<p>dstark, looks like Anthem Blue Cross for Stanford Hospital is in the situation Queen Fang would eliminate. Hospital services are covered, but doctors’ services aren’t. So if you have Anthem Blue Cross, you’re OK going to Stanford Hospital as long as you don’t see any doctors while you’re there. So very useful.</p>
<p>Blue Shield and Cigna cover Stanford for real, both hospital services and doctors’ services.</p>
<p>Good grief. If we as a country could cut down on unhealthy behaviors, insurance premiums for all of is could come down. But to some here that’s a controversial statement. </p>
<p>I think I wrote I would check… ;)</p>
<p><a href=“For Patients | Sutter Health”>http://www.sutterhealth.org/openenrollment/anthem-blue-cross-updates.html</a></p>
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<p>Who? Name names, please, or admit that you are mistaken.</p>
<p>IF people stopped taking phone calls and texting while driving, or IF people could lose weight, or IF people stopped smoking, or IF people got enough sleep, then health costs would go down and insurance premiums would go down. Nobody denies that because-- Fang’s Razor-- we’re not idiots.</p>
<p>if people go to an in-network hospital, they only pay in-network charges for all the care they get there. If, somehow, the hospital sends out-of-network providers to care for me in my in-network hospital, the hospital, not me, would be responsible
When I asked BCBS about this, they said, they would cover that as in-nwk, based on the facility and primary doc being “in.” (PPO.) People can check with their carriers.</p>
<p>Good for your insurance provider, LF, but not all insurance providers behave like that. But if I were Queen of the US, they’d have to.</p>
<p>I believe a lot of people don’t really want lower costs. They make money with higher costs.</p>
<p><a href=“Study Highlights High U.S. Medical Costs, Groups Alter Doc Guidelines | California Healthline”>http://www.californiahealthline.org/articles/2014/4/18/study-highlights-high-us-medical-costs-groups-alter-doc-guidelines</a></p>
<p>“The report found that the average one-day hospital stay in the U.S. cost $4,293 in 2013, six times more than the stay would cost in Argentina and almost 10 times more than it would cost in Spain. Meanwhile, various health care procedures were also priced higher in the U.S., including:
Heart bypass surgery, which cost about $75,345 in the U.S., about $15,742 in the Netherlands and $16,492 in Argentina;
An MRI, which cost about $1,145 in the U.S. and just $138 in Switzerland;
Knee replacement surgery, which cost $25,398 in the U.S. and about $8,100 in Spain;
Vaginal childbirth, which cost $10,002 in the U.S., $2,251 in Spain and $2,237 in Argentina; and
Caesarean-section births, which cost $15,240 in the U.S. and $2,844 in Spain.
According to the study, the U.S. offers slightly more affordable cataract surgery than other countries, coming in at an average of $3,762, compared with Australia, where the procedure costs $3,841.
