<p>Agreed. That’s why we are currently seeing more of the local stories. That’s where the action is right now. </p>
<p>The NYT’s is generally going to cover policy and the local paper will generally cover it’s effects on locals. Of course, there will be overlap. </p>
<p>I haven’t seen any articles that comprehensively cover the effects of ACA, state by state. Maybe after the sign-up period is over, we’ll start seeing them. </p>
<p>My criticism of the poor quality of journalism has been directed at large, national media outlets. The story about issues with specialty hospitals was on Bloomberg News. It reported a problem with a family whose policy network did not include Children’s Hospital, requiring them to buy a slightly more expensive (+$50/month) policy to cover their sick baby. Since the article also correctly reported that there were only two insurers on the exchange that included Children’s, it seems to me a no-brainer for the journalist to check to see what the policy costs would be for the remaining insurer – and to at least note that Washington families have a lower cost option. </p>
<p>Premera is a large, for-profit insurer, and Children’s wants its business, but Children’s probably is not willing to offer Premera the same favorable pricing terms that it has extended to Molina and Group Health. Children’s argument is that they need to charge more money for all services because they are a specialty hospital - and that at the same time, the state should force all insurers to include Children’s in its networks, thereby making it an option for non-specialty care. I personally don’t see that argument gaining a lot of traction in court – but maybe Children’s is hoping that the publicity generated from its suit will force some concessions from Premera. </p>
<p>Tatin, I posted a link to an article that reported enrollment figures and trends for all states a while back - that’s nto a “comprehensive” look at effects, but it’s a starting point. </p>
<p>Calmom, I don’t want to continue beating a dead horse here and sure they could have checked on the other insurer. My guess is that the report was on that family and their current situation, thus all that really matters is the policy that that family has and what it does or doesn’t cover for them, now. That stories are incomplete is really a given with a 2-foot tall law. They are all incomplete.</p>
<p>“Wow, look at these flames.” No, this doesn’t apply to every situation. Now, back to ACA."</p>
<p>Sometimes there are no flames yet a story is reported that there are. Sometimes a story blames ACA for a flame when ACA is not the fault.</p>
<p>When millions of policies were cancelled, to say millions of people with cancelled policies lost their insurance was an out and out lie. Why was this lie repeated over and over?</p>
<p>Saying there are going to be 2.5 million fewer jobs based on the CBO report is a lie. </p>
<p>Insurance companies are narrowing networks to lower premiums and costs below what they would be otherwise. </p>
<p><a href=“http://www.ibj.com/the-dose-2013-07-25-wellpoints-new-narrow-networks-stick-to-old-playbook/PARAMS/post/42623”>http://www.ibj.com/the-dose-2013-07-25-wellpoints-new-narrow-networks-stick-to-old-playbook/PARAMS/post/42623</a></p>
<p>This article was written in 2010.</p>
<p><a href=“Narrow networks: Will you be in or out? - amednews.com”>American Medical News - Home - amednews.com;
<p>Networks have benn narrowing since the mid 90’s.</p>
<p><a href=“Sitemap - Managedcaremag.com”>http://www.managedcaremag.com/archives/1202/1202.narrow_networks.html</a></p>
<p>"For employers, Aetna expects costs to be 1 to 4 percent lower with narrow networks than under more traditional plans. Health Net of Arizona predicts costs will be 10 to 20 percent lower, and Blue Shield of California predicts its first-year premiums for its Blue Groove product will be 10 to 15 percent lower than its traditional plans. Blue Shield also says costs for Blue Groove will rise by 5 percent or less in future years.
Health plans have been narrowing their network offerings since the mid-1990s, Domaszewicz notes. When the weak economy followed the recession of 2008 and 2009, employers demanded lower-cost options without any decline in quality. In response, plans offered networks of highly efficient providers that deliver quality care at the best price.</p>
<p>“It’s definitely a growing trend,” he says. “As health reform is implemented, there are only so many levers health plans and plan sponsors can pull if they want to change plan designs. That leaves the breadth of the network as being one area that is hard to manage on your own as an employer, but if health plans are building narrow networks, then it is one of the last frontiers that employers can tap into for greater efficiency.”</p>
<p>The economy was a factor because plan sponsors want lower costs, but a second factor is health care reform, he says. If insurers have to enroll everyone, then it makes sense to offer more efficient programs."</p>
<p>“Plus, narrow networks could be very popular when we have health care exchanges and health plans start enrolling patients who have previously been uninsured,” Domaszewicz says. “You can’t offer a very expensive plan to people who previously had no insurance or they are unlikely to take it. A third factor is that health plans want to steer patients to facilities and physicians in accountable care organizations or patient-centered medical homes that are delivering highly efficient care.”
