<p>[@</a> Lookingforward](<a href=“Affordable Care Act Scene 2 - Insurance Premiums - #10415 by lookingforward - Parent Cafe - College Confidential Forums”>Affordable Care Act Scene 2 - Insurance Premiums - #10415 by lookingforward - Parent Cafe - College Confidential Forums), this quote from the Salon article sums up my feelings exactly:</p>
<p>
</p>
<p>Just as an aside, has the policy changed about what publications we can link to.</p>
<p>I get the impression that an EPO is a cross between a PPO and and HMO. Like an HMO, patients in an EPO have to see specific doctors (or get authorized to go out of network). </p>
<p>But HMO doctors see only the patients in the HMO and no other patients: doctors who work for Kaiser work at Kaiser facilities and see Kaiser patients. In contrast, doctors who sign up for an EPO don’t work for the EPO. They’re just doctors in the community that see a variety of patients. They might see some patients in the EPO and other patients with other forms of payment.</p>
<p>Calmom, thanks for politicizing this by suggesting only conservatives are disgruntled with the law. Will see in Nov if you’re right. </p>
<p>So its okay to link to and quote Salon and Mother Jones articles. I link to major publications or TV stations and I am accused of being bias.</p>
<p>"Emilybee , because your defense of Obamacare would be a lot more credible if you did. I wonder how your experience with a chronic disease would have gone with an Obamacare plan.:</p>
<p>How so? My PCP, my Gyno and both urologists I saw are all on several plans on the NY Exchange for my area. Yet, under my employer coverage (which is excellent) only one of the PT pelvic specialists within approx a 50 miles radius of where I live is covered (I didn’t call any outside that area.) Nothing whatsoever to do with ACA. I have had a PPO for 20+ years and there have always been providers who don’t take my insurance. When I need to see someone, I simply look for doctors/providers my insurance covers. If there hadn’t been a PT who accepted my insurance I would have paid out-of-pocket for it. If I was on an exchange plan I would do the exact same thing - look for a doctor/provider who accepts my insurance. </p>
<p>Even the hospital, which my urologist’s practice is affiliated with, and which takes my insurance, only accepts it for the type of PT I need if it was after a surgical procedure. But again, nothing to do with ACA. </p>
<p>Fortunately, now that there is ACA and if my H lost his insurance, I will be able to get insurance, at a reasonable cost. NY has had guaranteed issue for 20 years but at an outrageous cost. Premiums for individual policies in NY since ACA have dropped 50%.</p>
<p>
That is true for Kaiser but not for all HMO networks. Both Blue Cross and Blue Shield run their own HMO plans using their networks of private providers, which overlapped but were not coextensive. See, for example, <a href=“HMO Plans - Employer Connection - Blue Shield of California”>Blue Shield of California | California Health Insurance; and <a href=“http://www.anthem.com/ca/calpershmo/”>http://www.anthem.com/ca/calpershmo/</a> – these plans are now available only as group or employer options, but they certainly exist. </p>
<p>Are your PCP, Gyno, pelvic specialists both urologists on the same NY exchange plan in your region? Could you see all these doctors with one exchange plan? Are you sure whatever drugs you took were included in the exchange plan formulary. Don’t answer unless you know for sure.</p>
<p>Personally, I’d like to see the onesie-twosies kept off this thread in the first place. They distract. They aren’t “proofs.” If the Salon and MJones are deleted, same info is on Washington Post And Huff.</p>
<p>I don’t begrudge anyone with a great group plan (I have one now) but it is irritating listening to them pontificate about how great Obamacare is and discount the experience of people who were forced into exchange plans. The people who hate their Obamacare plans would love to have your great group plans.</p>
<p>As I said earlier, you are missing where “cheerleaders” raise concerns. There’s very little pontification, just a repeat of the basics of the Essential provisions. IIRC, far less than the doom predictions. Just saying.</p>
<p>Lookingforward, you are linking to Mother Jones and you are accusing me of bias.</p>
<p>Nope, someone else linked to MJ. And these two links are far, far less than the Boonstras and Melzer and some practice in Riverside and and. </p>
<p>Goldenpooch, my PCP, and my present urologist are affiliated with one of our two major hospitals. My gyno and the first urologist are affiliated with the other major hospital (and the Pelvic PT specialist which is at what had been our community hospital before affiliating with the second hospital) are on almost every insurance plan offered in my area. These are the two dominant providers in my area. I don’t know if all four are always on every plan. It’s just happenstance that not all the doctors I am seeing have the same affiliation. </p>
<p>None of my doctors are in individual practices. They are all in huge groups which take almost every insurance. </p>
<p>edit: Just saw you wanted to know about my drug. It is Elavil. It is cheap, cheap, cheap and been around for ages. It is an antidepressant but used in very small dosages (10-25mg) for pain for things like Fibromyalgia and conditions like I have. </p>
<p>“Lookingforward, you are linking to Mother Jones and you are accusing me of bias.”</p>
<p>I asked Texaspg for a ruling before I posted the MJ article. You are free to dispute the findings in the article and present evidence to the contrary. </p>
<p>It’s not happenstance for people with chronic illnesses. Are all your doctors and both hospitals in one Obamacare exchange plan in your region. And if the plan is an EPO would everyone (including the hospitals) be in-network? We haven’t even touched upon the prescription drugs.</p>
<p>“I don’t begrudge anyone with a great group plan (I have one now) but it is irritating listening to them pontificate about how great Obamacare is and discount the experience of people who were forced into exchange plans.”</p>
<p>As I have explained numerous times on this thread, my employer insurance works just like the exchanges. We have our choice of about 10 plans (HMO’s, EPO’s, PPO’s) at different price points, different co-pays, different OOP, etc., and we can change our plan every year during open enrollment. We chose one of the PPO’s. .</p>
<p>People who work for the State of NY in other areas have different plans geared to their area - just like plans on state exchanges have. Prices (the employee share) are also different depending on the area. For instance - all the plans that are offered in the NYC metro for state employees are considerably more expensive than in most other areas of the state. </p>
<p>Employer insurance doesn’t work just like Obamacare exchange plans. The group PPO plans have far superior networks.</p>
<p>Mother Jones is about as left-wing as a publication can be. </p>
<p>^ Not in my area.</p>
<p>Dstark has a PPO in CA and he seems perfectly fine with his network. </p>
<p>“Mother Jones is about as left-wing as a publication can be.”</p>
<p>So you got nothing. </p>