'After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor's office.
A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.
Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.
Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin's lymphoma and discovered a suspicious lump near her jaw in early January.
But when she went to her oncologist's office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.
"I'm a complete fan of the Affordable Care Act, but now I can't sleep at night," Nelson said. "I can't imagine this is how President Obama wanted it to happen."
To hold down premiums under the healthcare law, major insurers have sharply cut the number of doctors and hospitals available to patients in the state's new health insurance market.
Now those limited options are becoming clearer, and California officials say they are receiving more consumer complaints about access to medical providers. State lawmakers are also moving swiftly to ease some of the problems that have arisen.
"It's a little early for anyone to know how widespread and deep this problem is," said California Insurance Commissioner Dave Jones. "There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care. Network adequacy will be a big issue in 2014."‘ - Obamacare enrollees hit snags at doctor's offices, Los Angeles Times, 02/04/2014
Link to the entire article appears below:
http://www.latimes.com/business/la-fi-obamacare-patients-20140205,0,1675336,full.story#axzz2sgbPiNeG
“New Obamacare health insurance enrollees may feel a pang of envy when they eye the coverage plans offered by Walmart to its employees.
For many years, the giant discount retailer has been the target of unions and liberal activists who have harshly criticized the company's health care plans, calling them “notorious for failing to provide health benefits” and "substandard.”
"But a Washington Examiner comparison of the two health insurance programs found that Walmart's plan is more affordable and provides significantly better access to high-quality medical care than Obamacare.”
For a monthly premium as low as roughly $40, an individual who is a Walmart HRA plan enrollee can obtain full-service coverage through a Blue Cross Blue Shield preferred provider organization. A family can get coverage for about $160 per month.
Unlike Obamacare, there are no income eligibility requirements. Age and gender do not alter premium rates. The company plan is the same for all of Walmart's 1.1 million enrolled employees and their dependents, from its cashiers to its CEO.
A Journal of the American Medical Association analysis from September showed that unsubsidized Obamacare enrollees will face monthly premiums that are five to nine times higher than Walmart premiums.
JAMA found the unsubsidized premium for a nonsmoking gouple age 60 can cost $1,365 per month versus the Walmart cost of about $134 for the same couple.
The medical journal reported a 30-year-old smoker would pay up to $428 per month, in contrast to roughly $70 each month for a Walmart employee.
A family of four could pay a $962 premium, but the same Walmart family member would pay about $160.
Low premiums are not the only distinguishing feature of the Walmart plan. The retailer's employees can use eight of the country's most prestigious medical facilities, including the Mayo Clinic, Pennsylvania's Geisinger Medical Center and the Cleveland Clinic.” - Surprise! Walmart health plan is cheaper, offers more coverage than Obamacare, Washingtonexaminer.com, 01/07/2013
Link to the entire article appears below:
http://washingtonexaminer.com/surprise-walmart-health-plan-is-cheaper-offers-more-coverage-than-obamacare/article/2541670?utm_campaign=Fox News&utm_source=foxnews.com&utm_medium=feed
‘Many plans being offered now on the new insurance exchanges sharply limit the number of hospitals where services are covered, according to a new McKinsey & Co. report. Insurers are making a bet that price is more important to consumers than choice, and limiting the number of hospitals and doctors allows them to keep the cost of a plan as low as possible. Many of the new plans offered still are more expensive than current plans because they offer more benefits.’
‘According to the McKinsey report, which looked at federal and state-run insurance exchanges in 20 cities including Los Angeles, Atlanta and Houston, about 60% of health plans offer coverage at a smaller number of hospitals than comparable current individual plans. McKinsey identified 120 health plans in those markets by examining federal and state exchange filings, as well as provider information listed on individual insurer and hospital websites. Some of these new plans limit coverage to one or two large hospitals.
The number of hospitals accepting insurance from a consumer who buys coverage on the exchange could be 60% lower than the number of hospitals in current individual plans, according to the McKinsey report, which included the 20 largest hospitals in each market that it measured.
Consumers can still buy plans on the exchanges that offer coverage at a wide network of hospitals, but they cost significantly more, McKinsey said. In a market where the same insurer offers two separate plans—one with broad hospital access, one with limited options—the more comprehensive coverage costs 26% more, McKinsey said.’
‘Leading research and teaching hospitals, such as Cedars-Sinai, the University of Chicago Medical Center and MD Anderson Cancer Center in Houston, are cut out of most plans sold in their home states. That move "is built on the premise that hospitals are commodities," said Thomas M. Priselac, CEO of Cedars-Sinai Health System, which is available on just one of seven middle-tier plans sold in Los Angeles. "That's just not true."‘
‘Consumers who need complex procedures like heart transplants will still be able to get them because their insurers will contract with hospitals that offer them.
Still, "when you need an organ transplant, it's a matter of life or death—do you want your insurance company calling us, working out a deal?" asked David T. Feinberg, CEO of the UCLA Hospital system, which includes Ronald Reagan. The hospital is included in just two of seven middle-tier health plans sold in the Los Angeles market.’ - Shrinking Hospital Networks Greet Health-Care Shoppers on Exchanges, WSJ, 12/13/2013
Link to entire article appears below:
http://online.wsj.com/news/articles/SB10001424052702304202204579256621005722460
“Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies.”
