<p>Thanks for the wine, Dietz. From the Santa Cruz Mountains, I hope. :)</p>
<p>So we’re back. I remember Texaspg used to warn about projecting what we think would be better. Perhaps that still stands? It would be good to know if there are still various limits to what we can discuss. Just saying.</p>
<p>OK, I’m not sure what is ok and what is not. </p>
<p>I just want to post a followup to a prior post of mine – this is in reference to anecdotal info about the network issues. Basically, this is my personal experience which is entirely unremarkable – except as a counterweight to some of the horror stories that have been posted here or in the media.</p>
<p>I’ve mentioned before that I live in a suburban community in the SF bay area, with only one doctor in town. I like my doctor but chose her only based on location – if I was going to rate or rank doctors I would probably give her 3 stars (on a typical 1-5 star ranking system). Fine for routine care, but I probably wouldn’t recommend that anyone come in from out of town to see her. </p>
<p>Her office staff was unsure whether she would take the new ACA insurance, but bills from January were processed as out-of-network. Doctor notified me several months later that she would not be accepting the new insurance, so I decided to find a different doctor. (BS did apply UCR for the out-of-network care to my plan deductible, and doctor did not balance bill).</p>
<p>I decided to switch doctors. I chosedoctor affiliated with PAMF (Palo Alto Medical Foundation) which is a large medical group with many offices, closely affiliated with Sutter Health. </p>
<p>After reading the various media articles and anecdotes in this thread about how long people were waiting for appointments, I assumed that it would take 4-6 weeks to get a non-urgent appointment. Not so. I called on a Thursday to select a physician and schedule an annual physical, and was given an appointment the following Tuesday. (I probably could have had an earlier appointment if I had been more flexible about time of day.)</p>
<p>My appointment was set for 3:45pm but they asked me to arrive 15 minutes early to fill out the paperwork. I showed up at 3:15pm. The paperwork was minimal - consent forms, but no detailed medical history - and took me less than 5 minutes to complete. At 3:25 pm, the nurse called me for my appointment. After taking basic measurements (height, weight, bp, etc.) she showed me how to access the online web site for management of my medical records, and had me set up an account with user name and password.</p>
<p>I really liked the doctor. I will give the facility and doctor 5 stars for customer service & professionalism, but I would need further experience beyond a routine physical to assess overall quality of care. I did ask for, and get, a shingles vaccine (thanks to another CC thread for the reminder!). </p>
<p>After I got home and logged into the computer… I was in for several pleasant surprises. (More to come)</p>
<p>First pleasant surprise after visit: All of the info now available online to me, including records from previous services offered via the same network (mammogram records) This is simply the benefit of choosing services via a group that has or uses a good online records management system – something my local community doctor understandably did not have. I probably could have accessed the older records before – but no one had told me about it or how to set up an account.</p>
<p>Second pleasant surprise: This time around, the mammography center expected my call. They actually phoned me to schedule an appointment. In the past my doctor would give me a written referral – but sometimes I would end up losing the paper and forgetting to schedule the appointment. So working with the new group is likely to actually get me to my appointments better – I have a history of letting these things lapse because I simply forget to follow through. So maybe now I’ll get the reminders that I need to stay on track with preventive care.</p>
<p>Third pleasant surprise: Insurance has already processed the claim for the physical +shingles shot and paid in full-- so the preventive care part of my policy seems to work. The only downside is that the insurance allowed 100% of the amount billed and billing is on the high side – $440 for the visit, $245 for the vaccination – this could be an issue for me down the line for visits that are subject to my deductible or copay. That is, if this doctor can charge and be allowed $440 for a routine physical, they might also be approved for a larger amount for routine office visits. So much for the story that doctors won’t sign up for ACA because of the low-pay under the new policies (although maybe PAMF/Sutter has worked out a better deal with Blue Shield than non-affiliated doctors practicing in the community can get.)</p>
<p>Anyway, for me: ACA is working. I had to change doctors to get in-network care, but that means that I got a free physical rather than having to pay out of pocket for one. My local doctor now schedules 2 appointments for a physical rather than one – whereas even in-network, the insurance only paid for one under the preventive care benefits – so at this stage I have saved money by switching doctors – and I do think it is an advantage for me now to be seeing a medical provider hooked into the online-records system, as it would mean better coordination of care if and when I do develop any sort of complex medical condition requiring specialist care. On the other hand, I’ll want to keep an eye on what I am charged for other services, because despite all the portrayal of post-ACA policies as being skimpy with provider payments, I don’t seem to be getting any discount for using an in-network provider. The “narrow” network, at least for me, might mean both a higher- quality network with plenty of room for patients, and a potentially higher-cost network for people like me with high deductible plans.</p>
<p>“Anyway, for me: ACA is working.”</p>
<p>After you get cancer and are told you need specialized care from various specialists and research hospitals as well as expensive medication for this catastrophic condition, then tell us if this law is working. Going for a physical is hardly proof that everything is hunky-dory. </p>
<p>My niece got cancer and needs specialized care, and the ACA is working for her. If not for the ACA, she wouldn’t have any insurance at all.</p>
<p>Gosh, GP. How do you know? You also knew she wouldn’t find a doc who’d take her plan, wouldn’t get a quick appt or efficient service. Everything is a negative with you. Calmom is reporting her firsthand experience. I’m glad she did.</p>
<p>“You also knew she wouldn’t find a doc who’d take her plan”</p>
<p>Can you at least try to be somewhat accurate when you attempt to characterize my position? </p>
<p>“Everything is a negative with you.”</p>
<p>Not everything. I am happy with my non-Obamacare plan.</p>
<p>CF-Happy your niece is getting good care. </p>
<p>“Different niece. Why do you ask?”</p>
<p>I don’t know… that niece made quite an impression on me with the statement you quoted by her in that thread. </p>
<p>Different thread, different issues. Not a good rebuttal to the good news the young woman is getting good care. Say you’re sorry and let’s move on.</p>
<p>This thread just will not die. Round and round and right back where it started. Whoops. </p>
<p>The good thing is it doesn’t make a bit of difference what GP thinks. </p>
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<p>She also at one point said the people in states that didn’t expand Medicaid deserve it if they now don’t qualify for Medicaid because they make too much or subsidies because they make too little. </p>
<p>^ Elections have consequences. </p>
<p>A few thousand posts ago, there were people on this thread bemoaning the fact that businesses were reducing peoples hours to below 30 a week so they could avoid having to give their employees insurance. They posted dozens of news reports about it and how it was ACA’s fault people were turned into part timers. Now, when my suggestion would make it more likely employees would work more hours per week they scream it will cause job losses. </p>
<p>Emily, you cannot just pass a law that everyone must have a full-time job with benefits or nothing and not expect more nothing/ The working people pay for the non-working people on way or another. How can you not understand this? It’s baffling the way you think. It really is.</p>
<p>“you cannot just pass a law that everyone must have a full-time job with benefits or nothing.”</p>
<p>I’m not. I said all businesses must provide health insurance to all employees, regardless of how many hours a week they work. </p>
<p>Okay, but then they will have less employees, obviously. That’s less people who can pay for food and rent and more people on Medicaid. How is that better?</p>
<p>I think one has to run some numbers to see how this works. Without that, one can’t see the costs, positives/negatives- ie, impact on employers and employees. </p>
<p>"Okay, but then they will have less employees, obviously. That’s less people who can pay for food and rent and more people on Medicaid. "</p>
<p>Why were those against ACA wringing their hands that the law was causing employee hours to be cut to under 30 a week? Under my plan, those workers wouldn’t have had their hours cut. </p>