A THCB Reader in New York City writes in to say —
“I am a self employed psychotherapist in New York City. I had health insurance through December 31st when my policy was canceled.
I bought an ACA policy in mid-November and had to fight to obtain my insurance identification number the entire first week of January. I did not receive my id number until January 9th.
Now, I still can’t use the insurance — even though I have an id number — because none of the doctors that I know who are actually taking the insurance have been placed on Blue Cross’s website as being in the ACA plan network.
Thus, I can’t change my primary care and I can’t get a referral for my pain management specialist (I have nerve damage in my spine due to a surgical complication). So, I have an insurance policy but I can’t see my doctors who have decided to take the ACA insurance. I essentially have purchased insurance that I cannot use at the present time and I don’t know when I will be able to use it unless I go to the few doctors they have put into their system.
I have been talking to the New York State Department of Health and so far, their aid if you will call it that, has been useless. I am still left with having to pay out of pocket to see my pain management doctor onJanuary 15, 2014.
Categories: Uncategorized
I would be willing to bet that most of the respondents here still voted for a Democrat or a Republican when the 2016 elections rolled around. What was it Einstein said – about the definition of insanity?
To address the actual topic, with some perspective as a few years have gone by, this was my experience with Obamacare. I registered for a plan during the initial November signup period, with BCBS. The Marketplace accepted the registration, and BCBS never got it. Fixing the mistake couldn’t be as simple as faxing the relevant documents over, oh no. The case had to be reviewed (supposedly within thirty days), at which point the case worker was supposed to figure out what had happened and send the information so I could actually be insured. Several months went by, and the case was “escalated” several times, to no effect. Every supervisor I talked to claimed it was impossible to figure out who was managing my case, and refused to do anything about it, the only solution being to wait for the negligent or overworked caseworker to notice it at some point. I maintain that it could have been as easy as sending a fax, but whatever.
A little over four months later, they finally got the paperwork, and I had insurance. BCBS claimed that I had retroactive coverage for those four months and charged me for it, though. No one I talked to held out much hope for a solution – despite the fact that I had no way of using the insurance during those months – aside from voiding the policy and starting over, sending it back through the very same system. I paid.
For the first year, the subsidies were reasonable, given the obscene cost of healthcare in the US, and the monthly payments acceptable. Finding a practitioner who accepted “Blue Select” was nigh-on impossible. There were a couple of general practitioners in the area (each with a three month wait time for an appointment), but aside from them, I had my choice of two clinics, each about an hour’s drive. I tried them both and was a little disturbed; both of them felt a lot like the free/”poor clinic” of their respective areas. Dingy buildings, young doctors hesitant to prescribe or do much of anything (though there was a great hospital right across the road, where Blue Select was pretty much laughed off). The goal seemed to be to throw the cheapest options at the problem first, then move forward, in sequence, and reluctantly. The cost – not my health – was always the primary consideration.
Because it takes so much effort to research the labyrinth of policy options (not to mention proving my identity to the Marketplace, which somehow, uselessly, involved Experian, and was its own battle), I kept it for several years anyway. I did find a very good dentist who accepted it, but dropped it as time went on. She was new at the outset, and explained that the company just wasn’t willing to pay enough for “Select” members.
I think the subsidies remained relatively constant, or dropped off a little, but the premiums skyrocketed. Not sure why, but within two years, the monthly price of my (relatively useless) plan had doubled. I was forced to drop it, and haven’t been insured since.
As an aside, here’s an experience that illustrates the problem of healthcare in the US, in a nutshell. I went to an in-network hospital to get two routine x-rays. I’d forgotten my insurance card at home, so I got them done anyway and paid the cash price: $75 each. Hoping for a reimbursement, I brought the insurance card in the next day, and was told they’d send the claim off.
A month later, I got a bill for about $3500. Apparently, the claim they sent the company was for $1700 and change, per x-ray, which BCBS refused to pay. They resubmitted the claim, at which point BCBS paid for one (but charged it to my deductible, so actually paid nothing), and denied coverage for the other. I had the receipts, showing that I’d paid the cash price of $150 for everything, but it still took me two months before someone at the hospital was finally able to cancel the debt. By that point, I had been contacted by a collection agency.
