<p>I understand about the choices. My wife is tired of wait times. Doctors want concierge fees. It is hard to find a family doctor for my youngest daughter. Around where I live, everybody seems to be full up. And I can walk and be in doctors offices in 10 to 20 minutes. I dont need a car. Doctors are everywhere. Everywhere and they dont want new patients. This has been going on for awhile.</p>
<p>I know people in the med field that really like Nor Cal Kaiser.</p>
<p>I also know people that love UCSF and Stanford too… Just to be fair. I cant walk to Stanford. :)</p>
<p>This is anecdotal, but in the cases I know about it was the doctor’s office at fault – and if there is anything “criminal”, it may be a practice of doctors discriminating against “Covered California” plans. Basically in the cases I am familiar with, the new patients verified that that the clinic accepted their insurance plan by name (Anthem “pathways” or whatever name Blue Shield has given the new plans) – but when the patients showed up at the doctors office with their insurance card, they were told that the doctor didn’t accept “Covered California” and turned away. When insurance agents got involved the patients were seen – either there is abysmal ignorance among the medical profession, with a large number of medical professionals erroneously believing that “Covered California” is a separate form of insurance-- or simply outright economic discrimination going on. </p>
<p>These are not situations of narrowed networks – these are situations where the provider has signed on to the new metal level networks with the particular plan, but specifically turns down people with the “Covered California” logo on their Blue Shield or Anthem ID card. </p>
<p>I’m pointing this out because the language that leapt out at me from the LA Times article you linked to is that phrase - that they don’t “take Covered California.” (NOT that they don’t take the new Blue Cross/Anthem/HealthNet plans). I’m skeptical about the claim that the insurance companies directories are wildly inaccurate. </p>
<p>Calmom, they are wildly inaccurate. My urologist is listed on the Anthem website as a pathway provider and when I called his office, they denied they were in the pathway network. When I told them about the Anthem website, they told me it was totally unauthorized.</p>
<p>The reason why many doctors refuse to join the exchange networks is because the reimbursement rates are too low. It’s not rocket science.</p>
<p>From ancient history working with medical practices professionally, front office staff is often reasonably clueless about what provider contracts the practice has signed, or the nuances that they’re in-network for this United Healthcare plan, but not in-network for that one. Current referral services find the same problems. </p>
<p>The reimbursement rate is the same whether the identical policy was purchased on exchange or off exchange. But there are medical practices that are telling patients that they will accept one but not the other. Again, I am aware of two specific cases (different patients, different doctors). In both cases it took someone knowledgeable to do some saber rattling, and then lo and behold it turned out that the doctors were on the plan after all. </p>
<p>I’m just saying that you can’t assume one way or another whether the doctor or the insurance company has made the mistake, without digging further. </p>
<p>I don’t know about Anthem and I don’t know about your urologist. But I do know already that calling the doctor’s office is not a particularly reliable way of getting accurate information. </p>
<p>Just saying. My new bcbs card is identical to the old, except for the id number and the new plan name (same name whether sold thru bcbs or the exchange.) No exchange logo or words. So who put Covered Ca on those? ACA?<br>
Don’t tell me. I know.</p>
<p>Read the LA Times article again. I promise you this is only a fraction of the people who will experience this difficulty finding doctors to take care of them. At some point, we will hit critical mass and the roof is going to cave in.</p>
<p>Lookingforward, I had a mixup with Blue Shield because they automatically rolled me over to a new policy and snet me a new insurance card, and and the same time I had signed up with the exact same plan on the exchange. I wanted the HSA, so no real choice – same plan, on or off exchange, but I wanted to be eligible for a subsidy. </p>
