<p>
</p>
<p>[Gallup:</a> Uninsured Rate Drops to New Low](<a href=“http://www.realclearpolitics.com/articles/2014/05/05/gallup_uninsured_rate_drops_to_new_low_122527.html]Gallup:”>Gallup: Uninsured Rate Drops to New Low | RealClearPolitics)</p>
<p>
</p>
<p><a href=“http://www.nytimes.com/2014/05/06/health/death-rate-fell-in-massachusetts-after-health-care-overhaul.html”>http://www.nytimes.com/2014/05/06/health/death-rate-fell-in-massachusetts-after-health-care-overhaul.html</a></p>
<p>Uhm. 3-percent. Regardless, given what we have seen in the VA lately, I wouldn’t be too quick to believe any numbers.</p>
<p><a href=“http://www.sacbee.com/2014/05/06/6380946/ask-emily-think-you-know-what.html”>http://www.sacbee.com/2014/05/06/6380946/ask-emily-think-you-know-what.html</a></p>
<p>Interesting column on the high out of pocket costs if some of the doctors who treat you are out of network. With the very limited networks, this is very likely to happen with a hospitalization.</p>
<p>Having a daughter who still stumbles into occasional “resistance thinking,” I guess I am sensitive to this powerful human urge to naysay, just because one can. I tell her, there’s a difference between evaluating, learning and testing, and some purposeful ‘critical thinking,’ versus just looking to criticize. </p>
<p>No matter what some of us say, others will always find some skeeter- some blogger, some tale of woe, some seer, some supposed reason to dismiss the whole. </p>
<p>So we get, *“It’s big,” said Samuel Preston, a demographer at the University of Pennsylvania and an authority on life expectancy. Professor Preston, who was not involved in the study, called the study “careful and thoughtful-” * and we get a whoopdedoo dismissal of that 3 percent. </p>
<p>You will always find tales of some dissatisfaction or confusion, some thing to point to. I guess my question is, but are you learning, becoming more informed, asking the right questions of your carrier, better able to evaluate? Better able to move forward with your own decisions? </p>
<p>Holy Moly…again…I had no idea…this is embedded deep down in the system…</p>
<p>EPO: is only good for docs in network, and the network is ONLY in the COUNTY for that specific EPO. So, Sutter/PAMF might take certain BS EPO plans but this does not mean ALL Sutter/PAMF docs are in the network. Oh nay, nay…ONLY those docs in the area for which the EPO is sold. So in the case of Santa Cruz and Alameda counties…you can only see those docs. Yup, Sutter/PAMF has great cardiologist in SF…but in order to see them one would need special permission from BS. (using this particular example because it is the specific one I pursued).</p>
<p>This info came directly from the mouth of a Sutter/PAMF benefits specialist and is handed out on a printed form. So, if one signs up for such a plan and the young’uns attend university outside of the county…they have NO coverage. Only emergency care is covered…and we can have a fun time playing mental games as to what would. Also, no out of state coverage except for emergencies. Kid at camp in another state, you’re visiting buddies out of your county and say you get a bee sting or cut, not an emergency but urgent care…nope, no coverage. Who knew!</p>
<p>The friend of the family who chose this option has no idea their kids in SF and Davis are not covered by local docs. Ugh!</p>
<p>Dietz, with all due respect, why is that a surprise? PAMF says, “An EPO functions in much the same way as an HMO. but is even more exclusive.” BS says, “An EPO plan provides access to our Exclusive network…” And, “The Blue Shield EPO plan covers care, including preventive visits, lab work, and specialist services, only when rendered by a provider in the Blue Shield network. The EPO plan does not cover you for non-network care except for emergencies.” One of the considerations, for us, was what sort of coverage we’d get in different scenarios. And a few what-ifs. </p>
<p>I understand there is confusion re: which actual providers. And that plan pricing matters. And that not everyone makes choices the same way, with the same interest in detail.</p>
<p>^^^ The out of network issue is not a surprise. In an traditional HMO the PCP needs to issue a referral, the patient knows this. In and EPO no referral is necessary. A reasonable person would make the assumption that if PAMF Santa Cruz is ‘in network’ PAMF in San Jose would also be in network. The EPO is a rather new product in my area. It is not well understood and that particular nuance took me by surprise. Even in your quotes from BS this is not apparent. Parents who purchased this type of plan are going to be very surprised when their college kids have NO network providers. </p>
<p>dietz, correct me if I am wrong, but your problem is the lack of any choices. If you take the Anthem plan, you are shut out of PAMF entirely, and of course you just outlined the problems with BS. This leaves you with lousy choices, not a pleasant situation for someone who is stuck with the individual market. </p>
<p>BTW, I am now starting to hear more horror stories of people with 2014 individual policies, like the person in the story Tatin linked, where they are now discovering how limited these policies really are.</p>
<p>Junk.</p>
<p>What were usual o-o-p limits for out of network care last year? I know that some people have narrower networks now than previously (and others have wider networks because anything is wider than nothing) but I’m wondering what limits if any there used to be on out of network out of pocket.</p>
<p>The only choice* I have at this point is Health Net - at a at 60% + premium increase. And that’s with a much higher deductible. I’m coming up with some pretty fancy/schmansy scenarios, which I’m running by my eye rolling broker, to see what would work best for staying in the group market.
