Ambetter Insured by Celtic?

Oct 27, 2015

  1. Pancur
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    Pancur Super Genius

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    They are very competitive in Cook county but that's about it. How in the world they are allowed to sell in the Marketplace? They are HMO with only one hospital (Swedish) on the northside. I thought that network requirements for ACA plans were much higher. I' pretty sure that Marketplace reps will enroll many of cook county residents into this crap. They don't really have any idea what this will mean for the people. They would easily decline any out-of-network claims even emergency unless you are really dying with stroke, heart attack and car accident at the same time. What a joke!
     
    Pancur, Oct 27, 2015
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  2. AllenChicago
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    AllenChicago Guru

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    Thanks for that info Pancur. I'm going to investigate them further, because Ambetter keeps coming out on top, with best rates. I need to understand the company/plans better, because people in Cook will ask.
     
  3. Rick441
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    Rick441 New Member

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    Since Ambetter's presence on the Cook exchange brings the SLCSP *way* down, this means subsidized premiums across the board are up to $200/month higher in Cook than in the other Chicagoland counties. The whole SLCSP thing is nuts, supremely arbitrary.
     
    Rick441, Oct 27, 2015
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  4. AllenChicago
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    AllenChicago Guru

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    I just investigated the Ambetter Sinai-Illinicare HMO network. No wonder the plans are so inexpensive. There are hardly no Chicago hospitals in the network, and none beyond the Chicago city limits.

    I've learned that being with a narrow HMO network is worse than playing with fire. Even with the huge Blue Cross HMO network, I had two clients this year who couldn't go to the recommended hospital for surgery, because the hospitals were not in the network. They had to settle for a surgeon who was OK, but not the best. That's scary for patients and family in life-threatening situations.

    However, I did fill out a "Contact Me" form in the Brokers section of https://ambetter.illinicare.com/find-a-provider.html , because the web page says that they're updating the HMO network. Perhaps "updating" means expanding. We shall see.
     
  5. Norwayguy
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    Norwayguy I have spent way too much time here.

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    Could also mean cutting.
     
  6. somarco
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    somarco GA Medicare Expert

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    Skinny networks are part of the race to the bottom to see which carrier can contract with providers willing to work for the lowest reimbursement.
     
    somarco, Oct 28, 2015
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  7. Pancur
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    Pancur Super Genius

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    Pancur, Nov 1, 2015
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  8. AllenChicago
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    AllenChicago Guru

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    My Blue Cross clients in Cook County are very angry!

    If they're subsidized, the presence of the dirt cheap Celtic-Ambetter HMO plans is causing their ATPC-subsidy $$$ amount to actually DECREASE on 1/1/2016.

    I just spoke with a 62 year old Cook County client (60611). Her Blue Choice PPO plan is increasing by 45% and the subsidy decreasing by 11%. Net result is that her actual out-of-pocket increase in premium is a huge 56%!

    If they're not subsidized, they have to endure the entire 45% premium increase that will kick in on 1/1/2016.

    Or, change to Ambetter-Celtic and pray for the best of health in 2016.

    I'm pretty sure that Celtic-Ambetter is violating HHS-CMS rules by not having enough physicians and hospitals in Cook county. The problem is the Federal Government will not take any action until enough people are severely hurt with huge medical bills..and start filing official complaints. It would be nice if HHS-CMS would take proactive action, by telling Celtic-Ambetter to de-list itself from the Illinois Marketplace, but that's not going to happen.

    But, I will send a note to the Illinois Department of Insurance and the Governor's office. Almost zero chance of any response or action, but at least they'll have a record (and so will I) that at least one health insurance professional attempted to warn them of the problems that Celtic-Ambetter's presence will bring to lots of Illinois residents starting on 1/1/2016.
    ac
     
  9. Pancur
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    Pancur Super Genius

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    Good idea Allen. I'm already tired of explaining why subsidies are much lower in cook county and who this ambetter is.
     
    Last edited: Nov 5, 2015
    Pancur, Nov 5, 2015
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  10. SamIam
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    SamIam Guru

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    Are they accepting brokers now?
     
    SamIam, Nov 6, 2015
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