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Next Obamacare Revelation


Epigonos
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It now appears that all of the top eighteen hospitals in the U.S. are opting out of many of the Obamacare policies. Here is California our exchange lists about ten difference insurance companies with acceptable policies. There rub is that some of our top hospitals are accepting the policies from only one or two companies. Examples being:

 

Cerdar-Sinai Medical Center - Will accept insurance policies only issued by Health Net.

UCLA Medical Center - Will accept insurance policies only issued by Anthem Blue Cross & Health Net

UCSF Medical Center - Will accept insurances policies only issued by Anthem Blue Cross

 

If an individual holding a policy from another insurance company enters one of these hospitals they are on their own as far as payment is concerned.

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Epigonos is only partially correct, at least with regard to Cedars-Sinai:

 

Under OBAMACARE, SO FAR the only HMO to have a contract with Cedars is Health Net. Blue Shield PPO and Anthem Blue Cross POS are also contracted.

 

Within OBAMACARE insurance groups, "narrow plans," i.e. those which do not contract with the more expensive hospitals such as Cedars and UCLA, will not be accepted and before Obamacare were not accepted either. Other plans (excepting "narrow" plans) by the same insurers will be accepted. Sort of like the difference between the Platinum and whatever they call the base plan.

 

As far as medical providers, it is almost the same, tho every MD that I know who works out of Cedars-Sinai is planning on being a provider for most of the companies AND most of the plan levels other than the most "narrow" plans. Those who take HMO plans will continue.

 

Other major companies such as United Health Care, etc. are also being accepted. I cannot speak to UCLA or other Hospital Centers.

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I do NOT claim to be an expert regarding Obamacare by any stretch of the imagination. I should probably have stated that I was simply quoting from an article that appeared in the Washington Post. Some states, Maryland being an example, require that ALL hospital accept the state approved Obamacare plans. Most states, including California, do not have such a requirement.

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I understand completely, Epigonos. The problem is that everybody is quoting every source, legit or not, accurate or not.

 

What I have reported is from the hospital itself, not secondary sources. I have spoken to hospital administration re: plans (and more contracts are in the works) as well as medical providers in the community. If anything, Obamacare will lead to MORE physicians being available, at least in Primary Care. It's a form of self-preservation. Better coverage will also lead more specialists being inclined to accept insurance whereas they may not at this time. At a point where enough specialists accept insurance, the rest will have to or face a huge patient drain.

 

As far as I know, Medicare will probably not be affected other than drug plans which actually might pay more.

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It appears to me that all of the plans offered by the insurance companies under Obamacare are HMO's. My parents were fanatics regarding researching the best doctor for whatever problem we had. I am the same and have always paid the price to have a PPO which is what I currently have - Medicare plus Anthem Blue Shield plan F gab insurance. I use specialists all over the L.A. basin who I feel are the best in their area of expertise. I'm convinced that eventually we will all be forced into HMO's including those of us on Medicare. Choice of any doctor anywhere will become of luxury of only the wealthy. My one hope is that I will die before the HMO for ALL dawns.

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It is not true that all policies are HMO's. There are PPO's as well as Managed Care (sort of a hybrid.)

 

Interestingly, all HMO's are not bad. Yes, they all have the same drawbacks of restriction of providers, requirement for referrals for specialist, testing, etc. However, choosing your primary care provider (PCP) is the most important facet and then finding an HMO or IPO group for which that MD is a provider is how you should ultimately choose your HMO. Most people erroneously do this backwards and choose an HMO and then look at the MD's who are the providers. Unfortunately, some HMO's have crappy MD's. Some have the same MD's you would choose if you had fee for service policies. The same goes for the specialists who are providers for any particular HMO within an IPO.

 

As far as those above-noted restrictions go, if you have a really good primary doc who knows the system, the only drawback will be the pool of specialists from which to choose. Everything else is a breeze.

 

The same goes for Medicare - there are great physicians who happen to take Medicare and others who do not. With Medicare and the supplement, at least in the LA area, there should never be a problem finding a great primary physician or specialist….they all are providers as are the hospitals. Out of pocket is minimal.

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That's the unfortunate part of this….employers are opting for the cheapest policies, thus the higher deductible. Are you sure that you can't get a lower deductible plan and pay the difference in the premium? Don't take your employer's word for it if he/she says , "no", but check with a reputable independent insurance agent. Also, check what the difference in premium is vs. cost of deductible. Sometimes, there winds up being not so much difference other than you are paying the deductible up front while paying premium over 1 yr.

 

 

Ain't it all a barrel of fun,

 

Funguy

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Funguy you might convince me regarding many of the points you have made. The one point on which you will NEVER convince me is that there are any good HMO's. I absolutely loath the limits they impose. The very concept of a gatekeeper is anathema to me.

