<p>This thread is hilarious. If I was in charge of things, I would require every supporter of Obamacare to purchase an exchange plan. You should all eat your own cooking.</p>
<p>The bottom line is no one in California has any idea who is in these networks. Even the doctors don’t know.</p>
<p>Do you have any idea how many health plans there are out there? Many years ago we maintained a database that had more than 200 health plans that were available in one metro area. A company like United Healthcare can have 50+ different plans in a single market. Then there are claims networks, like this one:
<a href=“Sloans Lake Health Insurance”>http://healthinsurancecolorado.insurancebrochure.com/sloans-lake-health-insurance.htm</a></p>
<p>I’d guess in a big state that there are hundreds of plans, maybe pushing a thousand in some of the bigger states. </p>
<p>I’ve no reason to think that providers are any smarter about the specific plans with which they participate today than they were twenty-five years ago. Just last year I called a local PT office and asked if they were a participating provider with my health plan. Their response? “Does the insurance company list any of our PT’s as providers? If so, we’re participating.” We had to go down the list of their PT’s to find one that was contracted, and that was then the one the billing went in on.</p>
<p>Insurer lists are also inaccurate. PP isn’t listed as a participating provider on the insurer’s website, but when D went to one of their clinics, they said they were participating, and the claim went through just fine. </p>
<p>I suspect that anyone who thinks that provider lists or doctor memories of what insurances are contracted are accurate now or at any time in the past has simply not worked with provider lists or doctors very often. It is a perpetual problem.</p>
<p>Assuming that the online provider lists for the Riverside area are accurate-- which seems plausible in this case because it accords with what the Riverside Medical doctors are saying–Riverside Medical doesn’t participate in any plans that are available on the exchanges, but does participate in individual plans that are not available on the exchange and that cost more money (Cigna, and the Health Net PPOs; Health Net only offers HMO plans on the exchange in that area).</p>
<p>I’m trying to understand why I would be the least bit concerned about this. Riverside Medical chooses to charge a lot of money, and some people don’t want to pay it. Other doctors in the area (presumably ones that charge less) do accept the exchange plans. If I lived in Riverside, had an exchange plan and wanted, let’s say, a rheumatologist, I wouldn’t be able to go to Riverside Medical. I’d have to go to some other rheumatologist, of which there seem to be an adequate number. </p>
<p>I’m sure that Riverside Medical thinks they should just be able to dictate a price, and all the insurance companies should pay it. Since I don’t share that view, I don’t see a problem here. </p>
<p>Haha, Flossy, yes. But I didn’t link them just because some part or two shored my thinking. </p>
<p>* I guess you can decide not to believe the doctor but the reporter doesn’t get to do that. Reporters report* Yeah, technically, they write something and it gets produced. That’s “reporting.” Right, wrong or indifferent. Reporters worth their salt are analytical and question to test what “seems” to be so. Try to put out that “Turth, the Whole Truth ad Nothin but the Truth.” That is no guarantee the job title is enough to prove one’s worth. With the pressures on the industry, much is now meant to draw attention. Sucker folks in. And yes, it happens in PR and promises and more, too. So, it;s left to us to…vet. (Assuming we have some interest.)</p>
<p>And no way the Riverside article was thorough. He knew the impact on fee reimbursement and not the impact on income via loss of patients? Nuts. Quacks like a duck. :)</p>
<p>The Administration recently said 6.3 million people were eligible for Medicaid between Oct and Dec because of Obmacare. Another lie by you know who. The number is more like 1.1 to 1.8 million.</p>
<p><a href=“http://www.washingtonpost.com/national/health-science/fewer-than-2-million-signed-up-for-medicaid-under-the-health-law-report-says/2014/02/05/4ac63f3c-8e78-11e3-b227-12a45d109e03_story.html”>http://www.washingtonpost.com/national/health-science/fewer-than-2-million-signed-up-for-medicaid-under-the-health-law-report-says/2014/02/05/4ac63f3c-8e78-11e3-b227-12a45d109e03_story.html</a></p>
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<p>Doctors’ offices have figured out how much overhead is associated in seeing each patient. If the reimbursement is below that of the overhead, then for each patient they see, they lose money. They do not recover that by seeing more low payment patients because the more patients they see, the more money they lose.</p>
<p>The medical group that I go to, limits the number of Medicare patients they see as a total percentage of their whole practice. That’s why at times they don’t accept any new Medicare patients if the quota is filled but they will grandfather in any established patients.</p>
<p>Interesting. I’m glad to see that someone trying to disentangle the Medicaid signups because of the ACA from the ones that would have happened anyway.</p>
<p>Why didn’t they do a year over year comparison, instead of comparing the October-December enrollments to summer 2013, I wonder? I’m not saying it’s wrong, but I would have expected that they’d at least make a gesture to justifying the choice.</p>
<p>CF, did you follow the link to the study? </p>
<p>Cbreeze, $x loss per patient times how many patients? 400, 40,000, more? They’re dropping patients and he claims not to know how many. Implies he doesn’t have a bottom line calculation. </p>
<p>I did follow the link to the study. I skimmed it, and didn’t see an explanation as to why they were comparing winter data to summer data, rather than making an adjusted comparison to previous winters.</p>
<p>Just an aside on the irony of the behaviorally-targeted ad that shows up on this thread: “$19.00 a month health plans.” 
