<p>When posts get deleted, do other posts get renumbered? I think the message LasMa is referring to, with the link to the suspect site, is now #15476.</p>
<p>That’s correct. </p>
<p>Well… My family has some issues. My wife was going to have cataract surgery. Her eye doctor’s office said my wife was covered. Blue Cross said no. Looks like the doctor is not in network. Looks like the office is wrong.</p>
<p>My wife could never get comfirmation that the gas doctor was in her plan. The latest was the doctor takes Anthem PPO plans. That is a broad answer, not a specific answer.</p>
<p>Marin General charges $10,000 for the procedure for people with insurance while Marin Opthamology ??? Charges $2500. The procedure was going to be done at Marin General.</p>
<p>My wife can not get a clear answer of her costs. Looks like $9,000 + if the gas doctor is in network. Who knows what the costs are if he isn’t. </p>
<p>My wife has been on the phone multiple times with Blue Cross, Marin General, the doctors offices and she gets different answers depending on who she talks too.</p>
<p>So, there is nothing definitive.</p>
<p>So she cancelled the surgery.</p>
<p>Talk about inefficiency. All the way through the process… There is inefficiency. A bloated ridiculous system from top to bottom. </p>
<p>Does Kaiser do the surgery? I know that you felt that your daughter received care on her employer-provided Kaiser plan – maybe you could shift to Kaiser during open enrollment and arrange the surgery next year? Actually, I think that network issues can also sometimes allow a shift outside the open-enrollment period, but it doesn’t sound like your wife even has a definite “no” could support a request. </p>
<p>But as far as I know, Kaiser is Kaiser-- you’d know who was in network without having to ask. </p>
<p>dstark, I’m sorry it’s such a struggle. Our system is insane. More people now have access to it, but it’s still insane.</p>
<p>Thanks. Yes. Kaiser does the surgery. We are going to switch to Kaiser this sign up period. On the plus side, she is going to need both eyes done eventually. Maybe she can have both done next year. She was going to have one eye done this year and one maybe next year. This financially did not make much sense. Anthem would not insure the better eye for cataract surgery this year. ;)</p>
<p>On the downside, she is close to blind in one eye. The cataract is making it very difficult to see. </p>
<p>Yes. We should have no more network problems. I know many people that work for or with Kaiser. (Probably obvious from my posts 
).Things will work out. </p>
<p>Our specific facts and figures are in. I thought I would simply post the information</p>
<p><a href=“https://www.blueshieldca.com/employer/documents/plans/medical/small-group/A46031-D_1-14.pdf”>https://www.blueshieldca.com/employer/documents/plans/medical/small-group/A46031-D_1-14.pdf</a></p>
<p>This shows our current plan on the left and the new ACA compliant alternative on the right. We have been given the option to continue our current plan with a 14% premium increase (plus the 5% ACA employer tax of which I think 3% was implemented last year). The non compliant plan has been ‘grandmothered’ by the State of CA. This term actually appears renewal literature, it is not an attempt to be derogatory. An explanation of the law can be found here…<a href=“Breaking News: Governor Signs “Grandmother” Bill for Small Employer non-ACA Compliant Plans | i2i benefits”>http://i2ibenefits.■■■■■■■■■■■■■/2014/07/07/breaking-news-governor-signs-transition-relief-bill-for-small-employer-non-aca-compliant-plans/</a></p>
<p>Renewal of the current plan will run us $1650/month and the new ACA compliant plan would be $2150/month. </p>
<p>One can see from the chart that the ACA plan is not only higher in premium costs but considerably higher in deductible, co-pays, OOP in general. The only case I can see where the ACA plan would be financially beneficial is if all 4 covered individuals were to hit the deductible. </p>
<p>From what I can gather, unless a group is required to re-certify it is simply presented with the group options for the upcoming renewal period. Who knows, maybe we will be offered group coverage again during the 2016 renewal period. But, as my DS would say…that is a problem for future me.</p>
<p>Anyway, these facts show what small businesses are facing. And, IMHO explains why many a small business will have a financial incentive to drop coverage. And again IMHO, this was the plan because it forces participation in the substandard individual market.</p>
<p>Cheers.</p>
<p>I’ve been looking at health insurance for my daughter and her business. I found Costco offers health and dental for small business. Does anybody have experience with those plans?</p>
<p>I just saw this offering in their last magazine. From what I can tell, Costco is functioning in broker type function so they can only offer what the ACA and the State allows. However, in my experience, Costco will have some sort of add on benefit. It probably worth a look, they tend to be very customer service oriented.</p>
<p>Ok…I just spent a couple of hours with somebody that works in the health insurance industry. In Calif, the make up of the sign ups is better than was thought. The companies were worried that there were going to be too many old sick people signing up. Didn’t happen. I know at least one major company is working on its network. ;)</p>
<p>I don’t really care because there were a few people at dinner and we talked and I am switching. The coordination of care is much better at the company I am switching to and that is important. </p>
<p>The following interesting bit of information shows up when playing around on the BS 2015 page</p>
<p>Great news for EPO plan members!</p>
<p>Currently, EPO members can receive covered services from EPO providers in the 26 counties where we offer EPO plans. In 2015, we are expanding the EPO Network to include certain providers in 28 additional counties from whom members can receive benefits for covered services. That means members pay less in more areas of California.
