of recombinant Factor VIIa because he has a bleeding disorder. ONE dose was over $11,500. The price has actually come down since the last time he needed it.</p>
<p>I guess the good news is that we will be
able to deduct some medical expenses this year!</p>
<p>A friend of mine reports that unlike California’s laggard exchanges, the New York exchanges have complete provider lists. She says that she has been able to sign up for the plan of her choice, and she is happy with her plan, which is cheaper than the COBRA she has now. (She’s a parent of two college graduates, so she is in the CC parent age group.)</p>
<p>“I was also told by the same agent that if my personal doctor was on my old plan, then she will definitely, absolutely be on the new Bronze plan as well.”</p>
<p>Calmom, I will take your word that the provider lists are not complete, but this statement by the agent doesn’t make any sense. If every doctor on the old plan (grandfathered PPO plans) will be on the new Bronze plan, then how do you account for the thousands of doctors no longer in the exchange network? Is this agent referring to your personal doctor only or is this a more general statement regarding everyone’s personal doctor? What am I missing here?</p>
<p>The agent said that networks were being trimmed in different regions from the one where I live. </p>
<p>Again, I don’t know. But I am 100% sure that the database was incomplete the last time I checked.</p>
<p>As I have said, I’ll wait until the directories are complete. The phone agent could be mistaken about my doctor, but it wouldn’t make much sense for my doctor to be excluded either.</p>
<p>Calmom, according to the LA Times, Blue Shield’s exchange plans are limited to 36% of its regular statewide network. Why is your region different from all the others? Which region is it?</p>
<p>Blue Shield said its statewide network for exchange policies will include about 24,000 physicians, compared with 66,000 doctors in its full preferred provider organization roster.</p>
<p>Golden, keep in mind that many of the doctors are directly associated with particular hospitals-- so if the UC hospitals and Cedars Sinai are cut from the network, all of their doctors on staff go as well. </p>
<p>There is no University of California hospital in my region, so therefore no doctors directly affiliated with UC. </p>
<p>It may be that seeing my zip code was enough to for the agent to know that no providers were being cut from my area. </p>
<p>Again, I don’t know. I’ll wait and see. It’s not a big deal to me anyway. I see my doctor once a year for a physical and I chose her mainly because she’s local. She opened up her office nearby about 10 years ago at the time when my daughter was outgrowing her pediatrician, and I thought a youngish female doctor would be a good option for a teenage girl. I wanted someone my daughter felt comfortable with, in a location that daughter could get to on her own without mommy driving her. It worked well. </p>
<p>But the doctor is not irreplaceable or amazing, and I’m going to have an HSA with a high deductible. So if she’s not in network, I might just keep on seeing her anyway and just write the check from my HSA.</p>
<p>Well Calmom, it’s okay if you’re healthy, but someday that may change and you might feel differently then. At that point you may be told to go to particular specialists (I like to choose a surgeon who is going to cut me open) because of their expertise and experience. Under those circumstances, a limited choice of doctors will be a significant disadvantage. I guess everyone can make his/her own decisions, which is what I wish this new law would allow. Personally, it is the reason why I never joined an HMO.</p>
<p>You should ask some of the health providers (doctors) in your region if they think there will be access limitations for subscribers of exchange/off-exchange plans. There have been articles in Bloomberg , the LA Times and other publications warning about having insufficient doctors in the network for the estimated number of people on the exchanges.</p>
<p>There’s all sorts of articles in the press full of all sorts of misleading and inaccurate information. I’m not going to rely on unsourced rumors in the press. I’ll see the provider network when I see it. So far I have heard all sorts of internet rumors but I have not seen anything to confirm that even one provider anywhere near me is being dropped from the network. </p>
<p>I’m going to be on a Bronze HSA plan. That means that the first $4500 of my medical costs will come out of my pocket, not from an insurance company check. If I am choosing a doctor or hospital, the last thing I want is to be overcharged – so I have a hard time getting too upset about the idea that the insurance network isn’t contracting with providers charge the highest fees. </p>
<p>I’m sure that there will be a time when I will have greater need for medical services and I am hoping that by the time that happens, I will be on Medicare. As far as I know, there are some doctors who accept Medicare and some who don’t. I expect I will get my care from a doctor who will.</p>
<p>Hayden, if removing caps ident cost the insurance companies or make any difference in premiums, why on earth did they cap in the first pace?</p>
<p>The caps were what had me look into insurance so deeply when I immigrated to the US back in '03, because my son had just been diagnosed with a brain cyst/tumor and at the time was undergoing observation to decide if it calcified and he needed brain surgery. (Turned out to be a cyst, advised against the tricky surgery, and to date, has not calcified.)</p>
