<p>“Ignore their pain.” Yow, that’s rough.</p>
<p>I checked all our Rx before deciding. I confirmed the appeal process, should there be a loose end.</p>
<p>Wait- so it’s opinion, not even necessarily fact? </p>
<p>Repeat: it is not necessarily accurate? Or the whole truth?</p>
<p>As a matter of fact yes, I do expect newspapers to fact check op-eds. Because I have the naive idea that a newspaper is supposed to inform its readers.</p>
<p>“Repeat: it is not necessarily accurate? Or the whole truth?”</p>
<p>I would assume it is the whole truth - valid for that one person. </p>
<p>GP has been writing essays about his formulary issues. If you want to discuss a study outlining the issues, this is the perfect thread. If you want to discuss your own problems, once again fine. If you want to discuss ACA based on one person’s OpED about his mother, we need to draw a line. </p>
<p>I don’t believe the hype nor the trashing based on personal stories if the law is enacted claiming to do greater good. I do like Dietz’s link because it provides a good amount of information about California law (GP does not seem to know about it? He should be suing his state based on under coverage).</p>
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<p>The article says 58000 doctors participate - is that 65% of doctors - if so that is low. </p>
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<p>Doesn’t sound low to me. In their wildest dreams, Covered California will get 2 million enrollees this year. That’s one doctor for every 38 people. They’re required to have one doctor for every 1200 people.</p>
<p>I don’t care about enrollees as much as doctor participation. I think it is ridiculous that a large chunk of doctors are refusing to participate or not signed up at all.</p>
<p>Note that what people threaten to do is not always what they actually do. This is certainly true of doctors, who often threaten to leave states with high malpractice insurance costs, but don’t actually do so. Some of this may be the same thing.</p>
<p>“The article says 58000 doctors participate”</p>
<p>First of all, this number comes from Covered Ca, the entity which had to take down its provider directories because they were riddled with errors. Also, this is a cumulative number for all the insurance companies in the state. A subscriber in a particular region with one insurance company is not going to see numbers like this. Some regions may have more providers than others, but for people who already had insurance, the network is looking significantly different. Lastly, not all doctors are the same qualitatively, so there may be some doctors in a particular specialty in the network which I wouldn’t dream of seeing.</p>
<p>Why? Why is it ridiculous?</p>
<p>American medical costs are more than twice as high as costs in the rest of the world per procedure. If you believe as I do that we need to stop paying doctors, hospitals, drug makers and device manufactures so much, then you welcome the free market as a way to bring down prices.</p>
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<p>How is a system that sets mandatory low reimbursement rates even remotely related to a free market?</p>
<p>If we are going to talk about reimbursements being so unsatisfactory, can we talk about this: I saw analyses that the doctor’s cost of service (I believe family practice) should average $60 up per OV with serious flags if a practice is approaching 90. (Practice management web sites.) Includes doc salary, nurses, staff, facility, equipment and recurring goods. How much is the reimbursement for an office visit? </p>
<p>I ask because I think we are looking at “unsatisfactory” rather blindly. Focusing on the complaints.</p>
<p>CF- Let me be very un PC. I don’t need to believe in anything anyone else here believes in or else I would need to be part of the “1984” world or drinking some coolaid. 
I have my own measure of ACA being “well” implemented which is that a large percentage of doctors being supportive of it by joining whether they get paid more or less. If you don’t need that that is your choice. </p>
<p>However, I am thinking 65% is low without any basis. What is the number for medicare?</p>
<p>Cost shifting has been an integral part of the payment structure for - well it seems life forever. Thus, while an OV SHOULD run $60 - it can’t because a Medicare reimbursement might be 1/4 - 1/2 of this rate. (yes, I actually tracked CPT codes on personal EOB’s and compared the charges - both charger rate and negotiated rates - and compared them to our rural Medicare reimbursement schedule) and the difference can astounding. So, if I were to pay $60 for an OV, and then a Medicare patient results in a - say $25 reimbursement - again, the algebra equation will not balance. So, either Medicare/Medical reimbursements need to increase to $60 (which of course drives up the artificially deflated cost of the program) or ‘I’ as a privately insured individual need to make up the difference.</p>
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<p>Medicare is a different patient population, Tx, in that it a rare doctor that cannot accept Medicare (due to its market size).</p>
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<p>Are those primary care docs? Assuming that I am doing my math correctly, that is 83.3 docs per 100,000 population, correct? If so, that is highly unlikely to be possible in California which has a lower ratio than that statewide today.</p>
<p>What is interesting about the article is that the insurance companies are having to make exceptions to get some doctors in the network because of the very low reimbursements. They are having to pay them the 2013 reimbursement rates. This tell you that the networks for the 2014 Obamacare plans are inadequate and causing significant anger among subscribers.</p>
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<p>You seem to be confusing Medicare and the ACA. Under the ACA, there is no “mandatory low reimbursement.” There is no mandatory reimbursement of any kind, and the government does not have a role in deciding reimbursement rates.</p>
<p>Rather, insurance companies make contracts with doctors, groups of doctors and hospitals. Insurance companies want to pay as little as they possibly can, to lower premiums. Doctors want to make as much as they possibly can, because money. In some areas, insurance companies are finding they have to offer more money in order to entice enough doctors to participate.</p>
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<p>No, that’s all docs.</p>
<p>I wasn’t referring to Medicare/Medicaid. What is reimbursement for a visit billed at $100-130-150? Aiui (maybe I am wrong,) M/M varies by state??</p>
<p>65% does “seem” low, but I’d also want to know what the 35% is. As well as what former figures were. </p>
<p>“I would assume it is the whole truth - valid for that one person”</p>
<p>I cant assume that . </p>
<p>Dietz, free markets working in health care. Where? Just name one country. I will look it up myself.</p>
<p>Enrollees and doctor participation rates have a high correlation.</p>
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<p>That’s not what it tells me. Rather, I see that in some areas, rural areas, insurers have to pay more. And in other areas, they don’t have to pay more.</p>
<p>“I cant assume that .”</p>
<p>Are you saying a guy wrote a whole story about his mom being not covered for medication?</p>
<p>" I see that in some areas, rural areas, insurers have to pay more. And in other areas, they don’t have to pay more"</p>
<p>I agree. They can’t break the law and so where they can’t find anyone, they need to pay more to provide minimum coverage.</p>