"</p>
<p>yeah, I am convinced: narrow networks are great. Stupid me for believing otherwise.</p>
<p>Some people and some businesses are going to be ok with narrow networks. Some wont.</p>
<p>Right now, insurance companies have to have 20 percent of the local providers in their coverage. There is talk of raising this number to 30 percent. This will probably raise premiums and costs if this happens. Depends on the contracts. </p>
<p>GP, when your tactic is to mock, my first impulse is to mock back harder. We can’t do go there and have a productive thread. </p>
<p>If the subject is the quality of service people across the country will now receive, it’s hard to just focus on what your neighbor’s troubles are. It may be true, from an earlier poster, that a co-worker waited at Harbor for 13 hours. Does that mean we would all wait 13 hours? Would I want advice: don’t go to Harbor, the waits are more than 10 hours and the proof is that guy’s friend waited long? No. It’s one guy’s tale.</p>
<p>Report as many cases as you can find of people who waited long- and all you get is those tales. Not why or under what circumstances or whether it is usual or unusual. Or, maybe, about the 9,900 others who waited under an hour.</p>
<p>So, it’s smart, plain old smart, to ask, “Why did the insurer deny those kids at SC?” Not jump to conclusions. </p>
<p>As I recall, the anecdote from SC was that of 21 submitted claims, Premera approved 13 and denied 8. So when we start trying to look at the larger picture, that’s a 60%+ approval rate, although far too small a sample to get a clear statistical picture. </p>
<p>Then an anecdote is related concerning one of the claims that was approved, but no facts about the claims that are denied - so again, no real information on circumstances. </p>
<p>How many children who needed specialized care in 2013 were denied -because they had no insurance coverage at all? How many claims were denied in past years because the care had exhausted policy limits? </p>
<p>The only workable approach I see other than narrow networks is more of a managed care and multiple tier system. Managed care to require patients to get pre-authorization or a referral from a primary care provider before getting non-emergency treatment at the specialized facility; multiple tiers so that the copays are higher at the specialized facility. (I think that’s probably why Group Health does include Children’s – I think that Group Health is more of a managed care approach which uses Children’s to supplement the care at the Group Health facilities.)</p>
<p>It has always been important to get pre-authorization for any planned, costly procedure (like surgery) with insurance. So that part really isn’t new – it’s just a matter of also adding in potentially differential treatment for the higher cost facilities – in the hopes that it would discourage non-essential use. </p>
<p>As reported, Children’s filed request on behalf of 125 of their patients. Of those, they say they got only 20 responses, eight of which were denials.</p>
<p>My first question was, are those numbers accurate? The newsgal says it, not Melzer. In his 30 seconds, he focuses on a few of the denied.</p>
<p>I also want to know if there was a procedural issue here- “submitted” says little. And, without info, it has impact to say, 125 requests- but for all I know, maybe 105 of them were under consideration and worked out.</p>
<p>It’s the problem with factoids. </p>
<p>But that just means that they are still waiting on determination on the others – and no information is given as to when those requests were submitted or what stage of the review process they are in. </p>
<p>I mean, there are a whole lot of students on this board who have submitted applications to Harvard and haven’t heard back yet – that doesn’t mean that Harvard is doing anything wrong. </p>
<p>The relevant question is what is average turnaround time on these requests. There may also be a different level of priority attached to some of these requests – I would expect it would be more important to process the claims of patients receiving ongoing, continuous care, than for those who received one-time services that have already been completed.</p>
<p>Right. It’s the USC Presidential threads- a few got notice they are under consideration and the rest are calling themselves “deferred” or some feel rejected. Not.</p>
<p>Or someone could have incorrectly submitted on those 8. Or the procedures may have been done before approval (assuming it was critical; it happens) and then not coded as such or need one more signature. Anything. Not necessarily that a new health law is leaving kids untended.</p>
