<p>I take it back, dietz. I couldn’t believe that anywhere near me would be more expensive than where I live, but sure enough, Anthem, which I think has PPOs in both Santa Cruz and Santa Clara counties, would charge me 13% more for insurance in Santa Cruz County. That makes me believe you are correct and Santa Cruz is even more expensive than Santa Clara County.</p>
<p>On the other hand, I can see why Blue Shield is going with the EPO in Santa Cruz. The Blue Shield Silver EPO in Santa Cruz county is way way cheaper than the Blue Shield Silver PPO in Santa Clara County.</p>
<p>A friend of mine just had surgery to remove his bladder and replace it with a rebuilt one. As you can imagine this is an incredibly complicated surgery which had to be done out of our region. He has a grandfathered plan so it wasn’t a problem financially for him. It would have been interesting to see what would have happened if he was stuck with an Obamacare plan. Thank god he didn’t change plans in the last 4 years.</p>
<p>It would indeed have been interesting, GP. I gather you think that the insurance people would have twirled their mustaches and said, That’s a complicated surgery and we don’t have anyone who can do it. So you can’t have it! BWAHAHAHA!</p>
<p>I think they would have said, We’re sending you to Dr. Knife over at Forest Resort.</p>
<p>I am fervently hoping that America will figure out that the architects of Obamacare are trying to shoehorn us into HMO-like plans, which many people discovered were denying them the care they needed in the 1980’s, and punish the ignorant politicians who have no idea how destructive this law really is.</p>
<p>"We’re sending you to Dr. Knife over at Forest Resort. "</p>
<p>The difference between you and me is I want to choose the surgeon; you seem to be just fine with allowing the insurance company to choose the doctor. </p>
I think part of the structure might be a hope to influence market development… If heart patients who live in Santa Cruz regularly choose to drive up the road to see cardiologists in San Jose, then there’s no particular motivation for a cardiologist to set up shop in Santa Cruz. On the other hand, if Santa Cruz residents have an insurance plan that locks them into seeing someone local … that may encourage more cardiologists to open offices (or at least branch offices) in Santa Cruz, to get some of that business. So at least in theory, development of strong EPO networks might encourage more doctors to resettle in the rural counties that Blue Shield wants to serve with those networks.</p>
<p>I realize that what happens in practice is not always the same as what happens in theory - but I can certainly see the rationale that might have been going through the minds of the insurance execs.</p>
<p>I do agree with Dietz, however, that this really is not fair to the consumer / insurance buyer. I also feel that there are relatively simply regulatory measures that could be put in place to assist such consumers. Dietz had some good ideas- I have some different ideas, but along the same lines. Let’s make sure that consumers have clear notice of the restrictions when they sign up for plans – and lets provide an avenue or procedure for them to access care in situations such as the away-from-home college student or the need to see a specialist in a neighboring county- and also require clear notice to the consumer as to what that procedure is.</p>
<p>Some of it isn’t difficult – the insurers know the age all policy holders in a family, so there could simply be a rule that required them to send some sort of brochure about insurance and college students to all families with children age 15 and over. EPO policy holders could be given clear printed coverage maps with their policies, plus notice of the procedure required to request non-emergency, out-of-area specialist coverage. The state could require all insurance companies, including HMO’s and EPO’s, to have some mechanism for coverage in these situations, without requiring it to be automatic in all cases. They just need processes in place, and clear notice to the consumers </p>
<p>Going back a page or two, dietz, I like some of your suggestions and I especially agree that the insurers need to be MUCH more transparent and accurate. Like LF, I encourage you to write some letters. You’ve spent many hours posting here ( like all of us), to people who can’t do a darn thing. Heck, just cut and paste some of your posts and sign it. You’ve already done the hard work of writing your thoughts down. </p>
<p>There were a couple of bets. One was how many people would sign up on Covered California: GP said it would be less than 500,000, dstark and I said it would be more. Poor GP was not close, since over 1.4 million signed up on Covered California. The second bet, between dstark and me, was how many total people would sign up on the exchanges by April 1. IIRC I bet it would be less than 6.25 million. I was way off and dstark prevailed. In both cases, the bet was clearly stated, and concerned how many people signed up. Not how many paid, not how many were uninsured. We bet on how many people signed up on the exchanges.</p>
<p>That expresses our difference exactly. I don’t want to hand my wallet to any sick person who has the same insurance I have, but you are willing to hand your wallet to your co-insurees.</p>
<p>“So I don’t look at it so much as a “cliff” but as a possible windfall.”</p>
<p>This pretty much sums up (besides the limited networks) why I hate this law. BTW, you could replace “windfall” with “avoiding an inequitable, unaffordable financial burden”.</p>
<p>CF and Calmom should have become govt bureaucrats. I think they would have been very comfortable with writing and reading huge manuals of mumbo jumbo regulations that only they and a few others would comprehend.</p>
<p>“That expresses our difference exactly. I don’t want to hand my wallet to any sick person who has the same insurance I have”</p>
<p>CF, if you truly believe this stuff, I think you should repudiate your Cadillac, wide-network group plan and join the 8 million people with Obamacare plans. I would be much more respectful of your position if you actually walked the walk.</p>
<p>I’m a software engineer and Calmom, I think, is a lawyer, so both of us have to be comfortable with the idea that not everything is simple. Sometimes complex things are complex and can’t be made simpler just because you wish they could be.</p>
<p>Mr. Fang is thinking of retiring soon, so we’ll probably be moving to the individual market. That has no terrors for me. Several plans now available have the doctors I use and the hospitals I’d go to. Based on the experience of others, I certainly wouldn’t buy a plan from Anthem, though.</p>
<p>“Mr. Fang is thinking of retiring soon, so we’ll probably be moving to the individual market”</p>
<p>Moving to the individual market would be one of the greatest mistakes you ever made, but the great thing about this country is you’re allowed to make dumb mistakes as long as you don’t hurt other people. Problem with Obamacare is that it was very dumb idea which did hurt millions of people. In a just world these people should have to pay for all the havoc they have wreaked on this country.</p>
<p>I don’t practice law any more… that was career #1. I actually do a little bit of software stuff myself these days… not much, but some basic, low end scripting. You and I might share something else, CF – engineers & lawyers are both “fixers” – we tend to view things that go wrong as simply as problems that need solving, because our careers pretty are built on our ability to solve problems. </p>
<p>I’d note that a lot of these ACA “horror” stories are not particularly different than issues I’ve dealt with in the past with insurance companies denying claims that they should be covering. I had a huge problem with my daughter’s college health insurance refusing to pay for something that had been pre-authorized by them. I finally had to get the Barnard health benefits coordinator involved. (My d. was studying abroad at the time). The college went to a different insurer the following year…so I’m guessing that my d. wasn’t the only student who ran into problems. </p>
<p>Sticky keyboard. Dietz, my primary career was engineering-related, too. Lots of lawyers and engrs on CC, it seems. (CC isn’t letting me correct that, btw, seems an edit took place.)</p>
<p>Dietz, as an engineer, you’re showing your fixer side. Even though you’re an ACA detractor, you’re coming up with proposed fixes: navigators should be liable for bad information, insurance companies should be required to be transparent, EPO contiguous service areas have to be no smaller than a certain size.</p>
Dietz, my primary career was engineering-related, too. Lots of lawyers and engrs on CC, it seems. (CC isn’t letting me correct that, btw, seems an edit took place.)</p>