<p>Those who have been responsible for ‘vetting’ their own insurance options for years - decades even - have a reasonable chance of figuring out the small print. Those new to the whole idea of insurance - most likely those who look at the bottom line after subsides and jump for joy at their ‘free or inexpensive’ options - have no clue how to vet this type of product. The issue with BS limited networks took even some well versed and involved consumers by surprise. Asking the right questions to vet an EPO plan would include - where is the next EPO county (since you’re only covered in EPO counties); how come your main website lists my doctor when I put in the EPO plan option but I know for a fact they are not in the network ( a small detail that become clear AFTER purchase); which doctors in my county are actually taking new EPO patients…etc.</p>
<p>A comparable situation would be having to ask your car dealer if - the windshield was included, how about tires, would the car drive outside of a certain geographic area. In other words, vetting the new plans is so not intuitive.</p>
<p>That’s my concern and I said it before. The folks who don’t or can’t get the picture accurately. </p>
<p>But it works both ways. Not only that one has to read the full information and place a few calls to confirm details, but that, equally so, the complaints also need to be viewed in their full context. It’s why we asked, eg, what the hairdresser’s viable options were. It’s not enough to say, “the price on her present policy went up 50%.” We should also know if there was a suitable replacement option. And, if not by price, then what about the benefits. Eg, maybe she pays x% more up front, but the coverage is at a lower co-pay or co-insurance rate. And etc. Questions, to learn more. </p>
<p>It helps to try to look at the “real” picture, not the one or two details that “seem” to make a point.</p>
<p>And I think it’s been noted on this thread that some insurers did a horrendous job of posting accurate provider lists and plan details. The most savvy consumer in the world can’t ‘vet’ that. It also seems that some insurers did not comply with the law’s requirement of adequate coverage in some geographic areas. To be an informed consumer, we have to rely on the insurers to inform and to follow the law. Let’s hope they do a better job next year.</p>
<p>There were a number of articles in the media yesterday that 95% of the 8 million (who knows how many have paid) are heavily subsidized, paying less than $100 a month for Obamacare insurance. Essentially, most of the newly enrolled are very low income or on the bottom end of the income subsidy scale. What we have is heavily subsidized insurance for the low income and a new uninsured class consisting of middle income people who are receiving less or no subsidies. Insurance is now unaffordable for the middle class with the high premiums and deductibles. Of course, when these very low income people get very sick, they will probably still end up in emergency rooms because they will be unable to pay their very modest premiums and deductibles or will have difficulty finding a provider that accepts their insurance. </p>
<p>The middle and upper middle class got screwed by this law: high premiums, deductibles and HMO-like networks.</p>
<p>“A comparable situation would be having to ask your car dealer if - the windshield was included, how about tires, would the car drive outside of a certain geographic area. In other words, vetting the new plans is so not intuitive.”</p>
<p>I agree - it is almost impossible for most people to try to navigate the incredibly opaque Obamacare landscape and make an intelligent decision about the limited selection of plans available to them. However, it is infuriating that all these insurance agents (so-called experts), navigators and non-profit agencies were also asleep at the switch. They were signing up as many people as possible without paying any attention to the provider network. </p>
<p>Anyone hearing about any pharmacy issues? One of our people complained to me saying that CVS refused to fill one set of drugs prescribed for sugar/BP issues and when the doctor gave a second set, they said no to them too. He is confused because doctor got frustrated and told him to find out what CVS would honor and he did not understand how that works. I told to ask the pharmacist to recommend a covered substitute back to the doctor.</p>
<p>Not only are the insurance companies with the tacit consent of Covered Ca restricting networks, they are also liars. No way Blue Shield has anything close to 82% of hospitals or 64% of doctors in its networks. LasMa, nothing is going to happen to the insurance companies so don’t get your hopes up. The last thing Covered Ca wants is for the insurance companies to raise their premiums because they were forced to widen their networks. This is a dog and pony show being put on by the regulators to demonstrate they are doing something because so many people are upset with Obamacare.</p>
<p>Texas, this is what happens when you have closed formularies that have been considerably narrowed.</p>
<p>Tpg, the pharm should be calling the doc, so they can do a little tech talk. This is how CVS has always handled any sort of confusion, for us. There are, of course, some meds that are outrageously expensive- and easily replaced with other Rx. We don’t have any idea what this employee was prescribed. </p>
<p>Meanwhile, in my state, more providers are offering plans next year. Next door, in New Hampshire, they’re going from one insurance company offering plans to six next year. </p>
<p>Dstark, good article. That is the kind of pressure I expected ACA may indirectly have. But I’d go a step further and suggest that formularies be separated entirely from exchange plans as separate policies with tiers…or all plans for that matter. The bloated pharma costs would become even more transparent to the consumer and I predict the free-for-all, over-prescribing, and illness caused by unintended med reactions/interactions would dial down a bit ;)</p>
<p>Regarding this, its such a fine example of greed and stupidity I think we should all take a moment to join hands and indulge in a little levity…or cry…
:
</p>
<p>It is a good thing perhaps that they did not attend kmcmom’s quippy practice, or this is what they might have heard:</p>
<p>For human #1 - Groovy…on behalf of all taxpayers we thank you for self treating. Maybe you weren’t so sick after all. Let us know how that brain-surgery-by-dremil tuns out Of course how DARE we ask you to pay $100 of the uncapped millions you might rack up. We’re soooo inconsiderate that way!</p>
<p>For human #2 That’s okay, we completely understand that you want service despite the evidence you don’t pay your bills and perhaps prefer to go to the movies every week or spend you money burning through mobile phone minutes… May I refer you to patient #1 who has found a much more economical solution to our service? He’s over at CVS right now getting supplies…</p>
<p>For human #3 Unless the elective surgery is a brain transplant for math-capacity…
"Fellow human, I don’t know why you’re in a grandfathered policy with an illegal deductible, but never mind all that. I have some beautiful swampland in Florida you must see this second before the market really explodes…don’t worry, we’ll finance it all off your Heloc…wait, wrong decade. Oops!</p>
Of course how DARE we ask you to pay $100 of the uncapped millions you might rack up. We’re soooo inconsiderate that way!</p>