 

I do have a primary physician where I live in North Orange County; however, I use him seldom and never. I go to Jules Stein at UCLA for my eye problems and I certainly didn’t trust my primary physician to tell me if and when I needed a knee replacement. I went to the best orthopedist I could find who specializes in knee and hip replacements and who happens to be located in Santa Monica. My urologist practices in South Pasadena and is associated with the City of Hope. I would NEVER have these choices even with the best of HMO’s.

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The problem is that everybody is quoting every source, legit or not, accurate or not.

 

Yeah. The noise comes from both sides (although one is decidedly highlighting the negative).

 

Chris Hayes on MSNBC did a great takedown this evening of ALL media coverage and the stuff that gets left out to serve the story the author wants to tell. Yes, the Florida woman will lose her $400/month plan and have to sign up for an $800/month plan. The part that gets left out is that the subsidy she qualifies for means she'll be paying $200/month and have actual health insurance as opposed to her current plan which folds like a cheap tent if she gets sick.

 

All of us need to read beyond most reportage. It's a sad time for journalism.

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Unfortunately even at $200/month it is the difference between eating or not. Eventually, I'm going to be one of ones that slip through the crack.

 

If $200/month (or $80/month, which was another Fox News O​UTRAGE that wasn't) will break you, you likely qualify for the Medicaid expansion unless you live in a state where a Republican governor blocked it. (Even Kasich in Ohio and Brewer in AZ finally gave in and accepted it because it makes NO fiscal sense not to!)

 

But if you want to talk about the difference between eating or not, how about conservatives throwing 40 million of the working poor off SNAP. Don't hear you complaining about that.

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That's the unfortunate part of this….employers are opting for the cheapest policies, thus the higher deductible. Are you sure that you can't get a lower deductible plan and pay the difference in the premium? Don't take your employer's word for it if he/she says , "no", but check with a reputable independent insurance agent. Also, check what the difference in premium is vs. cost of deductible. Sometimes, there winds up being not so much difference other than you are paying the deductible up front while paying premium over 1 yr.

 

 

Ain't it all a barrel of fun,

 

Funguy

 

I'm pretty sure. Last year, we were offered 3 types of health insurance, one of them being high deductible plan. This year they only offer 2 'consumer driven' health plans and both are high deductible plan. For an individual, one has $7000 out of pocket cost per year, the other has $8000 out of pocket cost per year. Copay is gone. One plan requires us to pay 20% and the other requires us to pay 30% each doctors visit. And our premiums went up instead of down with this shit.:mad:

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No you won't because I don't qualify for SNAP. Thus doesn't change my budget at all.

 

On the other hand, I'm finding it very difficult to obtain medical care because existing avenues for those that are in the donut hole of between 100% and 200% of the federal poverty level ($11,490 for single person family) are becoming hard to find.

 

Net result? In about 30 to 60 days when I run out of meds I won't be able to afford to replace them because ObamaCare will be the law of the land. Since ObamaCare passed, my meds have increased by 500% and I suspect will jump once again in December.

 

There is something much worse than being on the lowest rung of the ladder; It's being on the rung just above that. Their are a lot of people about find themselves on that rung.

 

We've been screwed over by both the Democrats and the Republicans. It's time to wake up and smell coffee, stop pointing fingers, and vote them all out of office.

 

 

 

But if you want to talk about the difference between eating or not, how about conservatives throwing 40 million of the working poor off SNAP. Don't hear you complaining about that.

"Gun Control means using both hands."

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Guest countryboywny
We've been screwed over by both the Democrats and the Republicans. It's time to wake up and smell coffee, stop pointing fingers, and vote them all out of office.

 

Daddy, I'm 100% behind you on this. I even changed my party affiliation from Republican to Independent. We are being screwed by both sides of the aisle. I have a friend who I took into my home because she lost her job and couldn't afford to live on her own. After several months of looking, she finally landed a job as a cashier in a local drug store chain. Now, I don't know how she spends her money or her financial situation, but the other day she said, "I'm going to ask the manager to cut my hours.. if I make too much, I'll lose my food stamps and medicaid supplement. I can't afford health insurance!"

 

I'm WTF?

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In response to Tighty - that is your employer's choice - to have the high deductible policies. Many other policies are available from crappy to premium. MOST employers will allow you to pay the difference for a better policy, at least in California. If not, you are allowed to opt out from the policy your employer offers and purchase your own through an agent or whatever market place your state has.

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Guest countryboywny

In New York state, employers, like me, have lost the ability to offer their employees insurance at a group discount. There is no longer an advantage to forming a group and buying insurance. Theoretically, my employees could go on the exchange and buy insurance at the same (much higher) price as I could get buying as a group. There's no advantage to me or my employees to continue "group" coverage. I will continue to subsidize their premiums as I always have, but the jury is still out as to how I can legally do that.