<p>If you want a presidential and you did not get called, you are rejected if the only reason you applied for was the scholarshp or in our case college full pay’s subsidy. So yes, they are rejected.</p>
<p>Well, I’d assume that some percentage of the submissions really are not appropriate for out-of-network care-- so they may be proper for Premera or others to deem as out-of-network under the terms of their plans. That is, if the 21 claims submitted, I’d think it unlikely that all 21 were bona fide cases where the procedures were necessary and so unique that they could only be provided at Children’s. </p>
<p>Also, keep in mind that for a PPO-style plan, out-of-network does not mean -0- payment – it generally means that the insurance will authorize UCR and the patient faces the prospect of balance billing. (I really don’t know what model the plans under discussion are - they could also be EPO’s with no out-of-network payment).</p>
<p>My brother lives near a Children’s Hospital, and they pretty much get all the kids’ care from the hospital & docs employed by the hospital. It is easy and convenient, and with his current insurance (copay based) it really doesn’t matter which providers he uses as long as they’re within network. </p>
<p>While I’m no longer in the market for Children’s Hospital services, a quick look at my high deductible plan treatment cost estimator shows that even though Children’s is “in-network” with our plan, the cost for services through Children’s is quite a bit higher than the cost is from getting the same service at our community hospital.</p>
<p>I’m sure Children’s loves my brother’s business – lots of kids with pretty ordinary kid problems (strep throat, ear infections, …) and one kiddo with a somewhat more complicated condition – but I can see why an insurance company would say that they don’t want someone using Children’s unless it is for something that Children’s is uniquely qualified to handle, not run-of-the-mill healthcare. </p>
<p><a href=“http://www.healthbenefitexchange.ny.gov/news/press-release-enrollment-new-yorkers-ny-state-health-tops-412000”>http://www.healthbenefitexchange.ny.gov/news/press-release-enrollment-new-yorkers-ny-state-health-tops-412000</a></p>
<p>From acasignips.net this looks like 60 percent signed up
For private insurance… 40 percent medicaid. 2/3 did not have prior coverage.</p>
<p>"The NY State of Health open enrollment period for individuals runs through March 31, 2014. New York is on track to meet or exceed its enrollment goal of 1.1 million people by the end of 2016.</p>
<p>“Activity on the site remains very high, and thousands of New Yorkers continue to enroll on NY State of Health. We are thrilled to see that more than 412,000 people have enrolled for quality, low-cost health insurance and nearly 697,000 have completed applications since the Oct. 1 launch of the marketplace. Also, 66 percent of enrolled New Yorkers were uninsured when they applied,” Donna Frescatore, executive director of NY State of Health, said. “I’d like to remind all New Yorkers that the open enrollment period runs through March 31, 2014, and we encourage individuals to take advantage of the opportunities available on the Marketplace.”</p>
<p>We live in CT. DD will be 26 on March 22. Does anyone have a guess…is her insurance through my husband effective until her actual birthday or is it until the end of March? Could you please PM me with the response? I can’t wade through this thread!</p>
<p>Since DH pays by the month…I would hope it actually ends March 31. He is asking his HR department too.</p>
<p>Under the law, the requirement to make adult coverage available applies only until the date that the child turns 26. However, if coverage extends beyond the 26th birthday, the value of the coverage can continue to be excluded from the employee’s income for the full tax year (generally the calendar year) in which the child had turned 26. For example, if a child turns 26 in March but is covered under the employer plan of his parent through December 31st (the end of most people’s taxable year), the value of the health care coverage through December 31st is excluded from the employee’s income for tax purposes. If the child stops coverage before December 31st, then the premiums paid by the employee up to the time the plan was stopped will be excluded from the employee’s income</p>
<hr>
<p>This answer is old, but should still be valid. Her father should ASK when the coverage terminates. It may be allowed for her to stay on the policy until the end of the benefit year.</p>