IFHP CEO Tom Sackville noted that the “price variations bear no relation to health outcomes,” adding, “[T]hey merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases reflect a damaging degree of market failure” (Pfeifer, Los Angeles Times, 4/17).”</p>
<p>Main point is we can ask. I remember this was an open question from some time ago.</p>
<p>Costs…</p>
<p><a href=“http://static.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/534fc9ebe4b05a88e5fbab70/1397737963288/2013%20iFHP%20FINAL%204%2014%2014.pdf”>http://static.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/534fc9ebe4b05a88e5fbab70/1397737963288/2013%20iFHP%20FINAL%204%2014%2014.pdf</a></p>
<p>Since a poster brought up the example of a brain tumor, you might want to check this article too see the experience of a person with a neurological disorder.</p>
<p><a href=“Brain patient: ObamaCare makes it hard to find doctors, meds”>http://nypost.com/2014/04/17/brain-patient-obamacare-makes-it-hard-to-find-doctors-meds/</a></p>
<p>Here is where Obamacare is leading us to in the future.</p>
<p><a href=“The false promise of single-payer healthcare”>The false promise of single-payer healthcare;
<p>Staten Island woman? Again? An anecdote doesn’t get twice as bad if you give us two different newspaper articles about it, Pooch. </p>
<p>^^ Lol</p>
<p>The second newspaper article covers another subject, far more terrifying than the problems of one patient. </p>
<p>There are people all over the country who will have the same experience as the Staten Island woman. It doesn’t take a degree in physics to know that limited networks with narrow formularies are going to generate thousands of these stories.</p>
<p>LasMa, does your husband receive Obamacare subsidies?</p>
<p>The thing about GP’s good old days was that my husband’s preexisting conditions weren’t something terrifying like cancer or brain tumors. About 10 years ago, he was diagnosed with high blood pressure and high cholesterol – hardly exotic conditions in a 50-ish American male. But because of those two diagnoses, DH paid 50% more than the base rate, and he was periodically shunted into closed blocks. And of course, we could never shop around for a better deal. Both conditions were quickly brought under control with medication and diet changes, and have continued in the healthy range ever since. But here’s the problem with GP’s good old days: It didn’t matter one bit to the insurance companies what the outcome was. Pre-ACA, it was the diagnosis that killed you. Once that was on your record, you were considered a threat to their profits, and that assessment stuck to you like Super Glue no matter what. </p>
<p>I’m not willing to discuss D’s preexisting condition, except to say that it wasn’t something horrifying. You wouldn’t look at her and think, “That kid is on death’s door.” And in fact, she wasn’t, and she has since made a complete recovery. But because of a short episode when she was in HS, she was pronounced uninsurable for at least 10 years. “Automatic decline” was the term that the broker used. So in GP’s good old days, since D is now graduated from college, she would be kicked off DH’s policy and would be walking around uninsured today. Through no fault of hers or ours, I might add. You wanna talk about terrifying, GP? That’s terrifying.</p>
<p>Someone said something upthread about empathy…</p>
<p>ETA – No ACA subsidies, GP. DH pays full price for his insurance, and it’s still cheaper than before ACA. With better deductibles, better OOP max, and better coverage. And that’s the end of our little 20 Questions game.</p>
<p>ETA 2 – In fact, I have just taken steps to ensure that the game is over. 
</p>
<p>You need to find six more articles about Staten Island woman. Or maybe ten. Then the problem will be even worse!</p>
<p><a href=“Health Plans Expected To Expand ACA Exchange Offerings in 2015 | California Healthline”>www.californiahealthline.org/articles/2014/4/18/health-plans-expected-to-expand-aca-exchange-offerings-in-2015</a></p>
<p>This could be good. Some states might get a little more competition next year…including Cal. That is what happens when you end up with 1.2 million paid customers. </p>
<p>United Healthcare, the biggest insurer in the country, said they are having a hard time competing in NY. UNH says premiums are too low in NY. The mew entries are pricing policies too low. We will see. A little competition. UNH doesn’t like a little competition. :)</p>
<p>CF: ^^ This is the exact situation in our neck of the woods. Local hospital in in network (for all Covered CA Plans), however, this hospital is bringing on more physicians from a group NOT in the network for 2 out of the three exchange plans. The reason…docs are leaving the area, retiring, cutting their practices so they have to grab what they can to cover the staff positions. The BS EPO plan has NO out of network coverage, the docs being brought onto the staff are not in the ER category. So, basically those who have the covered ca plans have no real hospital options in their home area. </p>
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<p>No EPO plan has out of network coverage. That’s the definition of an EPO plan-- that it doesn’t have out of network coverage.</p>
<p>CF: Until the advent of ACA I’d never heard of and EPO, so my education is a work in progress. </p>
<p>I have made about a dozen calls over the past week to get a definitive answer to the in network facility/out of network provider billing issue. The best I have gotten is ‘hmmmm…that is a very good question…but I have no idea, let me pass you on to…(voicemail).’ </p>