<p>Reminds me, maybe of no use to y’all: when I set up my exchange account, the site warned to check spam settings. Who knows. Doesn’t explain why calmom and dstark got no paper follow-up. I was able to pay by phone, today, with an exchange rep. (He said that, since Black Friday, they are incredibly busy.) </p>
<p>Calmom, my site is fine. Most things I would have done differently are too minor to think about. Except: I could have used a help page. Or even little pop-up bubbles, to explain some questions.</p>
<p>My wife got a letter from BCBSNC today confirming that they received her application via the Marketplace and we have been enrolled in the Blue Select Silver plan effective 1/1/2014.</p>
<p>“Your welcome kit and ID cards will arrive prior to your effective date.”</p>
<p>Very nice, but no mention about payment, which we would like to do. And no reference # or account # or policy #. We might call to see if/how we can pay.</p>
<p>“The plan I have signed up for hasn’t been approved yet. I have to call again next week.”</p>
<p>Oh my God. I can just see them putting everyone off until the week of Christmas, and then when you call in, you get a recording informing you they will be closed until Jan 2.</p>
<p>dstark, well I just got off the phone with Anthem and all I can say is that I have never encountered this level of disorganization and chaos in all my years dealing with insurance companies.</p>
<p>The good news is that Anthem will cover Cedar Sinai. However, it is considered a tier 2 hospital. Stanford is also tier 2. This means there will be higher copays for these hospitals (not disclosed in their marketing info), but the real kicker is that it also may mean that all doctors who use these hospitals will not be covered. On this point, the guy I am dealing with (the head of all sales) is not 100% sure this is correct. He can’t seem to get a straight answer from anyone at Anthem. He is going to call me as soon as he knows. Who knows when that will be.</p>
<p>He also admitted the drug formulary has been significantly narrowed. The big difference is that non-formulary drugs were covered in the past (at a higher co-pay) but will be excluded in the future. Again, this could be a major issue for some people.</p>
<p>Having said the above, Anthem is still way superior to Blue Shield (a non-profit), which doesn’t include any of these hospitals and has a very narrow network of doctors.</p>
<p>How can only some doctors be covered? Let’s say you surgeon is covered. Okay. But the hospital ‘assigns’, for want of a better term, the anesthesiologist, the hospitalist who may see you after surgery for pulmonary issues or infection, the radiologist, the pathologist. Would those doctors not be covered and be out of pocket expenses?</p>
<p>I know many have said NY has been one of the few success stories. Well, this article in the NY Times seems too contradict some of the stories were hearing about NY. </p>
<p>The individual health insurance market was decimated many years ago when NY adopted community rating and guaranteed issue for the health insurance marketplace. I have always wondered what people in NY, who do not have access to the group market, have done for insurance. This article explains that most of them have belonged to associations and have gotten their insurance through the associations.</p>
<p>Well, as you can imagine, these association plans are now illegal under ACA, and most of these professionals are now looking for 2014 plans and are dismayed with their choices. </p>
<p>You can not go out of network for many of the ACA plans and, of course, they are plagued with the issue of limited networks of doctors and hospitals, not to mention the higher deductibles and premiums. Apparently, many of these people are regretting who they supported in the last Presidential election, but this is a subject for a different forum. </p>
<p>TatinG, doctors not being covered even if you’re at a covered hospital is not a new situation. It’s been going on. People discover, after the fact, just the situation you describe: they went in for surgery, their surgeon was covered, the hospital was covered, but oops, the anesthesiologist was not covered and so they have an unexpected whopping out of network bill.</p>
<p>I’m in favor of a law that says that if a patient goes to a covered hospital, admitted by a covered doctor, then they pay the in-network price for everyone they see, and the rest of the fee for the doctors not covered by their network is the responsibility of the hospital itself.</p>
<p>Tatin, as of now all these doctors would not be covered for tier 2 hospitals. To tell you the truth, no one knows if this is correct. The head of sales at Anthem is not entirely sure about this. Hopefully, I will know more next week. I am hoping it is more an issue of whether each individual doctor is included the network as opposed to some blanket policy for all the doctors.</p>
<p>CF, this is a different issue. I have never seen a blanket policy for all doctors serving a particular hospital in the past. Don’t try to put lipstick on this pig.</p>
<p>Not all doctors at a hospital work for the hospital. Most of them are in private practice while the hospitals do employ some in each specialty directly.</p>
<p>I would think when a hospital is approved, you are getting only those doctors that are employed by the hospital and rest need to be on your plan or out of network.</p>
<p>Texas, this is exactly the issue I am trying to clarify with Anthem. Does this policy also include private practice doctors who may be in network? This high level executive at Anthem is not sure.</p>
<p>“I was just told that Cedars and Stanford Hospitals are covered as a tier II hospital in our network meaning that the hospital is part of our network but the Doctor’s are not.”</p>
<p>This statement was included in the email I received from Anthem the other day. My call today was trying to clarify what it meant. Does it mean only employees of the hospital or all doctors or only some of the doctors not in the Anthem network? No one knows.</p>
<p>We had the same issue with Anthem several years ago. The hospital and dr. were in network. The hospital used the only radiology place in town. Patients had no choice where their films were going and that office was out of network. Hospital CEO said they had no say about that. Oh phooey–that hospital was sending 100% of stuff there and could have used some pressuring. Ultimately they did, but many people got stuck with large bills in the interim.</p>