If you aren’t a fan of Obamacare – which was and continues to be a disaster – be aware that the failure was largely a result of political infighting between Democrats and Republicans. The bill as a whole passed, but enough portions were defeated that it was crippled, making it a sort of sad, expensive joke. To a citizen, that’s a shame; to a Republican, it’s a windfall – ammunition to be used in the next election. Democrats, of course, blame the Republicans. Anyone can see the devastating effect this is having on the country (see also, government shutdown). No one on Earth should have to put up with this, but I guess you did vote for it.
To the two people who are going to read this, I suppose this is my message. As long as you maintain US citizenship, get ready for more of this kind of thing in every aspect of your life, becoming exponentially worse as people elect one major party over the other, over and over again, and wonder why nothing changes. The national debt and the state of paranoia and “security” (aka the police state) and the national debt will keep growing, while very little of substance is done at the national level. The ridiculous squandering of everything America could be will continue until it reaches a state of crisis, or – judging by voter support through Trump/Hillary – until the country collapses, because apparently no one in the US can count past two.
Sorry for going on about politics in a healthcare thread, but this is the reason why healthcare is still an issue. Plenty of other countries have it sorted.
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I am in California and I am having the exact problem you are having with my Doctors office. I got into a argument with his office personal and have been denied an appt with my Dr that I see monthly under the guise that it’s an insurance problem. My insurrance allows me to go out of network and I even found a wonderful ins rep that called my Dr’s office and informed them that I would just have to continue as a cash patient and they have still refused to allow me to obtain an appointment with my Doctor. Check with patiences rights groups , and good luck . I am enlisting the help of an attorney to resolve my issue.
I think mass elder poverty is part of the reason my friend died. He didn’t want to call an ambulance because of the cost. I am terrified of living well into my 90s. What for? To have a horrible quality of life? To be impoverished? To be alone at the mercy of healthcare providers?
I don’t think so. I’ve got another plan here!
Thank you, John. They’re making it as difficult as possible and our representatives are not helping at all. You go to the government and you just get more red tape.
A friend of mine in his early 60s who went YEARS without healthcare in the middle of New York City, who worked as a psychotherapist with the poor (who were fully covered by Medicaid) died last Wednesday.
He never got an Obamacare policy. He was so sick, in so much pain and struggling with so many bills that he couldn’t even imagine getting a policy. Knowing this man, he would not have known how to navigate this system. He could barely manage email let alone the internet. Can you imagine finding providers when you’re not internet-knowledgable?
He’d spent 10 years in his 40s working on his PhD. He told me it was like being in the military. By the time he got his PhD, he was in his 50s. He was worked like a dog by the nonprofits here who provide services to Medicaid patients and don’t even care enough about their clinicians to provide them with ANY benefits.
I felt like a cab driver when I had that job. I didn’t get paid if the patients didn’t show and they had better benefits than I did.
My friend didn’t survive this situation. Obamacare was too little too late. Or let’s just say it was a whole bunch of nothin’ too late!
So you can imagine how I’m feeling this week.
It only gets worse.
If this man had gotten the care he deserved, he’d be alive today. Considering the kindness he showed the population he was working with, it’s downright shameful.
Thanks John. I appreciate your appreciation!
The Medicaid estate recovery nightmares are rarely for hospital bills. Most hospitals forgive their enormous bills when the patient has no ability to pay. This is done quietly, one patient at a time, so the word does not get out.
Instead the asset recoveries are for nursing home costs. What is going on here is that people are living longer, but the amount of money they earn and save is not keeping up with life expectancy. As you suggest, the scope of this problem is quite enormous. It will take another New Deal of some kind to prevent mass elder poverty.
One way to characterize
Spot on, Bob Hertz. Even with Medicare there is a difference between the supplemental private policies and Medicare Advantage. Last year was the first time I left original Medicare for a MA plan, but my wife remained with Medicare. We learned about four years ago that people with more expenses are better off (financially) with Medicare, but MA is a better deal for healthy people. For starters, where we live the premium is zero, I presume because they are working to increase enrollment. It’s more about money than medicine, it seems.
