They could just adjust the rates based on locality. i.e. Aetna of Iowa says, "oh you live in California, your rate would be $X + locality adjustment.
Of course there was no negotiation between Aetna of Iowa and Stanford Hospital in Palo Alto. That’s my point. Iowa insurers don’t make deals with California providers. They have enough to do making deals with Iowa providers every year. And therefore awc’s idea that my Iowa insurance policy should be good in California too-- that makes no sense.
“The public option is not the same as Medicare for all. It’s completely different. Don’t confuse the two.”
Point taken. However, I wouid contend that most people in the individual market would have opted for the public option and that wouid have been seen by business as a great alternative for them if they wanted to get out of the health coverage business.
But the fact is they want to have control over their employees health coverage.
Those who are wishing employer health care will go away - I’d suggest not holding their breath.
@emilybee why do employers want to control health insurance? As a benefit to lure employees?
My kids POS plan covers her across state lines. And it’s a lot more costly in our home state for things than in the state where the policy was sold.
Same with my Ppo plan.
Big employers presumably do like it because it gives them a competitive advantage in hiring or retaining employees over small companies or self-employment.
It is not surprising that a plan based in an expensive area can negotiate in-network rates with providers in less expensive areas.
@fretfulmother, yes, and to retain employees. It’s very costly to business have to keep hiring and training new employees.
It wouid also cost them more as people’s salaries wouid have to go up more than it costs them to insure them as an the employees heath insurance share of cost is paid for in pre-tax $. Also, for businesses, the cost to insure their employees is tax deductible.
They have no interest in changing the system as it is now.
@ucbalumnus You got my kid’s situation backward. Her insurance is far less costly than it would be in our home state where health care costs FAR exceed the state in which the POS is purchased. Still, the kid has had no problem getting the costs covered by her state…for things done in our home state.
How does the insurer afford to do that? Is it just that very few people who live in Cheap State and buy insurance from CheapCo go to Expensive State for care?
Probably because she is an outlier from the insurance company’s point of view. Most people who get medical care get most of it in their home areas, rather than engaging in medical tourism to more expensive areas, with only occasional out of area use by travelers who need urgent or emergency care or something like that.
That is different from the situation of an insurance company selling a plan to residents of a more expensive (for medical care) area who would mostly use the more expensive providers there.
Real life what happened with us is we had a family plan and our kid left for college OOS.
We had to remove him off our plan and buy the college policy for him in their state.
What happens when he comes home for winter break or the summer?
“Most people who get medical care get most of it in their home areas, rather than engaging in medical tourism to more expensive areas, with only occasional out of area use by travelers who need urgent or emergency care or something like that.”
So, for those who have a very limited network, as many healthcare plans are these days, has anyone had direct experience or an experience with a family member who has needed medical treatment while out of state? Do you bring your sick self/loved one home after the initial diagnosis/treatment? What if they can’t be moved easily? I’m sure this must happen but plans are so restrictive these days. Do people just pay huge amounts out of pocket because it is out-of-network care?
I no longer benefit from the generous healthcare insurance of yore with a 80% reimbursement for pretty much any facility or doctor. I’m sure many now have the same limitations on their policies that I do.
I just think a national network/universal coverage would solve this and the scenarios described in the post above.
@doschicos I was supposed to be presenting at a conference this weekend and didn’t go on the advice of my doctors. It was out of state and we didn’t know what would happen if I was hospitalized… again like I was only 2 or 3 weeks ago. It just wasn’t worth the risk 
Right. I would love to pay $650/month for an Iowa-based insurance plan that would also cover me here in the Bay Area. But I can’t buy one, not because it would be illegal, but because that Iowa insurance company emphatically doesn’t want to sell those policies to California residents at Iowa prices. They would be crazy to sell Californians policies that could be used in California but that cost Iowa rates. Fang’s Razor: Iowa insurers are not idiots. If Iowa insurers were forced to sell California policies at Iowa rates, they would raise Iowa rates to California rates. They’d have to.
We live in California and faced this same scenario when D went off to school in PA (Lehigh). Turns out the school plan (administered through University Health Plans) is a national plan and provides better coverage than mine. Check your plan details. Can’t say I’ve been happy to pay an additional $1875 per year but she is covered wherever she goes in the US…
Based on my experiences with DC/MD providers, reimbursement rates in our plan (GEHA, administered by UHC) are determined by the zip code of the provider. One of the (many) times I was disputing a charge, the insurance company also told me the same thing. Thank goodness our plan covers expenses anywhere.
Count me in as another person who got a surprise doctor bill from an in-network facility. The hospitalist who supervised my in-patient care after my heart attack is considered non-network, even though she ONLY works at this particular facility. She has an office outside the hospital. The cardiologist, consulting oncologist, anethesiologist (all of whom also have practices outside the hospital) were treated as in-network and covered at 100%. I fought the $1000 copay but lost.
What really peeved me, though was that the cardiologist who put in my five stents (2.5 INCHES of metal down the main artery in the heart) in a complicated three-hour procedure was paid $1200 for his efforts. Billed amount was $7200. His thorough and detailed notes about the severity and complications of my procedure were well documented – I have the surgical notes and in-patient records – didn’t count for diddly. Bless the docs who save lives out of deep personal commitment and care vs. the money.
@ClarinetDad16 – I just called my son’s health plan administrator to inquire and learned that the university plan appears to be better than the plan he will be able to purchase on the CT Exchange. The plan has three components: in-network in-area, in-network out-of-area, and out-of-network. The first one includes a list of providers within a set radius of the school, the next is a network of participating providers away from the school area, and the last is your typical out-of-network, subject to a much higher deductible. The second category requires payment of 20% coinsurance after the $25 copay whereas care received in the service area is only subject to a $25 copay. Several small differences of that sort, but annual OOP limited capped at $3000, whereas the ACA plan has a $3000 deductible up front before any care is reimbursed (other than annual physical).
The problem with the plan is that it will end a month or two after graduation. While I hope he is gainfully employed upon graduation, no guarantees.
My sister, who lives at home, does not work and lives at home with my parents who make 250k+ a year.
She just turned 20 so she can get insurance under her own name. Since she will make 15k at most if she gets a job, she gets:
Access to all her doctors she had before
0$ deductible
700$ max out of pocket
80$ a month premiums.
If she does not make 15k (which she probably will not unless she gets a job), she’ll have to pay a 375$ fee.
To top it all off, she has had severe depression, bulimia, and bipolar disorder. She was hospitalized last year for her eating disorder for 4 months.
Someone who contributes nothing to our will receive these amazing benefits…
Our system is flawed to say the least.
Wow. Just wow.
Anything more and I’d get put in the sin bin by the mods.
@Jpgranier Actually, your sister has other choices: She could stay on your parents’ plan until age 26 (either employer based or through the ACA exchange), she might qualify for medicaid. Your post doesn’t make any sense to me. If you are referring to the $375 penalty fee, your sister would not have to pay that because she does have healthcare options.
Are you actually calling your own sister out for having mental health issues and saying she contributes nothing to society?? You should be glad you don’t have me for a mother. [-(