<p>In California, the patient is responsible for ensuring the anesthesiologist is in the network for non-emergency surgery; otherwise he can be very surprised by his bill.</p>
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<p>I don’t understand this statement. I’m not buying on the exchange, but if I were, I’d have five Bronze plans, seven Silver, six Gold and six Platinum to choose from, from five different insurance companies. </p>
<p>That looks like quite a lot of choice to me. If I chose Blue Shield this year, and then I didn’t like it, I could switch to Kaiser next year. If Blue Shield got the reputation of a plan where you could never get a doctor’s appointment, everyone would switch to a different plan. Blue Shield is in the business of selling insurance; they don’t want all their customers to leave.</p>
<p>Lets see what the medical school says elective surgery is.</p>
<p>[Get</a> the Facts About Elective Surgery - Online Medical Encyclopedia - University of Rochester Medical Center](<a href=“Content - Health Encyclopedia - University of Rochester Medical Center”>Content - Health Encyclopedia - University of Rochester Medical Center)</p>
<p>"If a surgery is not an emergency, it is considered elective. There are many types of elective surgery.</p>
<p>Elective surgeries may be required in order to diagnose disease. One example is a biopsy to find out whether you have cancer. They may also be optional. An example is laser surgery to correct nearsightedness. Or you may have plastic surgery to replace your hair or tuck your tummy.</p>
<p>Just because these surgeries are optional doesn’t mean they aren’t serious. "</p>
<p>Cardinal Fang, all those plans to which you referred all have narrow networks. Everyone in Ca who is not grandfathered or in a group plan for now are stuck in these narrow networks. There is no alternative.</p>
<p>[Anthem</a> Blue Cross adds UC hospitals to Covered California offerings - San Francisco Business Times](<a href=“http://m.bizjournals.com/sanfrancisco/blog/2013/06/anthem-blue-cross-adds-uc-hospitals-to.html?r=full]Anthem”>http://m.bizjournals.com/sanfrancisco/blog/2013/06/anthem-blue-cross-adds-uc-hospitals-to.html?r=full)</p>
<p>I called Anthem Blue Cross because I want to be able to use UCSF if the need ever arises. (I hope it doesn’t. :))</p>
<p>I was told UCSF is going to be in my network and will be in my network under the Bronze and more expensive plans. I live in Marin County. I do not live in SF.</p>
<p>Blue Shield is going EPO. Anthem is staying PPO at least in my area of Cal. I was told that if UCSF was in network before ACA, it will be after.</p>
<p>My rates are going up from 1000+ a month. A bronze plan will be about 1370 a month. For some reason, Anthem said if I don’t choose a plan, they will put me in a plan that costs 1500+ a month. I called Anthem and asked what I get for 1500+ a month. The guy at Anthem said he didn’t know and call back in a week. This was a week ago so I guess I can call now. I did find it amusing that Anthem is recommending a plan their people did not know about. :)</p>
<p>dstark, you are right the Anthem plans include the UC hospitals. Blue Shield doesn’t. Make sure you check to see who else in your community is in the network before you choose a plan. Right now, the Anthem narrow network is probably better than Blue Shield’s narrow network. </p>
<p>My premium went up close to 100% for a plan that has a higher out-of-pocket maximum.</p>
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<p>I’m going to wait and see whether to believe you. So far, I’ve seen no reason to believe that anyone here knows exactly which providers are going to be available for the various networks in California. All the networks might be narrow, but I haven’t seen anything that makes me conclude that yet. In a few days we’ll know more.</p>
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<p>Then look at it this way: For all of your adult years up till now, you’ve been very very fortunate. Maybe the bright side is that you got all the way to age 60 without having really expensive insurance. I certainly can’t say that. Our new insurance will be expensive too, but that’s been the case for at least a decade. Consider yourself lucky. ;)</p>
<p>^This logic makes zero sense. I do see more people self insuring and paying a fine if they feel comfortable not paying twice the payments for half the care.</p>
<p>Texaspg, I wish I was rich enough to self insure. :)</p>
<p>If you were rich enough to self-insure, you’d be crazy to do it. If you were rich enough to self-insure, insurance premiums, even large ones, would be lunch money to you.</p>