You’ve been at this for some time. Have you any sense of where the politics is headed? Clearly the notion of “repeal and replace” is nothing more than a slogan. There are too many positive features that will never go away. And as the president said, they can’t repeal it mostly because it was a Republican plan to begin with.
The assessments at your site are excellent, by the way. I just love this:
Medicare has been an enormous success, but it is not self-financing. A senior who gets a hip replacement does not go out and earn more money and increase tax collections. Saving lives is expensive twice — first when we do it, and then with higher Social Security and Medicare costs in the decade of extra life. I have often thought that doctors should be taxed for saving elder lives, not paid to do so.
http://healthcarecrusade.com/Center/How%20to%20Control%20Medicare%20Spending.pdf
Are you aware whether enough Congressional policy makers are paying attention to make correctives? Better yet, do you have anyone’s ear (even if you are not at liberty to say who)? I sure hope so. Every time I listen to stump speeches and talk radio it makes me sick. Surely they know better, but they keep on with the same tired soundbites.
Aloson’s case is a nightmare, but the financial impact of medical bills is totally catastrophic for many whose entire net worth gets wiped out. When they can no longer work they are at the mercy of whatever Medicaid services are available where they live — and lately I’m seeing reports of states going after estates post-mortem with those five- or ten-year lookbacks, taking what little might have been deeded over too late to the next generation — who will face even worse prospects if changes are not made.
Thanks for sharing, Alison. I feel bad for what you have gone through.
Seems to me that narrow networks are a secret strategy of the insurers to cope with guaranteed issue.
Before 2010, insurers in the individual market could turn away sick people, and they did so in large numbers. And/or they drove off sick people tjhrough relentless premium increases.
All they can do now is to make their plans very unattractive to sick people, and to drive off sick persons with awful service.
Expanding Medicare down to age 55 would have been far better than the ACA in this regard.
Gotcha, John. You have clarified yourself completely here.
I am happy that the working poor have coverage and I supported the ACA for that reason. My complaint is that there is little discussion amongst Democrats of the real problems with the ACA and little focus on improving things. It’s about fighting the Republicans to keep the ACA. So, in the midst of this, those of us forced onto it are part of an experiment. To say that it was poorly implemented is an understatement.
Here and there you see an article with a horror story but this issue of the insurance companies not contracting with enough providers — or any at all in the beginning — is very problematic and it was very distressing to me to be in the middle of recovery from a serious nerve injury and to face not only NO care even though I was paying for insurance, but a drastic cut in my income as well. And then when I was as Little Red Riding Hood might say “lost and alone,” my Liberal comrades were downright mean.
I am still without a neurologist! Having a serious NERVE injury, I have no neurologist. Working on it. It takes time to replace eight doctors. And we all know the insurance companies know that. Think of how much money they’ve saved just with me by taking away my doctors and making those visits impossible.
I was a Democrat but I experienced a side of my party that was incredibly nasty, indifferent, and downright mean. And I was just a person having problems. I wasn’t even making a political statement in the beginning. I have been a supporter of the ACA in theory. I was very frightened and I couldn’t rely on my local Democratic representatives to help me, those who advocated and fought for this legislation, those who weren’t even interested in the people who were getting hurt by it and weren’t lifting a finger to help. It was quite disillusioning.
They should be ashamed. I left the party as a result. I am now independent, and the party has lost what most of the time could be counted on as a vote.
A single sole proprietor in her 50s gets fucked by Obamacare. Who cares?
There’s nothing anyone can say to make me feel better. If you could wave a magic wand and make my nerve better and let me run again (I can’t), that would make me feel better. That’s the only thing. I just want my health back. And I’m having to fight every step of the way, every single little thing. You have no idea what this is like (or perhaps you do if you’ve struggled with illness). I am alone with this. It is the most difficult thing I have ever faced.
So now, when I do get to a doctor, particularly at the hospital centers the Obamacare folks want everyone to go, you know these centers for care where they’ll take of everything, well, the hospitals incorrectly charge ALL THE TIME and of course, they’re always over-charging. The insurance companies don’t even process claims properly. For example, my copay for routine labs is $0. I was billed $35. This happens all the time. Now, that happened occasionally with my prior insurance, but it’s happening much with every single visit to a hospital clinic for my primary care. I am not getting the one free preventive visit, and my low copays are not happening. It’s a big fat lie.
