<p>I’m not arguing about how people ought to choose their policies. My point is about how a lot of people DO choose their policies. If I were having to buy a policy for my family and finances were tight, and I heard that it would cost, say, $5000 more a year to keep our doctors, I’d probably say, Bye bye, doc. I like my doctor a lot, but $5000 is a lot of money for many people.</p>
<p>My link from the Riverside Press-Enterprise is three days old! Hardly dated. </p>
<p>One of the largest groups of doctors in Riverside is not going to be taking Covered California, 140 doctors in 5 offices. It wouldn’t be financially sound to do so. </p>
<p>Riverside is not a wealthy community. But these doctors must have enough patients from employer insurance companies or Medicare or the UC Riverside student health plan that they don’t need to take patients with low reimbursement rates.</p>
<p>Dstark, my link is from mid November. I consider that pretty current</p>
<p>
</p>
<p>That’s a bogus average. You’re averaging the rates for people who had cheap healthy-people rates, and people who couldn’t get insurance at any rate. When you average in infinity (the cost of insurance for people who couldn’t buy it) with some other numbers, you get infinity. So on average, people are paying less; any finite number is less than infinity.</p>
<p>Are those with pre-existing conditions paying less than they would have paid on their state’s high risk pool?</p>
<p>California had a high risk pool. I thought the rates were subsidized by the state. It’s just that there was a waiting time because space in the pool was limited.</p>
<p>Cardinal fang, what about $5000 more per year, but with lower deductibles, wider network, local doctors, ability to get into a well respected Children’s hospital if your child needs it, etc? There are trade offs with both systems. In many places (not all), price corresponds to availability and options in care. It’s a personal thing. Those that can (even when it’s a hardship) may prefer the larger networks and providers/hospitals available in off market policies as opposed to those offered on the exchange. We needed to buy off the exchange so we and our employees could continue seeing local doctors and be admitted into our local hospital as they are not included in the networks offered for small business on the NYMarketplace.</p>
<p>When one side of a negotiation starts leaking to the press, watch out. Maybe they’re telling the truth, but expect a lot of spin. It’s kind of like contract negotiations with sports team figures who hold out: the player’s agent claims that the team is trying to pay the poor hardworking player pennies. And then at the end, the deal that actually is arrived at bears no recognition to what one side described in the press.</p>
<p>Should I believe that the actual reimbursements in California average 70% of Medicare, or in fact any number lower than Medicare? I’m deeply skeptical.</p>
<p>The ACA requires that policies sold on the exchanges be set up to “ensure a sufficient choice of providers” within their networks – so except for rural areas where there are overall doctor shortages, the networks are going to have enough doctors and hospitals to meet the needs of the people enrolled. </p>
<p>That doesn’t mean the network has to have the doctors or facilities that people choose. The reason there is an issue about networks where I live isn’t because there aren’t enough doctors & facilities – it is because there are more than enough, giving the insurers the ability to shut out particular facilities from the network while offering alternatives that may be less desirable to certain individuals.</p>
<p>But I don’t see Kaiser going out of business. Kaiser remains a very popular option, and that is an HMO that has always been built entirely around the idea of a restricted network. So I don’t think that consumers are necessarily averse to the idea of being given a narrower range of choices. In fact, from a psychological standpoint, many may be happier. (It’s easier to make a choice from a short list than a long one – the long list becomes overwhelming). </p>
<p>So it becomes an issue when someone already has insurance and an established relationship with a particular doctor or facility, and is looking at the possibility of change – but it isn’t particularly significant to someone who has not been insured or does not have a strong tie to a particular medical provider. It also isn’t really a new issue - people who had employer-provided insurance also experienced changes in networks when their employers shifted to different plans, or when they changed jobs.</p>
<p>CF, you think that the doctors are going to lie to a newspaper with their names and photos printed for all to see? I have more faith in doctors than you do I suppose.</p>
<p>I’m perfectly willing to believe that wider networks including pricey children’s hospitals and more local doctors are worth money to many people. I’m sure that you agree, those perks are not worth $5000/year to many people, and are worth $5000/year to other people.</p>
<p>It’s like airline seats. First class seats, business class seats and extended-room seats are better, no doubt about it. First class seats are a whole lot better. But most people aren’t willing to pay what it costs to get them. Similarly, some people won’t be willing to pay what it costs to have entree to Forest Resort Casino & Cancer Center, even if Forest Resort’s amenities are worthwhile.</p>
<p>
</p>
<p>Is that a joke? Fang Jr. and I think it’s pretty funny. Are you suggesting that people don’t shade the truth when speaking to the press? Or that people don’t say things they believe to be true but that turn out not to be true?</p>
<p>“Ensure a sufficient choice of providers” is about the mushiest language imaginable. Who determines that? </p>
<p>Are all the providers board-certified? Did the provider go to a U. S. medical school or to a Caribbean school or somewhere similar? What about someone who has a long history of ‘problems’ with the state medical board?</p>
<p>A list of names alone is worthless.</p>
<p>No. I don’t think the doctors would lie to the press on a fact that is easily verifiable with the insurance carriers. Wouldn’t other doctors call them out? Wouldn’t the insurance companies write a letter to the editor or call the author of the article stating that the doctor was incorrect?</p>
<p>"California Medical Association President Thorp said one of the health carriers also approached him with 10, 20 and 30 percent reimbursement cuts for three different plans. “And I said, ‘Thanks but no thanks.’”</p>
<p>Thorp, who practices in rural Paradise, was later informed he’d be included at his current rate because the insurance company didn’t have enough doctors in the area."</p>
<p>:)</p>
<p>Paradise is a tiny little town. He may have been the only doctor for a hundred miles.</p>
<p>
</p>
<p>Did you miss the part where the actual negotiated amounts between insurers and providers are regarded as trade secrets, both by insurers and by providers? </p>
<p>Sally Report asks Acme Insurance, “Can you confirm that Acme asked Cutts & Knife Medical group to accept 70% of Medicare as their reimbursement rate?” and Acme will blandly reply that their negotiations are secret and they have no comment. It’s interesting that the reporter in that article didn’t ask the insurance company, or didn’t give their response if she did ask them.</p>
<p>Paradise is near Chico.</p>
<p>The doctors in the Connecticut article said essentially the same thing. I suppose there is a conspiracy running all the way across the country with doctors in California and doctors in Connecticut backing up one another’s made-up reimbursement rates.</p>
<p>A quick google search shows several GPs and specialists in Paradise. </p>
<p>Also shows that Dr. Thorp has a low satisfaction rating with patients.</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.”</p>
<p>This happened to us. It’s not bogus. Our small business plan went from $24,000/yr. to $40,000/yr (in one year!) with Obamacare in the near forecast.</p>