<p>Per a Mc Clatchy article dated Dec. 26, some bronze plans in some states require the patient to pay the full amount of the doctor visit until the deductible is met. Not a co-pay. Many people may not read the fine print and will be surprised.</p>
<p>Yes, “some” plans are co-insurance plans, and “some” are co-pay plans. California offers a choice between each type. The difference is not explained in “fine print” – it is in big letters when you click to see “details” of each plan.</p>
<p>I agree that many people don’t understand how insurance works and would benefit from working with an agent who can explain this to them. </p>
<p>If you are referencing an article, please provide a link and also (for longer articles) please provide a quote or some sort of reference to the section you are citing to. It’s hard to respond to vague statements, although I would also note that since the news media seems to get a whole lot of things wrong in their reporting. There are a couple of exceptions, but for the most part the reporting seems to get things wrong more often than they get it right.</p>
<p>Just a little break from insurance company rate discussion for a real world hypothetical question. </p>
<p>So what is worse, waiting two hours for your prescription at a Kaiser facility while having an asthma flare episode with no rescue inhalers working or passing a kidneystone in line? </p>
<p>I felt bad for the new Kaiser patient today with kidney stones. They morphined him up and then got to wait to be sent home with more meds. He was in good spirits, but then opiates would do that. I tried to not pass out, although that might have expedited my order. ;)</p>
<p>I survived my long wait time to find out that one of the prescriptions today was being given as a three month supply, which was far more than I was expecting to pay. The doc didn’t tell me I needed to take for three months straight (he said to take for one month) so now I have a lot of this medication, which I may or may not use. Pharmacist insisted that is what was written. </p>
<p>Also, one of biggest Kaiser facilities in LA area on westside - closed their second pharmacy on the premises. It is a hospital and urgent care facility, and Kaiser patients have to use these pharmacies. Anyone who is discharged from hospital uses this pharmacy, as do all the walk ins. It was a mess.</p>
<p>“I find it hard to believe there is a difference with what the provider gets per plan.”</p>
<p>Ok, explain why the ALL THE same doctors on other BC/BS plans don’t show up on the CoveredCA plans? What is so magical about CoveredCA that they can’t be signed on other than a price?</p>
<p>Btw, if they get paid the same, why do they have sign up to each plan? BC/BS has a contract with that doctor already. Why bother with one more?</p>
<p>I thought the Riverside article was very accurate. No one knows for sure what they are getting from 2014 ACA-compliant insurance plans in the individual marketplace. I have had extensive discussions with very high-level administrators at Anthem, and they are totally confused about the networks. The provider directories are inaccurate and many doctors are unsure what is going on with these networks. I would be very nervous about participating in an exchange or off-exchange plan in Ca. in 2014. If you get sick, it could be a very ugly situation trying to get care from selected providers.</p>
<p>I agree most people only look at price and are totally ignorant about the network or the formulary. I will not have much sympathy for them if they are unable to get specialized care from a top-notch provider, if they were given a real choice of plans with a broader network. In Ca., this is not the case. People in the individual market, who have had their plans cancelled, will have to live these narrow networks and hope they don’t get really sick.</p>
<p>Calmon seems to like Blue Shield because they are a non-profit company. The attorneys suing Anthem because of the grandfathering issue told me that one of the reasons why they are not going after Blue Shield is because their attorneys fight these cases to the bitter end. Apparently, Blue Shield was much tougher with people who had their policies rescinded because of preexisting conditions. According to the lawyer, Blue Shield refused to budge on those cases while Anthem frequently reversed their rescissions.</p>
<p>I personally don’t understand how many people view health insurance. For me, I look at it as a vehicle to pay for huge medical expenses if I need care for a catastrophic illness. I don’t worry about routine care, but I do want great insurance for an extended hospitalization. I am trying to protect my family from a worst case scenario. This means having the option to go to the best hospitals, particularly the specialized ones like the MD Anderson Cancer Center or other facilities that provide specialized services not routinely found in many suburban hospitals. </p>
<p>The bottom line for me is I want a policy that will protect me from 6 figure bills and give me the greatest flexibility in selecting my providers in a worst case scenario. I never want to hear that my wife can’t get the care she needs because the network was too narrow. Unfortunately, most plans in the individual marketplace under Obamacare are not geared to provide this level of service. In a year we may see the same thing happen to the group market.</p>
This is just a rumor that you are reporting, but I’d point out that the other side of the coin might be that in the days when insurance could be rescinded, Anthem was more likely to try to rescind on weak or bogus grounds, whereas perhaps BS tended to be on stronger ground when they rescinded in the first place. So Anthem might have been willing to negotiate because they knew there was a high likelihood that they would lose in court, whereas BS could have been standing firm because they were confident of winning. </p>
<p>As to your other comment, I did not choose to stay with Blue Shield because they are not-for-profit, I chose to stay with them because (a) the best medical facility in my region is on the BS network but apparently not on Anthem’s, and (b) Blue Shield answered their phone when I called and answered my questions. Every time I called Anthem I would be asked for a lot of personal identifying information, and then transferred to an “agent”, only the transfer to the agents always went to voice mail and no one ever called me back. I am not particularly fond of any insurance company, but for me the choice was between one company that deserved a C- for customer service and another that got an F. So I went with the C- company. </p>