I think the hospitals are making these small errors in their favor and hoping that people will just pay as it’s not worth their time to fight. Of course, for me, it’s the principle; I’m not going to pay what I don’t owe, and so it’s a hell of a lot of correspondence and in terms of my time, I’m essentially losing more money.
So, I pay more for less, I’m nickle and dimed to death, I can only generic medications (nothing else!), and I’m terrified of becoming seriously ill because my options here in NYC will be very limited and there will be a fight for everything. When I’m sick and alone, that’s what I’ll be facing. Already I can’t get my medications at various pharmacies due to the government “protecting” me from myself.
I know these things happened before. But they didn’t happen to THIS extent and that’s what no one’s getting. Talk to anyone on one of these plans and they’ll tell the same thing. It’s a fucking mess and we’re the guinea pigs and it’s our lives at stake, our retirements, our peace of mind. It is absolutely terrifying.
If I could leave this country and go back to Canada and work there, I’d do it in a heartbeat. But I can’t as I”m a licensed professional and stuck in New York. Another example of government “helping” with licensing. Now, I can’t work anywhere but New York. I feel so incredibly hampered by government interference in my life that I fear I’m going to become, oh no, a Republican!
And get this — I could go to any number of hospitals in this city with my prior plan. My roommate had leukemia and went to Sloan Kettering and lived. They send me requests for donations but now, with my ACA policy, they won’t let me in their door if I had cancer. I’m shaking my head as I write this. The audacity.
Thank you for your thoughtfulness. There’s nothing anyone can do. I’m basically fucked for a while. I hope it’s okay to swear on this thing. Life is miserable enough as it is recovering from a serious nerve injury (unless you’ve had one, you just have no idea, it’s not even possible). Let me put it this way — I would have preferred my leg broken in a couple of places and staples and metal put in to the nerve injury (where there’s nothing they can do apparently).
I just didn’t need another form of hell in the form of Obamacare. I already have one that is bad enough.
Oh my. I’ve become a bitter person. I never thought it would come to this.
Alison, I doubt anything I write will make you feel better. But for the record I neither said nor inferred that ACA was aimed at keeping health care providers in line. In fact, I said almost the opposite,..
It’s too bad no public option… was allowed among the exchange choices. It would be a Medicare/Medicaid hybrid, and the existence of such an option would be a powerful incentive to keep both insurers and the health care providers in line.
Believe me when I say I’m totally sympathetic with the problems and challenges you have faced and still do. It’s no comfort to say this, but lots of people face deep income cuts, up to and including the complete loss of their job. I have reached retirement, but in the course of my career I once took an income cut so deep our children qualified for reduced price lunches at school. Fortunately I recovered and eventually paid the max into Social Security over twenty years. But careers that never have any setbacks are few and far between.
As for skin in the game, I did, in fact, work in a health care system after taking an early retirement from food service. I saw up close and personal the stark difference between the private sector and a so-called “not-for-profit” health health care system which was awash in money — marble floors, live plants, flat-screen TVs, concierge food service, industrial-sized laundry and landscaping departments and employee benefits I never imagined. I never knew what PTO was and sure didn’t have both 401(k) AND a defined-benefit pension plan. I realized THAT revenue stream comes from one main source — medical bills. I’m sure there are endowments, charitable contributions and tax considerations, but the serious money comes from seriously big bills. It’s no mystery that America has the world’s most costly medical care in the world.
As for ACA, unless SCOTUS and/or the GOP succeed in destroying it, there are now some ten to fifteen million people who have health insurance that were previously not insured at all (leaving that many more and then some STILL uninsured). I worked all my life with the working poor — people for whom “medical care” means enduring sickness, pain and injury as long as possible then going to the ED when it gets unendurable. As far as I’m concerned there is much to be done before America’s health care system becomes the world-class system it should be.