“But the cancellation notices, which began arriving in August, have shocked many consumers in light of President Barack Obama’s promise that people could keep their plans if they liked them.
“I don’t feel like I need to change, but I have to,” said Jeff Learned, a television editor in Los Angeles, who must find a new plan for his teenage daughter, who has a health condition that has required multiple surgeries.
An estimated 14 million people purchase their own coverage because they don’t get it through their jobs. Calls to insurers in several states showed that many have sent notices.
Florida Blue, for example, is terminating about 300,000 policies, about 80 percent of its individual policies in the state. Kaiser Permanente in California has sent notices to 160,000 people – about half of its individual business in the state. Insurer Highmark in Pittsburgh is dropping about 20 percent of its individual market customers, while Independence Blue Cross, the major insurer in Philadelphia, is dropping about 45 percent.” - Thousands Of Consumers Get Insurance Cancellation Notices Due To Health Law Changes, Kaiser Health News, 10/21/2013
Update 10/26/2013
“Hundreds of thousands of Americans who purchase their own health insurance have received cancellation notices since
August because the plans do not meet Obamacare's requirements.
The number of cancellation notices greatly exceed the number of Obamacare enrollees.”
“Several states have released Obamacare enrollment data, however, revealing extremely low rates. South Dakota reported that only 23 people enrolled in the exchanges, a mere 0.0000276 percent of that state’s population. North Dakota enrolled only 20 residents.
Alaska, meanwhile, comes in at seven total enrollees, or 0.000957 percent of Alaskans.” - Health insurance cancellation notices soar above Obamacare enrollment rates, The Daily Caller, 10/24/2013
Observation:
The prior individual plans would all be "private" plans hence one would expect such plans to have a rather wide negotiated network of providers. If one receives the letter and buys "off exchange" from the same insurer (assuming the insurer sells off exchange policies), meaning one is purchasing another private plan, then the network would be rather wide as it is the same negotiated network of the same insurer.
If one dumped the current insurer and purchased from another insurer, in an off-exchange situation, one would need to examine the network but more than likely it is the particular insurer's negotiated network they have been cultivating for years.
However, say one receives the cancellation letter and goes to the ACA exchange and buys. Those networks are much more narrow as supposedly, according to insurers, the narrower network lowers price. Here is a situation that is bound to happen and one may do one's self a disservice:
(1) cancel letter arrives,
(2) one has an income that precludes a subsidy,
(3) however, rather than going off-exchange one merely goes through the ACA exchange. No subsidy is forthcoming but anyone can use the exchange regardless of subsidy or no subsidy,
(4) one applies and is approved,
(5) one has just been approved for a narrow network rather than the broader network available in the "off-exchange" world.
The entire Kaiser Health News article and Daily Caller articles appear in the links below:
http://www.kaiserhealthnews.org/Stories/2013/October/21/cancellation-notices-health-insurance.aspx
http://dailycaller.com/2013/10/24/health-insurance-cancellation-notices-soar-above-obamacare-enrollment-rates/
Updated 11/05/2013
Flowchart of President Obama’s “You can keep your plan, period” defenses - Keith Hennessey, 11/04/2013
“Think of an insurance plan as having three main components: (1) a premium, (2) a list of covered benefits and (3) a network of doctors, hospitals and other providers. Under the Affordable Care Act, there is very strict regulation of benefits—right down to free contraceptives, questionable mammograms and non-cost-effective preventive procedures. At the same time health plans have been given enormous freedom to set their own (community rated) premiums and choose their own networks. They are using that freedom in yet another way to attract the healthy and avoid the sick.
In the ObamaCare exchanges, the insurers apparently believe that only sick people (who plan to spend a lot of health care dollars) pay close attention to networks. Healthy people tend to buy on price. Thus, by keeping fees so low that only a minority of physicians will agree to treat the patients, some insurers are able to quote very low premiums. They are banking on attracting the healthy and they may even have the good luck to scare away the sick.
Community rating is what makes this strategy work. In the ObamaCare exchanges, if I am healthy why wouldn’t I buy on price? If I later develop cancer, I’ll move to a plan that has the best cancer care. If I develop heart disease, I’ll enter a plan with the best heart doctors. And these new plans will be prohibited from charging me more than the premium paid by a healthy enrollee. (See a more comprehensive analysis.)
As a result, we are getting a race to the bottom on access—with private plans in the exchanges looking increasingly like Medicaid, just as they do in Massachusetts.
The Obama administration doesn’t seem to be bothered by this development. In fact they have been touting the fact that the premiums have been lower than expected, even though the reason is that the networks are narrower and skimpier than expected.
Think how different this is from what we were promised. During the 2008 election, every serious candidate for the Democratic presidential nomination repeated the “universal coverage” mantra repeatedly—and on the left “universal coverage” means universal access to care. No candidate even hinted that access to providers might not be any better than it is under Medicaid. - Obamacare’s Insurance Exchanges Will Foster a Race to the Healthcare Bottom, John C. Goodman, The Independent Institute, 10/03/2013
Link to the entire article appears below:
http://www.independent.org/newsroom/article.asp?id=4739
Updated 11/14/2013:
Think ObamaCare Is Bad Now? It Gets Worse Next Year, investors.com, 11/12/2013