<p>Anyway, Blue Shield also sent me a new ID card for the exchange plan – so I had 2 cards from Blue Shield. They were almost totally identical. They both have the Blue Shield logo printed in the upper left corner, and both have the words “BASIC PPO FOR HSA” printed at the bottom. There was a different subscriber ID, a slightly different group number, and one card had a teensy “Covered California” logo in the upper right (much smaller than the Blue Shield logo). In fact, that logo was the only way I knew which card was for which plan. </p>
<p>I honestly don’t know if that is a Blue Shield thing or if the other companies are also putting a teensy Covered California logo on their ID cards – just that is what is on mine. </p>
<p>But I am very, very skeptical of any doctor or facility that makes the statement that they do not accept “Covered California” or “Obamacare.” Neither term is the name of any insurance policy or program. The appropriate question for me would be whether the doctor accepts the “Blue Shield Basic PPO”. </p>
<p>(And I would expect any halfway competent journalist to have asked that question, but unfortunately halfway competent journalists are hard to come by these days.)</p>
<p>This journalist is the one at the Times who has the ACA beat. All the Times articles are written by him. Hopefully there will be a follow up article with information from the doctors.</p>
<p>Tatin, if it’s printed, no possibility of slant, inaccuracies, incompleteness-- or just picking a few examples to grab a reader’s attention and sway their opinion? Sell newspapers? Make you think that blogger who writes so authoritatively is…an authority? There are certain messages, images and subconscious prods that work. As brought up earlier, “Oh the children!” Anything can have spin. We could quote dstark… </p>
<p>“Dstark, resident of Northern California, said his costs are higher and his wife doesn’t like the waits.” </p>
<p>The LA Times is a very left wing paper. The article is written by one of their employees, not a blogger. If the Times could find a way to be a cheerleader for the ACA, believe me, it would. </p>
<p>There was an article I posted from the Riverside Press Enterprise weeks ago on why the biggest physicians group in Riverside wasn’t accepting Covered California. IIRC, it was the lower reimbursement rates.</p>
<p>"The CBO and the Joint Committee on Taxation said it is now looking like premiums for insurance plans sold on the new public exchanges will be about 15% lower than they initially expected, based on a look at early enrollment data. The new estimates also show that insurance companies may collect more than enough in premiums this year to cover their expected medical costs—reducing the need for future rate hikes. (See: The Budget and Economic Outlook: 2014-2024 )</p>
<p>“If the CBO is right than I would expect some insurers would either lower premiums—or raise their premiums less than expected,” says Larry Levitt, senior vice president at the Kaiser Family Foundation."</p>
<p>“The new projections released Tuesday show the CBO now expects that the government will collect $16 billion from insurers who are running a profit but that it will only have to pay out $8 billion of that to the insurance companies that are essentially running at a loss, creating a net $8 billion in savings for the government. Previously the CBO projected that the program would break even.”</p>
<p>So… From the marketwatch story…on a macro level…</p>
<p>Looks like insurance policies are priced correctly so we shouldnt have a rate shock going forward. We can stop worrying about that. This includes the 25 percent signees.</p>
<p>The government is making money. We dont have to worry about the deficit expanding because of the mispricing of rates. This includes the 25 percent young person signees.</p>
<p>As far as networks go…there seems to be a lot of confusion. This will lessen over time. Some people will be happy. Some wont. according to Covered Cal… 80 to. 90 percent of doctors are in network in Cal. This of course means 10 to 20 percent arent. This also doesnt mean that doctors that are in networks with one insurance company are in network with others.</p>
<p>TatinG, what does that mean? Does it mean they aren’t accepting any private insurance? Does it mean they aren’t accepting any private insurance except grandfathered plans? Does it mean they are accepting some new plans, but they carefully made sure that if a plan was sold both on the exchange and off the exchange they don’t accept it? </p>
<p>Or does it mean they aren’t accepting any plan called “Covered California” (but since there is no such plan that wouldn’t have an effect)?</p>
<p>The insurance companies may be advertising that 80 to 90% of doctors are in their Covered California plans. But as both articles show, the doctors listed don’t agree. So who knows what the real number is. </p>
Everywhere and they dont want new patients. This has been going on for awhile.</p>