<p>Those are sucker policies.</p>
<p>Yes they are.</p>
<p>I found something interesting. I had assumed that the Washington plans which included Children’s Hospital would be more expensive, but that turns out not to be the case. I went to <a href=“http://www.wahealthplanfinder.org”>www.wahealthplanfinder.org</a> and entered information based on my son & grandson (ages 30 and 3) , with hypothesized annual earnings of $65K a year (outside of subsidy range, so I would be sure to see full cost premiums). </p>
<p>I used the search feature for Seattle Children’s Hospital – and was given this statement (which seems quite clear to me):</p>
<p>
</p>
<p>Then I looked at premiums for Silver plans:</p>
<p>Lowest price: Coordinated Care Ambetter Silver $339 ($1750 deductible; $250 emergency room, $40 copay)
2nd Lowest price: Group Health Core Silver : $389 ($1500 deductible, $150 emergency room, $20 copay)
Highest price: Community HealthEssentials - $464 ($2000 deductible, $250 emergency room, $30 copay)</p>
<p>The other 5 plans, including several Premera options, fall somewhere in between. </p>
<p>That would make the Group Health plan also function as the benchmark plan (used to calculate tax subsidy amount). In addition to being reasonably priced as compared to other plans – it also has a lower deductible and copays than the others – so it seems to me that would make Group Health the logical choice</p>
<p>So now I’m having a really hard problem seeing what the problem is. When my son graduates this summer and resumes full time work, the exchange will offer him an array of choices, including a very affordable option that means that he continue to take grandson to Children’s Hospital for care. </p>
<p>Seems to me that if Children’s wants to be on the Premera network, they are going to have to negotiate some sort of deal with Premera. But I don’t get the point of their lawsuit (other than their own financial bottom line) - it looks to me like Washington consumers have good choices, and any parent who really wants to be sure that the network includes Children will clearly have an affordable choice. </p>
<p>(Note: This is what I am referring to when I gripe about poor standards of journalism. This information was very easy to ascertain from the web site, which is quite easy to navigate and use.)</p>
<p>Journalism reports…no vetting anymore. </p>
<p>I am not sure why that is something to be proud of…leads to lots of misinformation.</p>
<p>Maybe there was never much vetting and we just grew up.</p>
<p>Calmom, I like your post.</p>
<p>No, there never was vetting. There was a 3 source rule about rumors. But, direct quotes do not get vetted. They never did.</p>
<p>"If you like your plan… </p>
<p>Shape of earth: opinions vary</p>
<p>That was a lie.</p>
<p>
</p>
<p>Flossy, Medicaid is typically serviced by insurance networks. My grandson is on the Molina network (so when he goes to a doctor, he has a Molina ID card).</p>
<p>
</p>
<p>Source: <a href=“http://www.modernhealthcare.com/article/20131012/MAGAZINE/310129971”>http://www.modernhealthcare.com/article/20131012/MAGAZINE/310129971</a></p>
<p>Molina is a health care network that services Medicaid program in several states. Apparently Seattle Children’s is willing to accept one reimbursement rate from the Molina Medicaid network, but not for the Molina plans sold via the exchange. </p>
<p>One sticking point may be a “facilities fee” that Children’s tacks onto its bills. See <a href=“http://seattletimes.com/html/localnews/2019600338_facilityfees04m.html”>http://seattletimes.com/html/localnews/2019600338_facilityfees04m.html</a> - It’s an extra charge tacked onto the bill just for having come to Children’s. SCH waives that for Medicaid … but perhaps they have not been as flexible with the other insurance companies. </p>
<p>
There’s a little icon you can click under the post to preserve that sentiment for posterity. :)>- </p>
<p>So Flossy, what is percentage of people, before ACA, that were on the same individual health plan before for more than 2 years ACA?</p>
<p>When there was an article about no exchange plans that included Seattle, Cedars and Sloan Kettering, what were the 3 sources? </p>
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</p>
<p>If the care he needs can ONLY be found at the expensive specialty hospital, then any ACA-compliant plan would cover it, whether or not it’s in-network. But since GP wants to have access to the expensive hospital regardless of medical necessity, then he pays more more for the privilege. I’m still not sure I understand why this is so outrageous. </p>
<p>As I said upthread, I have no problem with GP choosing a Rolls. But he shouldn’t expect me to pay the difference between the Rolls and the sturdy sedan that most of us are content with. </p>
<p>That’s a technicality.</p>
<p>Plans on the individual market change all the time but not dramatically. I had Blue Shield for about ten years but it was probably not the same plan. I don’t even know. However, apart from continued price increases it seemed the same to me. Most importantly, everyone took it no questions asked. And, I never felt the need to research networks because it was never a problem. Yes, of course it might have been for someone at some point but not like this. The individual market has now changed dramatically and not necessarily for the better. Yes, I know it’s better for some in some ways. Overall, remains to be seen. </p>
<p>I’m not sure what point you are trying to make. I was simply explaining that apart from less investigative reporting which has been replaced by bloggers so is easily discounted even though it is often very accurate and revealing, journalism hasn’t changed much at all.</p>
<p>Then again, if I had a job as a journalist and every time I spent effort on research in order to present an objected, balanced view of the facts behind a story, and then my editors consistently rejected my work because it didn’t echo their own POV… I could see how I might get discouraged and lazy. Why bother?</p>
<p>Calmom, your sleuthing on the internet is giving us a very slanted picture of what is really taking place with Obamacare. For instance, I looked at the Group Health provider directory in the Seattle area. Although it does provide coverage for Children’s, it has only one of the ten best hospitals (excluding Children’s) in Seattle metropolitan area as awarded by US News & World Report. 9 of the 10 are not in the network:</p>
<p>University of Washington Medical Center
Evergreen Health Medical Center
Harborview Medical Center
Stevens Healthcare
Tacoma General
Northwest Hospital and Medical Center
Swedish Medical Center - Cherry Hill
Swedish Medical Center - First Hill
Multicare Good Samaritan
Valley Medical Center</p>
<p>If someone from Seattle was poking around the internet they might conclude that Health Net is a good plan in LA because it includes Cedar Sinai; however, they would be dead wrong. Health Net has by far the worst network in Southern California. </p>
<p>How many hospitals do you need to go to? One good one is enough.</p>
<p>CF, think about that answer.</p>
<p>I’ll think about it.</p>
<p>OK, I’ve thought about it. I still think I don’t need the choice of twelve hospitals. </p>
<p>None of these sound like well known hospitals other than UW Medical Center and UW is rated number 1 school for primary care several years in a row but also top 10 for research. </p>
<p>What other hospitals are left for people to go to?</p>
<p>Goldenpooch:</p>
<p>
</p>
<p>[The</a> Hype Over Hospital Rankings](<a href=“http://www.nytimes.com/2013/07/28/sunday-review/the-hype-over-hospital-rankings.html?_r=0]The”>http://www.nytimes.com/2013/07/28/sunday-review/the-hype-over-hospital-rankings.html?_r=0)</p>
<p>I looked at Healthgrades and of the 10 hospitals receiving 5 stars in any category within 10 miles of Seattle only one is in the network of Group Heath. As a matter of fact, Group Heath only has one hospital for adults within 10 miles of Seattle. The best hospitals in US News & World Report line up almost perfectly with Healthgrades’ best hospitals.</p>