<p>A parent isn’t going to request treatment at a specialized place like Children’s unless their child is very ill. Routine appendectomies, tonisillectomies, and the like can be done almost anywhere. </p>
<p>Prior to ACA, when there was a dispute between the insurance company and the insured, the insured could petition the state’s insurance board for a resolution. That was before the state had an interest in the matter. Now with some state’s administrations having a political interest in keeping the ACA alive, one wonders if the insurance board won’t have a conflict of interest in favor of the insurance company. After all, they need to keep the insurance companies in the exchanges. With the insurance companies and the state governments partnered up, one wonders whether the insured can get a fair shake. There are always the courts and I understand that Children’s Hospital in Seattle has sued to be included in more networks. </p>
<p>CF, every news article about Obamacare which you don’t like is a hit piece. Unfortunately for you, there are hundreds of hit pieces everyday in almost all the major publications in the country.</p>
<p>Want to add that Seattle Childrens initiated a lawsuit against Premera or whatever- for not including them in-network (as is.) And Premera countered about the high charges at SC and block in negotiations. I don’t think “Obmacare” is involved in this suit. Nope. But I do think certain “public relations” statements are not surprising.</p>
<p>SC advised their on-going patients about Premera earlier, when people were decision-making, named the insurers they were in-network with. What one tv station does not tell us, is the details. SC also states they treated the kids, to allow parents more time to pursue in-network reimbursement from the insurer and clarify the policies they have. Remember Paul Harvey: we need, “the rest of the story.”</p>
<p>For crying out loud, Pooch, that Georgia article has nothing to with the ACA. Insurance didn’t get expensive in rural Georgia this year. </p>
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<p>Hospital system consolidation is a problem in areas all over the country, including where I live. One hospital system (hello Sutter) buys up all the hospitals and then jacks up prices. The trend started before the ACA, and it has nothing to do with the ACA.</p>
<p>SC is in-network with other insurers. And the blurb did provide details about some of the ailments. But- as even an anti-ACA blogger states- there is a blip in the video which suggests an editing out of something. And, it ends before they compete the statement about the spokesman for the insurer.</p>
<p>Wow, it is so easy to convince some people of something, with less than adequate detail. What strikes me is how the only media picking up this tale are ALL secondary or tertiary. Or “anti” bloggers, Lyndon Larouche site. But GP gets us in motion. Again.</p>
<p>Tatin, give me something that shows me they are in partnership to the extent that this is all RICO-like conspiracy against us. Crap, I’ve been following my state’s oversight since the first talks about 2014 rates and the state is most certainly not about to let the insurers run rampant.</p>
<p>You really don’t know if there is the extent of collusion you state. </p>
<p>GP, you exercise us. I am grateful for what I have learned- on my own from your sidetracks. But it’s tiring. All this shooting fish in a barrel.</p>
<p>Re: Georgia: A 60-year-old making $47,000 in Albany would have to pay a quarter of her income for the least expensive mid-level “silver” policy, the level most consumers are buying. Someone tell me how this works if there is a 9.5% max. And so on.</p>
<p>Do YOU know what they were paying or doing before? </p>
<p>Lookingforward: I can’t get political. But blue state governors and legislatures have a political interest in trying to keep the ACA alive. Don’t you agree? They can’t keep ACA alive without the cooperation of insurance companies willing to participate in the exchanges. </p>
<p>A presumed interest. That doesn’t tell us it is real or how it supposedly functions or what the checks and balances are. I agree, it is a question. Not that it is a fact. If anything, the relationship between my state and the insurers is highly contentious. We are very “blue.” But cannot tolerate letting the insurers pulls us by a nose ring. In fact, we kicked out a few insurers who wouldn’t get in line.</p>
<p>It may be this thread where we mentioned how some states are seeking to expand the list of insurers, going forward. The state position is it will encourage competition. Doesn’t sound like some attempt to protect a few carriers. Yes, we can ask questions. But not assume. </p>
<p>Here’s the first two paragraphs of the Georgia article Pooch cites:</p>
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<p>If you can explain to me why the ACA made insurance almost twice as expensive in southwest Georgia as it is in super-pricey Beverly Hills, please proceed. If you can’t, I will continue to believe that the expense is due to the monopoly power of the one hospital system that controls the entire southwest Georgia area.</p>
<p>I thought charitable organizatiins were going to step in and help
Those that cant afford their coverage. I have been told we can get rid of government and charity will take over.</p>
<p>I thought all of us could rely on the kindness of strangers to pay for our health care needs if we cant afford the care.</p>
<p>The Washington Post article also states that rates are much higher in rural Nevada, southwestern Connecticut, Wyoming and Alaska. These areas have more than one hospital. That’s not the entire story. </p>
<p>The article also attributes the high costs to the high rates of obesity and cancer (read smoking) in the area, saying that Minnesota has low rates because of a healthier population. SW Georgia also has only one insurer willing to write for that area, and many doctors in that area are not participating. </p>
<p>“Georgia: A 60-year-old making $47,000 in Albany would have to pay a quarter of her income for the least expensive mid-level “silver” policy, the level most consumers are buying. Someone tell me how this works if there is a 9.5% max.”</p>
<p>The $47,000 for a family of one doesn’t qualify for subsidies. The example is correct.</p>
<p>Edit: Just saw CF’s post regarding the accuracy of this example.</p>
That’s not true. My grandson broke his leg in December and my son has been taking him to Childrens’ – originally he was taken to an emergency room at a different hospital and given a referral to one of their orthopedists, but my son preferred Childrens’ so he called and made an appointment there instead. </p>
<p>But it’s a routine fracture and very common type of fracture. It could have been treated anywhere. Of cour</p>
<p>My son didn’t need special permission to go to Children’s, as treatment is covered via medicaid – but there is nothing to prevent a parent whose insurance is restricted to a different network to request that the child be allowed to see a doctor at Childrens’, especially if there had been ongoing treatment by a specific doctor. </p>
<p>I’m not saying the opposite - that is, I’m not denying that some kids may be very ill – but the point is we don’t know. Childrens’ hospital has well qualified specialists on staff, but they also have many patients with far less serious or complex ailments, and probably everything in-between. </p>
<p>Childrens’ appears to be engaged in dispute with various insurance companies over reimbursement rates, and they also appear to be playing politics with the children they treat by waging a PR battle in the press rather than trying to come to terms through negotiation with insurance companies. </p>
<p>I personally don’t have a problem with the idea of them doing that in general – if they want to release stats (“we have had X number of children turned away”) - that’s fine. But IMHO the specifics about nature of treatment needed that were included in the article crossed the line in terms of privacy. There was enough information given about the specifics of the handful of examples given that people with a little bit of knowledge about the children or families could make the connection. </p>
<p>And if Lookingforward is correct that Childrens’ dispute is primarily with Premera – then that should have been stated. It’s a disservice to families whose insurance does cover treatment at Childrens’ to blame “Obamacare”-- as it may discourage others from enrolling via the exchanges. That would especially be a problem for the many families whose income is low enough for their children to qualify for Medicaid under CHIP standards-- some of whom may learn that their children’s qualify only via the enrollment process. </p>
<p>“It’s a disservice to families whose insurance does cover treatment at Childrens’ to blame “Obamacare”-- as it may discourage others from enrolling via the exchanges.”</p>
<p>The reverse is also true. I had a friend who told me he was going to cancel his grandfathered plan because he heard how great the exchange plans were. I told him if he didn’t qualify for subsidies not to do it. He went back and looked at the premiums and the networks and immediately changed his mind. The state with all their propaganda is bamboozling many people into making these type of decisions </p>