<p>Since we didn’t have all the info at that time, I’d consulted with a US brain surgeon about possible costs relating to surgery and rehabilitation. (We had started the immigration process before his dx, and believe me, although I was engaged to be married, I seriously considered returning to my home country over this.) His opinion was that we could easily cap-out at five million (not a typo) if things went badly and were looking down the barrel at rehabilitative care for years. But of course, that was worst case. There is less than a one percent chance now that it will ever burst and cause a life threatening situation.</p>
<p>For me, at the time, capping was obviously a very scary aspect to the already scary phenom of the American heathcare system. Exclusion, of course, was also an issue, and I was grateful that pooled care was available at all. In retrospect, I’m now glad we’ve been paying for pooled care, because it makes the rate adjustments less shocking to the system ;)</p>
<p>At any rate, given the differential between the former costs of plans with higher caps versus lower caps, I would personally find it difficult to believe that is not a factor influencing premium cost today.</p>
<p>Here’s a link for Canada’s health plan premiums. Are we so much sicker than Canadiens?</p>
<p>[MSP</a> - Premiums](<a href=“Ministry of Health - Redirect”>Ministry of Health - Redirect)</p>
<p>Kmcmom13, the insurance companies capped their policies at $1 million many decades ago, back when $1 million equaled a big multiple of that in today’s dollars. Back then the cap was academic as no one ever came close. Since everyone did it, no one changed. As we saw during the fights over Obamacare, most consumers didn’t even realize there was a cap, so removing it would not have given an insurer a competitive advantage. Plus from an accounting perspective, it’s easier to count your maximum exposure based on how many policies you have instead of actually trying to quantify an exposure that’s uncapped. So it just stayed. Medical bills went up and up, and there was no force compelling insurance companies to change it. </p>
<p>Strangely enough, much of the public worked to protect the cap for insurance companies. When people came forward to say they’d gone bankrupt because of medical bills, lots of people criticized them for not having insurance. When they said they did have insurance, many just shook their heads and continued to think it was the fault of the person who went bankrupt. After all, all of you who have medical benefits: have you ever read your insurance policy? Have you ever even seen one? I know I haven’t.</p>
<p>As a small business owner, we get a copy of the policy after we change plans and all insured also get a copy. I’ve read them cover to cover. Unfortunately, it is purposely very vague and generic, giving only info deductibles, out of pocket, what’s supposedly covered. But it leaves out so much of the grey areas that it’s really useless. For example, the literature and contract says our prescription plan falls under the deductible, but doesn’t say that it goes under the out of network deductible. </p>
<p>The real contract is in the insurer’s hands and they won’t disclose it.</p>
<p>Goldenpooch. I can’t speak for CA, although I believe Calmom already said this. The doctor databases are NOT COMPLETE yet here. In other words, the doctor list on the exchanges is incomplete. There are very few doctors listed because the exchange plans do not YET have all of the doctors listed on them. Ours supposedly will be complete this week.</p>
<p>So…the reason you are seeing fewer doctors on the exchange list is at least partially because the doctors (and some hospitals) just haven’t been added yet.</p>
<p>Wait a few weeks, then check again.</p>
<p>So I’m on HealthCare.gov, trying to set up a marketplace account. First, I get a page that the site is too busy. Login page finally appears. First job is to pick a user name. I enter one and am told it’s not correct. The instructions state: “The username is case sensitive. Choose a username that is 6-74 characters long and must contain a lowercase or capital letter, a number, or one of these symbols _.@/-” If you read that literally, just about ANY word, 6-74 characters long, would be acceptable. “OR” is what is stated. </p>
<p>I tried several different words that were rejected (not for being duplicates, but for not following the instructions). I finally figured out that it should have read, “The username is case sensitive. Choose a username that is 6-74 characters long and must contain a lowercase or capital letter AND a number, BUT NOT one of these symbols _.@/-.” So my user name is “[myname]1.”</p>
<p>If they can’t even give you correct instructions for picking a user name, I’m a little worried.</p>
<p>MTA: I clicked on “Create Account” and got, “Important: Your account couldnt [sic] be created at this time. The system is unavailable.” The browser tab at the top of my page now reads, “HC - Sign up Unsuccessful.”</p>
<p>I clicked on “Try Again,” and it takes me back to the very first page. So I have to type in everything again, I guess. Good grief.</p>
<p>Not open to a political discussion. Just posting it for the benefit of those in California.</p>
<p><a href=“Obamacare’s winners and losers in Bay Area – The Mercury News”>Obamacare’s winners and losers in Bay Area – The Mercury News;