<p>I think some of the economics are being reversed for a group of middle class folks. There are groups out there that are subsidized enough that the numbers being high does not impact them whatsoever. So they don’t care about 20k price tags since their price will be subsidized. However those that don’t make the cut for whatever reason (lets assume someone with over 400% income) who is suddenly faced with a huge price tag but used to diligently pay insurance all these years will have to make a choice whether to give up a big chunk of their income with still a big deductible or wait for that medicare to kick in.</p>
<p>Maybe the bright side is you’ve gotten all the way to age 60 with good health intact. That’s a very bright side indeed. Plenty of people who have done everything right can’t say that.</p>
<p>I’ve “done everything right” but have a very serious chronic health condition that has baffled all the best docs in the world. My kids have similarly “done everything right,” but also have serious health conditions. Our neighbor did “everything right,” but has had juvenile diabetes since age 2 or 4.</p>
<p>I’m glad there is insurance and neither I nor anyone I know would be self medical insured, even if we could afford it. Yes, it is a hassle when you have to work with insurers, but I would hate to spend a ton of resources for medical care because I chose not to get insurance.</p>
<p>I have had anesthesiologist for myself (multiple times) and my S (once). I was able to state a preference once or twice for myself and they MAY try to honor it if they can but more often than not, it is chosen for the patient. In theory, the medical center is supposed to find a participating and preferred anesthesiologist but in practice that doesn’t always happen. When it doesn’t, you can have some prolonged “discussions” to get the insurer to not have you as the patient stuck with the extra bill. </p>
<p>If I didn’t have these discussions, I would have had to pay a very hefty bill for the difference between what the insurer was willing to pay and what the anesthesiologist was willing to accept. After considerable arguing, I was able to get the bill reduced and pay the portion I would have paid if the anesthesiologist had been participating & preferred and the insurer paid the remaining reduced amount.</p>
<p>In my crystal ball, there will be some new careers in financial planning exclusively devoted to minimizing one’s insurance bill. I think taking a percentage of savings shown is where the real money will be.</p>
<p>Cardinal Fang, what really annoys me more than anything else is that 2 years ago I lost my grandfather status because I went into a less expensive plan because of a premium increase. No one knew back then what this grandfather status really meant. So because of this rational decision I made at that time, I am now being severely penalized. The statement by Obama that you could keep your plan if you like it is a very hollow promise in my case.</p>
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No one has to pay a fine of any sort if the only insurance available costs more than 8% of their family income. I am guessing that the IRS will probably use the lowest cost Bronze plan as a benchmark.</p>
<p>GoldenPooch, you switched plans 2 years go in order to save premium dollars, so that is 2 years of savings to you.</p>
<p>What was the premium on the old plan 2 years ago? What would the premium be today if you had kept that plan? What is the cost differential between plan A and plan B? What rates will Blue Shield be charging for that old plan in 2014?</p>
<p>The term “Elective Surgery” is typically used in insurance contracts to refer to non-essential procedures that are typically excluded from coverage. Example:</p>
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<p>(Defined as a listed exclusion in a United Health Policy, <a href=“http://www.usg.edu/student_affairs/documents/2012CoreSHIP.pdf[/url]”>http://www.usg.edu/student_affairs/documents/2012CoreSHIP.pdf</a> )</p>
<p>An insurance contract can use any definition it chooses – that’s why policies usually do have a “Definitions” section – but I have not seen the phrase “Elective Surgery” used in any other context within a policy than the one I quoted above. </p>
<p>To whoever commented on whether people actually read their policies, the answer is YES, I do. Not only that, I have an order in which I read. The “Exclusions” and “Definitions” sections would be where I usually start.</p>
<p>Sounds like the insurance companies are still putting the screws to the hospitals. And the hospitals are slowing falling in line.</p>