Let me repeat what I said at first — I did not say ACA was intended to keep health care providers in line. And I have plenty of complaints about how it was crafted and continues to be having problems. But the mess we call health care in America was a mess before ACA and will continue to be a mess even if it is destroyed. For example, even as we speak the “Doc Fix” (which Congress has neglected to correct since 1997) is an ongoing embarrassment which last time I checked meant 29% reduction in your income — and that preceded ACA by a decade.
I really hope your health care issues are resolving and your practice flourishes enough to generate enough for your retirement. At times like this I wish I were wealthy enough to just write a check and make it all better. But all I can do is wish you the best.
This all occurred with the ACA so I’m not sure this is simply an “insurance” issue versus “governence.” It’s the law that caused insurance costs to go up for MOST (even my corporate patients have high deductibles now and higher costs) and this is because ACA demands that MORE be covered.
The result is MORE is covered by LESS doctors.
Look, I don’t know what the answer is, I really don’t, but what’s disturbing to me is that I see almost no newspaper coverage of the fact that none of us can find quality doctors and someone with a brain tumor can’t get care.
Good job, good job, Obama. What a big fat liar.
Health care providers who take the ACA plans — and I’m one of them — take at least a 20% cut if not more to provide services to members. I do it myself as I’m one of the victims of the ACA but my guess is that other providers might not be so inclined to take such a cut.
John Ballard, keeping us “health care providers” in line? Would you take a 20% pay cut to fund the ACA? I have. Do you have any skin in the game? I’m really just curious, not trying to be rude here but I’d like to know your thoughts on taking a 20% pay cut to fund ACA. Would you do it? Do you believe in it that much? That’s the cut I took, and my health insurance costs rose while I was in the midst of a terrifying health crisis (and I got little sympathy from ACA supporters).
Would you personally go for that at over 50 years of age and when you have to save for retirement? What do you think this has done to my potential to save for retirement?
This is a matter of some people paying for ACA and others not at all. It has to be paid for somehow, and perhaps the public option would have been the fairest of them all.
I hear from other providers who take Medicare that Medicare is often six months behind in paying them. Providers are people who get paychecks that they then take home to pay their rent, their grocery bills, etc., etc. “Providers” is another word for a group of people who are being expected to foot this bill.
I am going through this right now. I was diagnosed with a brain tumor at the end of the year before my insurance was canceled. (Turned 26) I got a new plan thanks to the ACA but now, I have no doctor I can use. I do agree that this is an insurance issue and not governance issue…but I just want to express my deepest sympathy to you. I know exactly what you are going through.
This must be the shortest post at THCB ever to receive so many words in the comments thread. If nothing else it underscores the fact that insurance and health care are not the same. Health care providers and insurance companies are both involved with risk management, but while doctors manage health risks, insurance companies manage cost risks. It’s a toxic mixture to be sure.
It’s too bad no public option (eliminating the insurance industry) was allowed among the exchange choices. It would be a Medicare/Medicaid hybrid, and the existence of such an option would be a powerful incentive to keep both insurers and the health care providers in line.
Hey there, Elaine. He wasn’t nice, was he? I didn’t really understand these responses. My original post was posted without me knowing it actually be posted (I had sent in an email not knowing what these folks were going to do with it). I don’t mind that they posted it but they didn’t use my name (I am AKA THCB NYC if you didn’t figure that out from these posts.Then these guys accused me of making all of this up and hiding behind the name the blog assigned me. Like did it matter what my name was anyway? Anyone can make up a name.
The unfortunate thing that I try to tell folks who are supportive of Obamacare — and I have actually been one of them — is that they should WANT to know what the problems are instead of attacking a consumer who is saying “Hey! There’s trouble here!” I really didn’t know what to do and in fact did not replace the bulk of my doctors and went without needed healthcare. That was not accidental; that was the way the insurance companies funded the first year — by making it difficult for consumers to use their insurance and hiding behind the “this is all new and we couldn’t possibly be prepared” line.
