<p>What does this mean:</p>
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<p>What is an “Obamacare reimbursement rate”?</p>
<p>“And grandfathered policies from before July 2011 aren’t protected. Those subscribers are on their own against the insurance company, just like the good old days, Goldenpooch.”</p>
<p>Except that in Ca. there is already an internal and external review process for all denied claims. Every insurance company under state law must have an internal review process for denied claims. If you are unsuccessful with the internal review, you can appeal to the state Dept of Insurance. Every subscriber in Ca. can appeal any action taken by his/her insurance company.</p>
<p>The appeal process predates Obamacare.</p>
<p>Cardinal fang, I’m pretty sure reimbursement rate is the rate they (plans bought on the exchange) pay (reimburse) the doctor for their service.</p>
<p>I looked at the exchange plans available in my area. We are covered by employer insurance, so I’m not in the market, but I was curious to see whether the narrow networks others have talked about were true of my area, Silicon Valley.</p>
<p>They are not. The plans available to me include my doctors and thousands of other doctors.</p>
<p>I conclude that networks for plans available on the exchanges are narrow in some areas of the country, but not in other areas of the country.</p>
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<p>Then a reference to “Obamacare reimbursement rates” as if they were a single unified set of rates is gibberish. Each insurance company negotiates rates with the providers in its networks. There is no unified thing called “Obamacare reimbursement rates.” As with other reimbursement rates, the reimbursement rates for exchange plans will vary widely depending on which plan and which area of the country.</p>
<p>Jim Powell, who wrote the article in Forbes, works for the Cato Institute.</p>
<p>That article doesn’t make sense. </p>
<p>You don’t buy some monolithic “Obamacare” plan. You buy a policy through an insurance company. How can they possibly generalize to every single insurance company selling plans through the exchange?</p>
<p>Yes, but it sounds to me that the reimbursement rates for the plans bought on the exchange are much less than plans bought off of the exchange. Sure, rates vary among the exchange policies,but they’re still less than what plans off of the exchange reimburse. At least this is how I understand it. Our broker said the same thing. </p>
<p>Why should a doctor accept a plan that pays him pennies on the dollar? I don’t want a doctor that has to work based on quantity of patients per day–like a fast moving assembly line. Take a number and I’ll give you 5 minutes of my time. I prefer a doctor/medical care that’s based care on quality and a patient relationship over time.</p>
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<p>I’m sorry, but *** does this even mean? </p>
<p>I don’t know about anyone else, but I signed up for a plan with BCBS. There is no.such.thing as signing up for “Obamacare”.</p>
<p>Nysmile, it sounds to you? </p>
<p>Do you have any facts?</p>
<p>There were only 17,000 people who had individual insurance in your state.
Yeah… Things were just rosy in NY.</p>
<p>There were more signups on Dec 23 for individual insurance in your state than the total
amount of people with individual insurance in your state.</p>
<p>I think the exchange is good for people who qualify for large subsidies. Otherwise, I think one can get better coverage on a plan bought off the exchange. At least in my area anyway because what good is an exchange plan if the deductibles are ridiculous and the local doctors and hospital aren’t in the provider network?</p>
<p>Dstark, NY is a big state. If one lives near NYC, the exchange plans may work fine because they have access to more doctors. There is a lot more to NY than NYC area. I never said NY is rosy. Where did I imply such a thing? AS I said, if one qualifies for a large subsidy, it makes sense to buy on the exchange. Some insurance is better than none. However, for those of us who live in small towns and villages throughout NYS, the exchange plans may very well be not of much value if the small number of doctors in our local area and the local hospital are not within the exchange provider network.</p>
<p>[Obamacare:</a> Doctor, hospital participation in exchange health plans still being determined | The CT Mirror](<a href=“http://www.ctmirror.org/story/2013/09/18/obamacare-doctor-hospital-participation-exchange-health-plans-still-being]Obamacare:”>http://www.ctmirror.org/story/2013/09/18/obamacare-doctor-hospital-participation-exchange-health-plans-still-being)</p>