- Is a choice of 1 a choice?</p>
<p>o-o-p limits and balance billing were always problems for out-of-network care, but it didn’t really matter too much because the in-network was FAR SUPERIOR to the junk networks we have now for the individual market. </p>
<p>Dietz, keep in mind that if you have kids attending college out-of-county (or out of state) --you have the option of putting them on separate plans. It doesn’t sound like you are eligible for subsidies, so no particular benefit to having everyone in the family on the same plan – and depending on where the kids are, they might have much better options. I agree with you about the EPO concept – it’s not something I’m comfortable with - I think I’d opt for Kaiser over an EPO - at least I would know going in what the limits were. But BS offers a regular PPO in my county – so no issue, I can take my policy and go “in network” without paying attention to county lines. </p>
<p>Another advantage to having separate policies is that you can pick plan and deductibles to fit individual needs.The disadvantage is that the total possible out-of-pocket is increased – but unless some of your family members have known, chronic illnesses, its fairly unlikely that family members living apart are each going to have high-end medical costs in the same year. Not impossible, but it might be a risk you are wiling to take in order to get better insurance for your kids. </p>
<p>Lots of time spent on the phone today. I think I may have caused some damage to braincells, both mine and the brokers.</p>
<p>I mentioned to one broker that for several months now whenever I logged onto my BS account a banner line ran across the page saying this plan was cancelled. That line has disappeared. hmmmmmn</p>
<p>One broker mentioned hearing a new term ‘grandmothered plans’. There is supposedly some wrangling going on at high levels which MIGHT make allow carriers to continue offering these plans. However, she also stated given the time and $$$$ investment carriers have put into complying with the ACA standards, they might drop all non ACA compliant plans anyway. She was very clear that is was all rumor at this point!!!</p>
<p>Oh and another broker with high level contacts says we just might have Kaiser in our area w/i the next 18 months. And, they never audit the address you put on your account…so…hmmmm…</p>
<p>So there you have it folks…your ACA rumor and vocabulary phrase for the day. Maybe Grandfather and Grandmother can get together and make beautiful health insurance plans together.</p>
<p>“But BS offers a regular PPO in my county – so no issue, I can take my policy and go “in network” without paying attention to county lines.”</p>
<p>Yeah, but don’t come to Southern Ca. because the in network for BS in this part of the state is awful.</p>
<p>Don’t commit fraud, dietz. If you get an expensive illness, they might go back and check your address. They’re still allowed to kick someone out if they intentionally falsified the application. </p>
<p>^^^ That true. And I don’t intend too…but it was a curious statement. </p>
<p>However, if one is now kicked out (ie - loses) insurance it would be a qualifying event…and since there are no pre-existing condition clauses…wouldn’t one just simply fix the error and go on to the next insurance company?</p>
<p>Really, not planning on any of this but it doesn’t seem to difficult to manufacture a ‘qualifying event’ and change insurance plans as needed.</p>
<p>I’m not sure how fraud is treated in terms of losing your policy, someone should check. But the issue is getting payment for expenses already incurred.</p>
<p>Hmm good question. Does falsifying one application prevent you from being able to apply somewhere else in the future? calmom?</p>