BCBS in New York got into trouble because they had almost NO network and I went after them via the health department as did others (I’m assuming). See this story:
http://longisland.news12.com/news/empire-bluecross-blueshield-offers-3-weeks-of-free-health-coverage-amid-issues-1.7002222
It wasn’t just that people couldn’t get ID cards. We couldn’t even get through to Empire BCBS for 2 to 3 weeks! I went through their lists of doctors trying to find specialists and, for example, they had six doctors listed in New York City for pain management. That’s it. Guess what? I called all six of those doctors and there was only ONE that actually existed and took the plan. So, that’s one out of six. Not very good odds, was it?
When you look at a provider listing for almost any health insurer, you need to know that it’s a LIE. They don’t update the information, they rely on providers to do it and they make it difficult for providers to do so. Every insurer has a different way of doing it and it’s cumbersome. So when a doctor leaves a practice, he doesn’t tell the insurance company, and the insurance company doesn’t mind because his name on their network list makes it look longer.
This issue of false networks is not being addressed anywhere that I’ve seen. They all do this and it should be illegal. They should be forced to provide accurate information. All it takes is calling the providers’ office. it takes assigning a few employees to manage the listing. That’s it. It’s not rocket science. A clerical worker could be trained to do it.
2015 update: Empire BCBS’ network is larger now for Obamacare enrollees. They were forced into it. You know what the benefit to me was as a provider? For the first time, BCBS allowed mental health counselors into their network. We’d been fighting them for years and voila! Along comes Obamacare, they need providers for mental health, and so now I’m on their panel. I know it’s a deal with the devil but I don’t mind. The Obamacare policies pay 20% less than the corporate policies. So, if Obamacare takes over, I’ll be looking at a 20% pay cut over the next few years.
I wonder who would be happy about that? The other dirty little secret of Obamacare: providers are partly funding it being forced to accept reduced payments. This is why doctors don’t want to take Obamacare enrollees. I do because I’m sympathetic but it’s very easy to weed out someone who has an Obamacare policy. Sad but true.
Pul-EEEZE. You know nothing about me.
Bobby Gladd You are a nasty, uncaring inhuman being. People like you make me want to puke.
Vince, you have NO out of NETWORK benefits. Now, the health insurance companies have to have, in theory, a sufficient number of providers on their panels. This is in New York overseen by the Department of Health. So, in Texas, you have to find the government body that will assist you. You need a neurosurgeon most likely and they have to have some neurosurgeons on their panel; if not, they have to pay somebody to do it — or they have to have an orthopedic surgeon who does back surgery. But you do not have any of network benefits with an HMO.
This is the dirty little secret of Obamacare that its supporters — and I included myself as one of them at one point and in theory I would be in support of everyone having insurance — don’t want anyone to know OR they don’t even know this at all and are extremely ignorant. We have all had to deal with panels and not having enough providers. What Obamacare supporters don’t seem to get is that it is a sham because it’s not a matter of having to call around a lot and maybe finally getting a doctor, it’s that the contracts were not even in place and the networks barely created for these particular policies. When I bought BCBS in 2014, they had not even contracted with many doctors AT ALL.
So you have insurance with no doctors available. Wonderful. Great. Thank you, Mr. Obama.
You have to fight even harder for what you need and you have to get the state to help you. Good luck with that. But the insurance company is OBLIGATED to have a provider who can perform the surgery you need and if they don’t have one, they are capable of making special deals with out of network providers. But I wouldn’t try an out of network provider first. You can’t. You have to try their network.
When I had spinal fusion, a plastic surgeon had to sew me up after the second surgery to repair the “equipment failure.” He was not in network but because of the circumstances, my health insurance did pay (this was an Oxford plan and Oxford is generally a better company than Blue Cross, generally, depends on where you are).
So, you have to make a lot of phone calls to prove that the network does not have the doctor you need. They will also try to find you a doctor that will perform the surgery and you will have to see the doctors that they recommend.
If I had crappy insurance, I wouldn’t be inclined to have a serious back surgery by just any doctor.
Aren’t you able to change plans at this time? I thought we are still in a period where you can. Have you considered looking for a better plan? I’m not familiar with Texas but in general, in New York, the better insurers are BCBS, Oxford, United Health, Aetna, and Cigna. Most doctors take these insurers however they will not necessarily take the Obamacare plans. BCBS has gotten its act together to some extent.
