"Medical Homelessness"

[RayNY]

The issue I've seen is that carriers made entirely new networks, with new names, that are drastically smaller than existing networks.

Did I mention, they never terminated existing doctors, because technically the old networks still exist? As far as the doctors know, yes, they still accept carrier XYZ. They were never notified a new network exists (the only network available now), and they're not part of it.

It certainly doesn't help that doctors categorically say "we're not taking obamacare", which is parroted by their billing dept/reception. That generally leads to 5-10 minutes of banging your head against something solid while explaining that obamacare is a law, not an insurance company, and repeatedly asking if they participate in ABC network with XYZ carrier.

 

[somarco]

One hospital in Macon, GA finally came out of the ether and looked at reimbursement rates for the SHBP (state health benefit plan) covering 600k employees and dependents and decided they would not participate in the network.

Many rural hospitals are also not participating in HIX plans, mostly the plans issued by BX. In some areas patients must drive 100 miles or more, past other hospitals, to get to a par provider.

 

[GreenSky]

One hospital in Macon, GA finally came out of the ether and looked at reimbursement rates for the SHBP (state health benefit plan) covering 600k employees and dependents and decided they would not participate in the network.

Many rural hospitals are also not participating in HIX plans, mostly the plans issued by BX. In some areas patients must drive 100 miles or more, past other hospitals, to get to a par provider.

Is that a feature of Obamacare, or a benefit?

Getting rid of bad doctors and hospitals will save money by centralizing care.

Rick

 

[somarco]

Rick, I believe you have (almost first hand) experience with Obamacrap networks.

 

[mattcvick]

There have been rumors and callers tell us that some states like Florida doctors have rfused to use marketplace insurance. Does anyone have the truth about this?

 

[lisamc]

The issue I've seen is that carriers made entirely new networks, with new names, that are drastically smaller than existing networks.

Did I mention, they never terminated existing doctors, because technically the old networks still exist? As far as the doctors know, yes, they still accept carrier XYZ. They were never notified a new network exists (the only network available now), and they're not part of it.

It certainly doesn't help that doctors categorically say "we're not taking obamacare", which is parroted by their billing dept/reception. That generally leads to 5-10 minutes of banging your head against something solid while explaining that obamacare is a law, not an insurance company, and repeatedly asking if they participate in ABC network with XYZ carrier.

BINGO. Many of the carriers created new networks for ACA plans and went out and negotiated contracts with the providers for the new networks. However, there is one carrier in Texas (a color) that did not do this. Instead, they stuck all of the ACA plans in the previous network. However, when you contacted a provider they were quick to tell you they were not taking any ACA plans and never agreed to take them and did not care that the carrier had their information listed as a provider --it was incorrect. This carrier went so far as to list each plan name under each provider; whereas, pre-ACA plan names were not listed but rather just the network.

When we as the agent would contact the carrier directly to inquire how we could get a true and accurate network list, they advised us it did not matter what plan someone had enrolled, whether ACA or pre-ACA, the networks were the same. When we questioned them why they had the specific plans listed under each provider and why there were some providers that actually listed the plans names they accepted on their provider website, we were told over and over again, the plan name did not matter--all that mattered was the network.

So why is it that at midnight on the last day of this carrier's extended OE, did their provider search change? Now you can search by each specific plan. And why do these search results come up with different information than just two weeks ago when you just searched the network in its entirety? It appears as though in order to seem more appealing to shoppers and seem as though its ACA network was larger than the other carriers, they conveniently did not negotiate a new network pre-open enrollment and are just now getting around to sorting out which providers will take these new plans and which will not.

 

[houcoogster]

BINGO. Many of the carriers created new networks for ACA plans and went out and negotiated contracts with the providers for the new networks. However, there is one carrier in Texas (a color) that did not do this. Instead, they stuck all of the ACA plans in the previous network. However, when you contacted a provider they were quick to tell you they were not taking any ACA plans and never agreed to take them and did not care that the carrier had their information listed as a provider --it was incorrect. This carrier went so far as to list each plan name under each provider; whereas, pre-ACA plan names were not listed but rather just the network.

When we as the agent would contact the carrier directly to inquire how we could get a true and accurate network list, they advised us it did not matter what plan someone had enrolled, whether ACA or pre-ACA, the networks were the same. When we questioned them why they had the specific plans listed under each provider and why there were some providers that actually listed the plans names they accepted on their provider website, we were told over and over again, the plan name did not matter--all that mattered was the network.

So why is it that at midnight on the last day of this carrier's extended OE, did their provider search change? Now you can search by each specific plan. And why do these search results come up with different information than just two weeks ago when you just searched the network in its entirety? It appears as though in order to seem more appealing to shoppers and seem as though its ACA network was larger than the other carriers, they conveniently did not negotiate a new network pre-open enrollment and are just now getting around to sorting out which providers will take these new plans and which will not.

I just ran a search for Hospitals and there are about 20 new additions that were NOT there before. I knew they were working on the provider search tool....this is awesome! I even told clients that those hospitals were NOT in the network....so they will be glad to know this. Way to go Blue!

 

[GreenSky]

I just ran a search for Hospitals and there are about 20 new additions that were NOT there before. I knew they were working on the provider search tool....this is awesome! I even told clients that those hospitals were NOT in the network....so they will be glad to know this. Way to go Blue!

My son has Blue Shield of California. Please tell me when he can go to Tarzana Hospital (local), Cedars (best), UCLA (also best), City of Hope (best for Cancer), and other quality facilities in the Los Angeles area.

He could go to all these with Blue Shield prior to Obamacare. But I guess a limited network is a feature. Or is it a benefit to keep people from having to worry about getting quality care? (If people die, the cost of care goes down).

BTW, the network in and out of Covered California is identical.

Rick

 

[Ann H]

There have been rumors and callers tell us that some states like Florida doctors have rfused to use marketplace insurance. Does anyone have the truth about this?

Yes, we are getting a lot of calls from clients who say their doctor's office practically assaults them with questions like, "Is this Obamacare?", or "Did you use healthcare.gov to purchase this plan?". These doctors are insisting that they will not take Obamacare plans.

I told my OFF-exchange clients that technically they are all Obamacare, but the doctors' staff doesn't understand that, so just tell them you purchased it privately, direct from the insurance company.

After all, what the doctors are worried about is that 90 day grace period. Not only is it wide open for uncompensated care, the exchange clientele are the ones most likely to have been uninsured previously and poor enough to let the policy lapse.

 

[Justin Bilyj]

Man I am glad I sat out the on-exchange plan sign-ups this year...I sent out a notice to my clients, "I will only offer off-exchange plans, if you qualify for a subsidy and would like to redeem it for your plan then you must go to healthcare.gov"

Some were smart enough to go off-exchange, the rest wanted the government cheese...little did they know it was RAT POISON!