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countryboywny,

 

My employer is having the same problem. He is using an HRA. I think that stands for Health Reimbursement Account. Sorry, I don't have the paperwork with me. The way it was explained to me is: The company puts a fixed amount every month into an account with the HRA for the employee. The employee buys health insurance on an exchange, from an agent, or directly from an insurance company and is then reimbursed for the expense. The money is not taxable to the employee. I don't know if this is available in New York state.

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On the other hand, I'm finding it very difficult to obtain medical care because existing avenues for those that are in the donut hole of between 100% and 200% of the federal poverty level ($11,490 for single person family) are becoming hard to find.

 

How much were you paying for this coverage before? It sounds like you had an amazingly good deal, the kind that doesn't exist and never did.

 

Net result? In about 30 to 60 days when I run out of meds I won't be able to afford to replace them because ObamaCare will be the law of the land.

 

Technically, it has been the law of the land for three years but it doesn't actually take effect until next January. But you can safely ignore it because the law specifically forbids federal agencies from enforcing any penalties.

 

Since ObamaCare passed, my meds have increased by 500% and I suspect will jump once again in December.

 

And, of course, the cost of your meds have never jumped before. The out of control runaway costs of medical care we've had for the last 20 years are just fine with you.

 

I suspect you're not being wholly honest.

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My employer is having the same problem. He is using an HRA.

 

Alone? Just an HRA? (And I think you mean HSA.)

 

You cannot legally qualify for participation in an HSA (or HRA) without coupling it with a qualified HDHP. (Archer MSA plans were phased out too, but that was 10 years ago. Where was the outrage?)

 

But yeah, your employer may have seen some of their junk plans cancelled. It is no longer legal to sell "health insurance" for $600/year that only covers the first $50 of hospitalization. Waaaah. That isn't health insurance!

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Unfortunately even at $200/month it is the difference between eating or not. Eventually, I'm going to be one of ones that slip through the crack.

 

Well, I can say one thing with 100% certainty. Anyone for whom $200 a month is the difference between eating or not should not be spending money on escorts--ever (or cigarettes, movies, beer, etc.). Another certain thing is that this person qualifies for the expanded Medicaid. Even those with significantly higher incomes qualify for subsidies.

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I'm being honest; Your being oblivious.

 

How much were you paying for this coverage before? It sounds like you had an amazingly good deal, the kind that doesn't exist and never did.

 

 

 

Technically, it has been the law of the land for three years but it doesn't actually take effect until next January. But you can safely ignore it because the law specifically forbids federal agencies from enforcing any penalties.

 

 

 

And, of course, the cost of your meds have never jumped before. The out of control runaway costs of medical care we've had for the last 20 years are just fine with you.

 

I suspect you're not being wholly honest.

"Gun Control means using both hands."

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Let's see... Don't HIre... Don't Smoke... Don't Drink... and only go to the $5.00 Movie about once every month or so. Another case of somebody being oblivious...

 

Well, I can say one thing with 100% certainty. Anyone for whom $200 a month is the difference between eating or not should not be spending money on escorts--ever (or cigarettes, movies, beer, etc.). Another certain thing is that this person qualifies for the expanded Medicaid. Even those with significantly higher incomes qualify for subsidies.

"Gun Control means using both hands."

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Well, I can say one thing with 100% certainty. Anyone for whom $200 a month is the difference between eating or not should not be spending money on escorts--ever (or cigarettes, movies, beer, etc.). Another certain thing is that this person qualifies for the expanded Medicaid. Even those with significantly higher incomes qualify for subsidies.

 

I am opposed to telling someone how they can spend their money. One of the things conservatives use to demonize the working poor is "LOOK! THEY HAVE FLAT-SCREEN TVs AND CELL PHONES!" They're still poor!

 

And you can't necessarily claim that everyone at a low income gets Medicaid. Qualifying for it and getting it are two different things. In Texas, for example, 25% of the population does not have health insurance in any form. They didn't have it before Obamacare and the won't have it after Obamacare because Governor Perry has refused the Medicaid expansion (because, you know, OBAMA).

 

What I object to in all of these discussions is the blind acceptance of claims made by outraged citizens who have not bothered to investigate their options. That $600/year insurance I mentioned earlier is a real case. She was trotted out in the conservative media as someone who would pay a lot more (gasp) under Obamacare. The part they leave out is that the $600/year plan only covered the first $50 of hospitalization, once, and the subsidies she will receive have her now paying less out of pocket for full coverage with no lifetime cap.

 

Tell the whole story, people. Not just the parts that serve your agenda.

 

I repeat: if it is really true that Obamacare is ruining millions of lives surely you can come up with one REAL example. I haven't seen one yet that will withstand basic scrutiny. I'm sure there actually ARE edge cases out there that need attention and action. They won't get it with all the noise and nonsense sucking the air out of the room.

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