To view the list of 2015 EPO doctors and facilities, click “Change Selection” above and then choose “2015 Individual and Family EPO Plans (including Covered California)” from the menu. Then select the type of provider and add your location.</p>
<p>
</p>
<p><a href=“http://www.abqjournal.com/467870/news/nation/fewer-uninsured-patients-admitted-to-hospitals.html”>http://www.abqjournal.com/467870/news/nation/fewer-uninsured-patients-admitted-to-hospitals.html</a></p>
<p>dietz199, I did what you suggested in your last post.</p>
<p>My wife’s opthamologist is on the list. There are other doctors I was happy to see on the list. </p>
<p>There are plenty of doctors that are missing. My cardiologists are on the list. Well…former cardiologists. Don’t need one right now. </p>
<p>Hmmm…there is a disclaimer that some of the doctors on the list arent really in network.</p>
<p>" choose to view search results for all doctors and hospitals in Blue Shield of California’s provider network. I understand that some of these doctors and hospitals do not offer in-network services for medical plans purchased either through Covered California or directly from Blue Shield of California.</p>
<p>I understand that Blue Shield of California is not responsible for paying any fees to providers who do not accept the medical coverage I have purchased."</p>
<p><a href=“Find a Doctor, Dentist, Hospital, Vision, Urgent Care, Pharmacy, Health - Blue Shield of California”>Find a Doctor, Dentist, Hospital, Vision, Urgent Care, Pharmacy, Health - Blue Shield of California;
<p>There are only two anesthesiologists on my list and they are miles and miles away.</p>
<p>I checked on the one particular cardiologist which needs to be in our network. - Name begins with 'H" 
. He appears on all the EPO plan lists when I use the BS website. However, when I then click on his name and get taken to the CPMC site, the list of accepted insurances is different. Not sure if that reflects the current 2014 status (where EPO is not accepted at the SF office, but is at the Marin office), or if it truly reflects the 2015 upcoming status. </p>
<p>We are structured so that H is employee 1 and I am employee 2 and carry two dependents. Both H and I entered new (5 year ) rate bands during 2014 so premium adjustments were made during the past 12 months. The newly offered ACA compliant plan (shown in my post #15486 and which we are not taking because of cost and decreased coverages) increases my H’s rate by 22% when compared to the current plan. However, it increases by a whopping 68% the premium costs for myself and the 19 and 22 year dependents. That comes as a surprise to me.</p>
<p>At this point I’m just hunkering down and staying below the radar as much as possible. The renewal gives us the option to watch the game for another 12 months from the safety of - albeit very expensive - sidelines. Next year, who knows…</p>
<p>On another note… I listed to Doctor Radio when in the car. A caller was relaying their problems with Good Samaritan Hospital. She was going to use their maternity center - it is where her Dr. practices. She was told NON of the anesthesiologist accept ANY insurance plan. I’m not exaggerating, this was the exact nature of the phone call to the hosts at NYU Langone Medical Center. They advised switching doctors which of course at about 8.5 months the patient did not want to do.</p>
<p>If I bought a BS plan, I see that H is in the plan too. </p>
<p>Dietz199, you are looking at gold or platinum plans. You said your family is not a big user of healthcare. When the time comes, Maybe 3 of you should be on a bronze plan and your husband can be on a different plan. Play with the numbers. Your family might be overinsured.</p>
<p>I looked at your plan. There is an out of pocket maximum per individual. I did not see a lower out pocket maximum for a family. Is there a lower out of pocket maximum for a family?</p>
<p>My wife is pretty angry right now. In July, my wife was treated by the opthamologist and the opthamologist was treated as in the plan by Anthem. 3 months later, Anthem says she is not in the plan. Anthem sent my wife this long of opthamologists, it is a long list, there isnt a shortage, and the opthamologist is not on the list. </p>
<p>The opthamologist office says she should be on the list. If I was the opthamologist, I would have my office on the phone with Anthem. The doctor would make over $2,000. Maybe she is losing more business. These office people make very low salaries. A few calls to Anthem can pay for an office worker’s salary for a month.</p>
<p>dstark, you might want to contact the Department of Insurance, about Anthem’s switcheroo on the opthamologist. Also, I’m PMing you.</p>
<p>Our current plan has a $5500 OOP per person. This includes the deductible. That would make it a 22K OOP max for family. This applies to in network usage. Out of network has no limit. The new plan would have a $6300/pp with a $12.7 K family max for in network. OON runs 10 K/pp 20K per family. Hence my comment that the new plan would be better if we all were say in a major accident. (spit spit, throw salt over my shoulder and make the sign of the cross).</p>
<p>D starts a grown up job with benefits in November. S has the option of joining the UC plan which seems to be very good for the price. Since at this point I do not trust the BS sites responses to my queries regarding who’s in network and who’s not and since I am very comfortable with the answer as it pertains to my current policy, I’ve chosen to stay put. My attempts to call BS and Healthnet last year during open enrollment resulted in way to may cups of coffee consumed while on hold listening to horrible music. </p>
<p>Given the changes with the ‘children’, I’m assuming if it makes sense to change plans the beginning of next year we would qualify for under one of the condition clauses and be able to change outside of the standard enrollment period. Really, with all the unknowns, changes, legal challenges Hail Mary saves etc… who the heck knows what things will look like in another 12 months. So for now we (or those folks to whom costs can be passed ;)) will pay the new rates.</p>
<p>I am very confident the network issues will be better at BS in a year. </p>
<p>I am too. They’ve gotten a lot of bad press about this, not to mention attention from the state, and lawsuits. That does tend to focus Anthem’s mind.</p>