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<p>I have had a few people ask me over the last 2-3 weeks if we can go back to the old plans. They are having issues getting prescriptions covered which are always out of network. For most, if the prescriptions are covered, they won’t pay a dime based on their income.</p>
<p>I know there will be lots of lectures coming my way about how this can be rectified but it is a simple fact these are all less savvy consumers sucking air.</p>
<p>Tatin, I have to stay within the bounds set for what we can say and how. But plenty of folks screamed about not going to a system that would ignore state boundaries, tons of scare stories that altered Joe Q Public’s perceptions. Thus you end up with state by state.</p>
<p>Did the doc in UT ask her plan to approve in-net status for out of network docs who are physically closer? Anyone mention that? </p>
<p>Nothing prevents insurers from including New York doctors in a plan sold to people who live in Hoboken, New Jersey, TatinG. And nothing prevents Utah insurers from including Colorado doctors.</p>
<p>I’ve been trying to figure out whether a Utah resident can buy a Colorado health plan with Colorado doctors. I haven’t found anything that says she can’t, but I suspect that the Colorado plan wouldn’t satisfy the requirement that she have insurance. Does anyone have links that deal with the subject? </p>
<p>[It seems that if California had restrictive health regulations, and Wyoming had less restrictive regulations, then FangCo could set up Wyoming insurance plans that only had California doctors, and sell them to Californians. I suspect that is illegal.]</p>
<p>I seem to recall certain people calling for insurance to be sold across state lines. </p>
<p>Do plans in remote areas access doctors and hospitals across state lines? </p>
<p><a href=“Uh oh. This page does not exist.”>https://www.coveredca.com/faqs/Student/</a></p>
<p>Covered California does not have any health plans that include out of state doctors or hospitals. So if you live in Tahoe, you can’t go to Reno. If you live in Blythe you can’t go to Yuma. If you live in Baker you can’t go to Las Vegas. </p>
<p>People who talk about insurance being sold across state lines are usually talking about evading a state’s requirements by setting up a plan in the least restrictive state, then selling it in a more restrictive state. Including out-of-state providers in a network is not the same thing.</p>
<p>Are California insurers prohibited from including out-of-state doctors and hospitals in their coverage? If they are not prohibited, but they choose not to do it… well, just because you want to buy something doesn’t mean the seller has to sell it to you.</p>
<p>But when there is a provision for special approval, people should try to use it. It’s not enough to just lean on some tale that Mrs So and So had issues or didn’t try and is now in a pickle. I;m not understating some of the challenges. Just asking that we try to get a clear picture.</p>
<p>I agree, LF, and it’s also clear that some people bought the wrong insurance. If you KNOW you are going to have expensive health needs, you should evaluate whether a high deductible policy is the right one for you. Maybe a high deductible plus HSA might be right, but otherwise, you should run the numbers before buying.</p>
<p>@Cardinal Fang
Oh dear heavens…that was the basis for pre-existing conditions exclusions. I thought ‘we’ didn’t like that. I thought ‘we’ wanted to buy something simply because we felt entitled to buy it…therefore a system had to be enacted that forced the private market to provide a product it didn’t want to sell. Are you advocating the private insurance market doesn’t have to provide a product (ACA plans) just because you happen to want one???</p>
<p>Well, sometimes when you want something the seller does have to sell it to you: Trader Joes can’t refuse to sell trail mix to black people. But the mere fact of your wanting something does not guarantee that a company has to offer it for sale. I might really want a salty trail mix with nuts, m&ms and chips, and nothing would prohibit Trader Joes from selling such a product, but they don’t.</p>
<p>Similarly, if FangCo Health offers an insurance product to people in South Lake Tahoe, they can’t refuse to sell it to people with cancer. AFAIK, FangCo would be allowed to include Nevada doctors in that plan, even though it is sold to Californians. But people in South Lake Tahoe are not entitled to be able to buy a plan with Nevada doctors even if they really want it, if no insurance company has decided to sell such a plan.</p>
<p>What is the proposal here? Do you think that insurers should be required to offer plans with out of state providers to people living in border areas?</p>
<p>People should be able to buy whatever type of insurance is right for them. Insurance companies should be able to offer plans that people want. Simple.</p>
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<p>Are you claiming that California insurers are prevented right now from offering Nevada doctors to California subscribers? </p>
<p>I can’t understand your point. People are never going to be able to buy whatever type of insurance package they might have a hankering for-- they couldn’t pre-ACA, and they can’t now-- because insurers are always going to choose to offer some products and not other products. </p>
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<p>Why are Health insurance companies singled out? Other companies can refuse to sell to those who can’t pay the asking price…or for that mater to those not wearing shoes or shirts. Or, if you can’t get past the bouncer…no entrance to the cool club for you. Ever come across one of those signs at a bar 'we reserve the right to refuse service"?</p>
