<p>I agree. I just don’t think they should be able to pay a doctor less for a procedure done through an ACA policy. That won’t happen in Maryland. Doctors receive the same whether the patient comes from Medicaid, Medicare or private carrier. The doctors are okay with it because they get more than other doctors for Medicare/Medicaid and less for private so it averages out. They don’t have to pick and choose patients based on the insurance they carry. That is what makes sense to me so that those with ACA policies are not treated as second class citizens.</p>
<p>"You and your employees are part of the 80% (or whatever) who have the option to keep whatever plan they have and are not directly impacted by ACA. "</p>
<p>It sounds more like a case of joining another group plan that is part of “keep whatever plan they have” since nysmile’s company is moving to a new insurance.</p>
<p>Are you sure that the state of Maryland sets reimbursement rates for doctors? I know that Maryland sets hospital rates, but I’m skeptical about doctors’ fees.</p>
<p>Typically, for private plans the rate is whatever the provider and the insurer negotiate.</p>
<p>Calmom, You are wrong. We had to switch plans because our group plan was being discontinued as of Dec. 31st thanks to Obamacare. We were not able to keep the plan we had as you infer in your post. Because of Obamacare, our plan was discontinued and we received the infamous letter that we would have to look for and enroll in a new insurance plan in order to maintain coverage beyond 12/31/13. </p>
<p>Yes, Magna DOES sell policies to small businesses. As I have mentioned numerous times, we own a very small business and we offer medical insurance to our few employees. We feel it is important and if we can manage to do it, we will.</p>
<p>The plans offered on the market to small businesses in our area do not work for us. Because we live in a very small town and far away from a major city, our choice of primary care doctors is limited. The plans offered to businesses on the marketplace for small business in OUR area won’t work as the local doctors are not part of those limited networks. Thus, we had to shop around and find something that will work and sign up ASAP as we wanted continued medical coverage beyond 12/31/13 when our previous small business plan will be discontinued (thanks to ACA).</p>
<p>We wanted to keep our doctors. Obama told a big untruth when he insisted we can all keep our plans and our doctors if we like them. Lie. Well, I suppose we could have kept them if we paid cash for everything without the help of insurance. </p>
<p>Magna Care does sell policies to small businesses. They sell it (via our insurance broker).
We bought it. It works better than any small business plan offered in this area on the NY Marketplace. Unlike the choices on the exchange, we will have more choices of care via providers and hospitals. We won’t need referrals to see specialists. We will have less out of pocket expenses–lower deductibles. The coverage is very good and the price for the policy is competitive with anything offered on the marketplace for small businesses.</p>
<p>The competitive price that I referred to is BEFORE any tax breaks. From what I understand, Magna Care received a lot of money from the government to enable them to offer competitive prices as a way to build up the company and create competition with other insurance companies. Magna Care doesn’t have shareholders so it’s not out there to share profits with shareholders. Our new Magna Care policy in an EPO at their Gold level.</p>
<p>A small fee is great but not smaller depending on whether signed up through ACA or not. I don’t think Carefirst should pay my doctor more if I sign up through their website for a silver plan than if I sign up through the Maryland exchange for a silver plan. </p>
<p>The all payor system applies to hospital rates. I think it should also apply to other payments.</p>
<p>This sounds imaginary to me. Do you have a credible cite for any plan that pays less for a person signed up on the exchange versus a person signed up for the same plan, but not on the exchange? I can’t imagine why an insurance company would negotiate such a deal with a provider: what do they care whether a person signed up on the exchange. Nor can I imagine a doctor wanting to agree to such a thing, since it would be one more hassle in billing.</p>
<p>At least here in MI, the BCBS plans are exactly the same (same name, same price, same everything) whether they’re on the exchange or not. The exchange’s premium is just subsidized to the consumer by tax credits. BCBS gets the same amount of money either way. It wouldn’t make sense to have any differences between the exchange plans and non-exchange plans with regards to the fee they’re reimbursed. Can you imagine the headache for all involved? At least in this circumstance, I don’t buy that there would be any differences between the SAME plan bought either off or on the exchange.</p>
<p>ETA: The BCBS exception might be the multi-state plan. I don’t know if that’s on the exchange or not. (Edit 2: Yes, it is.)</p>
<p>So, are you all saying that it’s a myth that doctors are not signing up for exchange plans because of low reimbursement rates and regulations? I have also heard this repeatedly including from some doctors who began shaking their heads about all of this years ago.</p>
<p>Our new Magna Care policy in an EPO plan at their Gold level. I’m not an insurance broker nor do I care to be. I don’t know all of the insurance jargon. We just wanted a plan that would work for our small business because our plan was being discontinued (via the dreaded letter that many people received) as of Dec. 31st.</p>
<p>Flossy, It’s not a myth. It’s happening where we live.</p>
<p>Also, when I say we own a small business, I’m talking less than 6 employees.</p>
<p>Did anyone say that? No. Nobody said that. </p>
<p>I would like to know what “regulations” you might be talking about that apply to patients signed up on the exchange versus patients not signed up on the exchange, as far as doctors are concerned. Could you name one such regulation? In the absence of an example, I’m forced to conclude that any such regulation is imaginary.</p>
<p>As to doctors not wanting to sign up for lower reimbursements, doctors don’t want to be paid less. Insurers (and patients) don’t want to pay more. Hence, the negotiations. I’m mystified by the notion that I should blindly accept the opinion of a doctor on what he ought to be paid. I so do not want my insurer to just hand over whatever a doctor demands.</p>
<p>So, are the plans in New York on the SHOP exchange group plans, or individual plans? Is there a single risk pool for everyone who enrolls there, or what? How does it work?</p>
<p>I can’t claim to be an expert on insurance. We use a local insurance broker. He helps us sort through the “crap”. He knows what works for people in our area. He knows the local doctors. He uses the local doctors. All I can say about our new plan is that we own a small business and the plan we purchased is for small business owners who want to cover their employees (and themselves/family). If one really wants to know the ins and outs of policies, I recommend having a sit down appointment with a reputable broker in your area. Insurance specifics are out of my comfort zone.</p>
<p>I hope it is not true and clearly I don’t think it should be. However, people on this board and some doctors are reporting that reimbursement rates for the ACA plans are much lower.</p>