<p>You seem to have been more successful at getting someone to actually phone you back, though I personally would still take whatever they tell you orally with a grain of salt. It’s pretty easy for someone to sing their own company’s praises while bad mouthing another; not necessarily very accurate.</p>
<p>“Ok, explain why the ALL THE same doctors on other BC/BS plans don’t show up on the CoveredCA plans? What is so magical about CoveredCA that they can’t be signed on other than a price?”</p>
<p>What are you saying? That doctors who sign up for Anthem’s individual plans are charging various prices for the same procedure depending on the individual plan? Why would anybody pay more for the same procedure?</p>
<p>Or are you saying doctors are bypassing the exchanges and just signing on with Blue Cross for individual plans off the exchange?</p>
<p>It’s also possible they were previously contracted with an insurance company but don’t like the reimbursement rates under ACA. Some don’t even know what they are yet.</p>
<p>I think that at least in California, the doctors are being asked to sign new contracts with different rate structures for all 2014 ACA compliant plans, whether purchased on or off exchange. The situation for grandfathered and group plans may be different, although I also believe that the insurance companies have the power to change reimbursement rates whenever they want, and I doubt that doctors are presented with a full schedule of rates when they sign the contracts. I think it’s more like they may be told what they will be paid for routine office visits. </p>
<p>I think that there probably is a lot more detailed negotiation when it comes to larger health facilities, because I can envision a team of accountants at, say, Sutter Hospital sitting down with insurance execs and going over items line by line – after all, they are the ones who are deciding that they will charge patients $100 for a tylenol caplet. So they are likely to look at things line by line.</p>
<p>As to the lists, I honestly don’t think they are anywhere near complete outside of the medical facilities. I think doctors are taking a wait-and-see attitude, mainly because they can. Many are already busy and have a full complement of patients, and so might be thinking about the issue differently: they don’t want to sign up for the 2014 plans because they don’t think they can handle all the new patients. But when the patients they already have start showing up with their new insurance cards, the doctors might realize that ACA is not restricted to a new population of previously uninsured people.</p>
<p>So we’ll see. I have my new insurance card and I’ll run by my doctor’s office sometime soon to give them a copy, and see what they say.</p>
<p>It is a good article TatinG.
Calmom, has posted quite a bit about people who qualify for subsidies should look at silver plans.</p>
<p>By the way, it looks like silver plans are the most popular plans. </p>
<p>I have found that some people who get their insurance from their employer dont understand what the indivudual market is like.</p>
<p>So… I really like this…</p>
<p>“Meeting the deductible before most coverage kicks in is common in the individual market, but it differs sharply from job-based health insurance. More than three-fourths of the insurance plans offered to Americans with coverage through their jobs pay a substantial chunk of the cost of doctor visits without the workers having to meet the annual deductible first, according to an annual survey of employers by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)”</p>
<p>Ah. Peter Lee of Covered California said, around Dec. 18, “About two-thirds of people receiving subsidies are choosing silver plans, while most of the rest choose bronze plans.”</p>
<p>That’s good. So preliminary data from California says a lot of people with subsidized premiums are choosing the plans with the out-of-pocket subsidies. I was worried that lower-income people were choosing Bronze plans they couldn’t afford to use.</p>
<p>As far as I know, that is true of all insurance companies selling on any exchange - they are selling identical plans on and off exchange. I don’t think there is any such thing as an on-exchange policy that can’t be purchased directly from the companies.</p>
<p>Some companies are also offering additional policies in addition to those offered on the exchange. In California, Anthem does; Kaiser does; Blue Shield does not.</p>
<p>The ACA mandates that the same premium be set for the on-exchange policy and the identical off-exchange policy; and also mandates a unitary risk pool for the state’s individual market. </p>
<p>The policies are identical. Blue Shield sent me a letter 3 months ago saying that if I did nothing they would roll me over to their bronze-level HSA plan. That is the plan I wanted, but I went on to the exchange and bought the plan via Covered California. I did not notify BS to hold off on the rollover because I thought they would do that automatically. They didn’t. Two days ago they sent me ID cards for the CoveredCA plan, and then yesterday they sent me ID cards for the rollover, direct-from-company plan. Both cards describe the plan by the same name (“Basic PPO for HSA”). They have different subscriber ID numbers and the only way I know which is which is that one also has the CoveredCA logo on the card. (I’ll give them a call sometime next week to confirm which is which and cancel the direct one – but I am very, very confident that these are the exact same plans, and the only difference as far as BS is concerned is where the premium payment comes from).</p>
<p>CF, I think that the CoveredCA web site does a pretty good job of steering people to the best plan. For example, using the shop and compare tool, if I enter in data for a 60-year-old in San Francisco with $21,000 income, this message pops up:</p>
<p>
</p>
<p>There is also a very simple graphic bar chart that makes it obvious that at the 87% CSR level, the silver plan paying more (but costing less) than the Gold plan. The Enhanced Silver plans are also presented at the top of the page, above the Bronze. (It’s the other way around for me – at my income level, I see Bronze first, then Silver).</p>
<p>So it is really structured so that the people qualifying for the CSR’s will be encouraged to select among the Silver plans.</p>
<p>Would Any group of doctors say we are not going to take Blue Shield on exchange individual plans but we are going to take off exchange individual plans? </p>
<p>Why would doctors do this? Could they do this?</p>
<p>Looks to me like doctors are in or out of Blue Shield.</p>