<p>Health insurance companies also refuse to sell to those who can’t pay the asking price.</p>
<p>Still trying to figure that out myself. Best guess is that your health is one of those things like a right to privacy - no matter how little you stir yourself to provide for it, it’s still become an inalienable right. Even for aliens.</p>
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I can’t think of an aspect of this that doesn’t lack precision. From the malleable stats on the number of uninsured and medical bankruptcies that were used to bring us where we are, to the unverifiable number of enrollments/age mix, this has been a calculated study in imprecision. Anecdotal sob stories should be just as moving now, as they were way back when. </p>
<p>Heck, the Census bureau even changed methodology as to who’s uninsured to avoid being precise.</p>
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Which is why if I was drawing up FangCo’s business plan, I’d budget some serious money to lobbying for California’s restrictive regulations to be universally adopted. That’s the usual method for dealing with excessive personal choice.</p>
<p>No you wouldn’t, catahoula. FangCo isn’t deeply concerned about whether we’re required to cover acupuncture services in Wyoming. We’ll leave that to the acupuncturists’ lobby. We’ll use our valuable lobbying dollars for issues we care about more, and we are unlikely to lobby for more regulations for our company.</p>
<p>One size fits all is where the car’s being driven to, CF. Dr. Love has an out-of-network issue that has to be resolved, and I doubt the NYT’s is ever going to say she needs to forget about it and pay more. Because if she did, she’d be skewing the premium numbers in the wrong direction. Nope, more likely is that pressure’s applied - regulatory pressure, with CA access regulations as the model - to put a willing (hah) doctor within reach, at an unwilling price to treat her. Today, tomorrow, whatever… these things take a little time. Picking and choosing which parts of CA regulatory we want to spread isn’t likely an option for FangCo, so if we’re going to fight the good fight, we’ll have to let the acupuncturists ride along for free.</p>
<p>I’m thrilled, myself. California-style regulation makes sense, if you squint at it, and don’t give much of a hoot about costs. To explain that sentiment, I’ll digress a moment (but not really):</p>
<p>Bought a new, in the box Ryobi weedeater a few years back. The thing ran like a belching flatulent cow from day one, fouling plugs, never hitting a speed worth a darn, and after checking and realizing the carb adjustment screws had been idiot-proofed (courtesy of the CA market), took it in and had it adjusted by a certified technician. Not small change, a significant percentage of the purchase price for the cow. Ran OK for about two weeks during the grass season here and then started smoking and bogging again… just what my environmentally conscious mind is stunted by. Said, screw it and used a Dremel to un-idiot proof the guards around the adjustment screws and tuned it. The difficulty level was about .3 on a 1 to 10 scale (the adjustment, not the grinding off of the screws, which took some ingenuity and time) and while I did it I thought of a passage from ‘Cryptonomicon’, by Neal Stephenson:
And where California goes, so do the rest of us.</p>
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<p>This makes no sense to me. The California insurance regulators have no way of forcing a doctor to join a network. All they can do, and what we’ve been saying all along that they should do, is force insurers to have adequate networks, in the situations where they don’t currently have adequate networks. And it’s quite obvious how the insurers will have to do that: by paying doctors more and charging more to subscribers in order to recoup the increased costs.</p>
<p>I think dstark is right in his assessment that providers are going to start forming their own accountable care organizations, and cutting out the insurers. That <em>might</em> make things better for subscribers. Maybe. It’ll make things better for doctors, in any event, because they’ll be freed from billing hassles.</p>
<p>Just for the record, its entirely possible to be under regulated and over-regulated at the same time if the guiding regulation is the product of partisan compromises that don’t make intrinsic sense to the intent of the regulation ;)</p>
<p>Lots of examples come to mind…wall street, the housing bubble…even the application of the penal code in things where “political darlings” like the war on drugs means a purveyor can do more time than a violent criminal. And the tax code…there’s a shining example of tomes producing outcomes that make no sense…</p>
<p>So yes, I maintain that if you’re going to regulate something, then ya better regulate the unintended consequences too through tweaks in situ – like network access ;)</p>
<p>Sorry, cat, if you find that incredible. I just find it sensible, as uncommon as that may be 
Not necessarily achievable, just sensible…</p>
<p>The creative work-arounds continue…</p>
<p><a href=“http://online.wsj.com/articles/companies-try-to-escape-health-laws-penalties-1413938115”>http://online.wsj.com/articles/companies-try-to-escape-health-laws-penalties-1413938115</a></p>
<p>So companies are complying with the law in ways buy…</p>
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<p>So now the Treasure Department is getting into the business of law interpretation?!</p>