<p>The article discusses that some insurers are reimbursing hospitals and doctors at lower rates for plans bought on the exchange than regular commercial health insurance policies. </p>
<p>One CT company is reimbursing at the same rate.</p>
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<p>It would be good if you would pull facts out of places that supply facts and data, instead of wherever you are getting your factoids. </p>
<p>I’m kind of wondering why insurance companies would be paying much higher reimbursement rates for some plans than other plans, without charging subscribers more. Charging more for a plan that offers a bigger network makes sense to me-- I might not buy the more expensive plan, but I might; it’s a reasonable choice to offer to your potential customers. But offering a better policy without charging more, just because one plan is off exchange and another is on exchange, that makes no sense to me whatsoever.</p>
<p>[Doctors</a> Complain They Will Be Paid Less By Exchange Plans - Kaiser Health News](<a href=“http://www.kaiserhealthnews.org/stories/2013/november/19/doctor-rates-marketplace-insurance-plans.aspx]Doctors”>Doctors Complain They Will Be Paid Less By Exchange Plans | KFF Health News)</p>
<p>I’m not making it up.</p>
<p>Nor am I</p>
<p>[Some</a> doctors back away from Obamacare | Center for Health Reporting](<a href=“http://centerforhealthreporting.org/article/some-doctors-back-away-obamacare1255]Some”>http://centerforhealthreporting.org/article/some-doctors-back-away-obamacare1255)</p>
<p>Doctors staying out of Covered California because the plans pay them only 70% of what Medicare pays. </p>
<p>The article also discusses that the networks are about half what they used to be.</p>
<p>The article is originally from the Riverside Press-Enterprise in case anyone wants to doubt the source.</p>
<p>So the article that TatinG posted from the CT Mirror says that insurers were (the article is from September) trying to make the exchange plans lower in price, because they were convinced that consumers on the exchange would choose by price (which they have been doing).</p>
<p>So then, to the extent this is true, the reason to buy an exchange plan rather than a solely off-exchange plan is obvious: exchange plans are cheaper, because the insurers deliberately focused on price. </p>
<p>One thing is unclear about TatinG’s article, though. People buying on the exchange were expected to be looking for low priced plans, and this turned out to be true. But aren’t the people buying off-exchange looking for low-priced plans too? Those off-exchange buyers aren’t getting subsidies, so you’d think they’d be even more cost-conscious. I hear GP whispering that network size is important too, and indeed it is. But people care a whole lot about price.</p>
<p>Price is important, but so is peace of mind knowing that you can keep your local doctor and have access to a wider network of hospitals, doctors, and specialists should something unexpected and serious come up. Imagine older patients who have been with their doctor for 20 years being told they now can’t see their doctor and they will have to travel an hour away to visit a new doctor. It’s a hardship for them. For many people, peace of mind trumps cost and they are willing to do without other things to pay for it.</p>
<p>Except that on average, people with individual plans who don’t get subsidies are paying more for their health insurance than before ACA. So they now pay more and get fewer physicians in network.</p>
<p>If a doctor can fill his time with people who have insurance that pays a higher reimbursement, why wouldn’t he/she? Only doctors who need more patients are going to accept the lower reimbursement plans. Seems to me that would be doctors just starting out in private practice or doctors who have a less than stellar reputation.</p>
<p>These links are dated. </p>
<p>We will see how things play out. There is a lot of nervousness when things change. Some people can not handle change. </p>
<p>Insurance companies are trying to make deals… Lower rates for more customers…</p>
<p>If true, I am surprised that insurance companies are trying to reimburse doctors at rates lower than medicare. Pretty soon, hospitals and doctors are going to be begging for medicare rates. </p>
<p>NYsmile, if people can buy better plans off exchange, they should.
You dont gave to buy a plan on an exchange.</p>
<p>That article published in the Riverside article is a little strange.
Anthem told me many times their networks were the same no matter what individual plan was purchased.
So is Anthem offering doctors less than medicare rates across the board?</p>