Clearly, the oh so sophisticated algorithm that delivered that ad for the junk insurer doesn’t have an AI capability to comprehend the content it thinks is relevant to its ad :)</p>
<p>But hey, if I had that $19 month plan, I could complain that ACA caused by premiums to increase by 5,000 percent :)</p>
<p>What is the total population of the 108 counties with the majority of the uninsured?</p>
<p>I’m looking at the picture of the counties with all the uninsured people in them, and I’m saying… oh, yeah, the counties with the uninsured people are the counties with cities in them. In other words, a lot of uninsured people live in counties where a lot of people live. What a surprise that Los Angeles County has a lot of uninsured people-- almost ten million people live there, more that the population of many states.</p>
<p>In LA County, many of the uninsured are illegals, who are unaffected by ACA.</p>
<p>Obama may grant a 3-year extension for cancelled insurance plans that were extended for one year last Nov. Unfortunately, 22 states, including Ca, didn’t allow these plans to be extended. </p>
<p>Note to Obama: Too little, too late.</p>
<p><a href=“Bloomberg - Are you a robot?”>Bloomberg - Are you a robot?;
<p>That is a peculiar way to do a map – basically, large population counties are likely to have larger absolute numbers of uninsured, but small population counties could have much higher percentages of uninsured and yet not be visible on the map.</p>
<p>To GP: Try reading the ARTICLE rather than the headline.</p>
<p>To anyone else: the article linked to says that during a phone call to investors, the CEO of Aetna (Bertolini) told shareholders "“There’s some talk out there to have keep-what-you-have continue for three more years.” Note that Aetna is NOT participating in the exchanges… </p>
<p>Aetna (AET) reported its earnings today and fell short of forecasts – see: <a href=“Bloomberg - Are you a robot?”>Bloomberg - Are you a robot?;
<p>Not a good day for Aetna – the stock dropped 3% after the earnings release.</p>
<p>“Insurers Face New Pressure Over Limited Doctor Choice
Regulators, Lawmakers Look at Ways to Increase Number of Providers”</p>
<p>Apparently, the federal govt is going to enact regulation to force insurance companies to widen their networks next year for exchange plans. So the feds are now admitting it is a problem. Can you imagine the chaos of having the govt scrutinizing every health plan in the country. This should be a bureaucratic nightmare.</p>
<p><a href=“http://online.wsj.com/news/article_email/SB10001424052702304450904579365373011903340-lMyQjAxMTA0MDAwNjEwNDYyWj”>http://online.wsj.com/news/article_email/SB10001424052702304450904579365373011903340-lMyQjAxMTA0MDAwNjEwNDYyWj</a></p>
<p>You may have to google the article if there is a paywall.</p>
<p>Calmom, I do believe HHS has confirmed that there is “some talk” about a 3 year extension. I heard a radio report this morning. No time to Google around now.</p>
<p>There seems to be a trial balloon floating out there. The HHS spokesperson did not deny based on an AP story with sources besides Aetna.</p>
<p>However is anyone still worried about buying more reprieves?</p>
<p>“However is anyone still worried about buying more reprieves?”</p>
<p>I would think it means more upward pressure on premiums for exchange plans next year. </p>