Obamacare shoved individuals onto the marketplace, the people who could least afford it, rather than corporations and small businesses. They were exempted the first year. So, we got experimented on. It was even worse in 2014.
Look at some of the responses to me on this blog. People accused me of lying, of not being a real person, and they were very blase — “we all have problems with insurance networks.” They had and have no clue what it is like to deal with these Obamacare policies.
You have to fight and fight a lot because no one in politics will help you. The Democrats are too invested to admit there’s anything wrong and the Republicans are so against Obamacare that we are lost. And of course, if you had to get one of those plans, you’re inherently irresponsible.
It’s not pretty is it? I finally found a decent primary care after four tries and he and I both talked about how scared we are due to the dismantling of our healthcare system.
And I am a provider as well.
My problem is that I have a Blue Cross Blue Shield of Texas HMO self-paid plan. Most Drs. within the network do not accept patients within the HMO plan. I have a general Dr. within the network, but none of the OB/GYN’s accept the HMO plan. Need a well woman physical or pregnancy check up? Sure, it’s covered under my plan, but there are no doctors who accept my plan within my network. It’s B.S.
Hi, unfortunately I had to sign up for state assisted health insurance as I was loosing mine due to work. I went to the Health.Gov website, very nice people there 24/7. For the most part very knowledgeable. I had about 10 plans to choose between 3 companies. Long story short, I picked a plan that I thought suitable. The fine tiny print I didnt research, my bad. The fine print is an EPO, “Exclusive Provider Organization” plan., they say they pay 94%. There list of Dr’s like everyone keeps stating is there are none to be found on their preferred list.
I went to an orthopedic surgeon on their list, He does not do the kind of surgery I immediately need. He explained to me that I HAVE NO out of pocket benefits. The Healthcare.Gov and Amerihealth networks could have cared less that I need this surgery immediately. My only option I see is it is all out of my pocket, its a 34,000 surgery. Can anyone help who may be reading. Honest to god I need this neck cervical spine fusion immediately.
Thank you, God Bless.
Vincent H
vincehutchison@gmail.com
Sadly I have found the same thing this week. My job doesn’t offer insurance, so I was thrilled that I could afford the “same plan” I had access to through a previous employer. Now, 2 weeks in, I can’t see any of my doctors and I haven’t been able to get my prescriptions. Big problem and it wasn’t at all explained when I purchased it. 🙁
Does your site have a contact page? I’m having a tough time locating it but, I’d like to shoot you an e-mail. I’ve got some ideas for your blog you might be interested in hearing. Either way, great website and I look forward to seeing it expand over time.
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Kelly, I’d be happy to help you with this but this forum can be hostile at times and I’d rather just help you out directly. Please feel free to email me at abowleslmhc@gmail.com and we can talk.
It may be true that Blue Cross is forcing their providers on the plan. At least, new providers HAVE to take us (I know because I’m one of those new providers). Note that Blue Cross is paying 20% less to any provider who takes a patient who is in the exchange network.
I was someone who initially bought Blue Cross only to find out that I lost all of my doctors and there were almost no doctors in the network — they hadn’t bothered to contract with anyone for this insurance. It should have been highly illegal — what they did — but no one seems to care as we are a minority of people suffering. Look at some of the hostile responses to my initial plight. To be honest, I found it quite hurtful. Here I was in physical distress, illness, and my confusion and anger was met with hostility and distrust.
My guess is when everyone else starts going through this, they’ll do something about it. In the meantime, we are on our own.
Feel free to email me and we’ll exchange numbers and we can talk on the phone.
I too feel so frustrated with my Empire Blue Cross insurance ( pathway). I have the Silver Guided Access which I pay almost $500.00 a month for and i find that almost no doctors take this insurance in fact I feel as if I have the “plaque “when i asking if a particular doctors takes it! Even when you going to their website that refers you to Doctors that are supposed to be in network most don’t take it! I’m really confused as to why I pay so much and get so little? Why do doctors not take this insurance can someone explain it to me? I originally had Blue Cross through the government and I paid a little bit more but i found virtually every doctor excepted my insurance. What’s the difference? When i talked to someone from Blue Cross they told me by Jan 1st 2015 most doctors that except the regular Blue cross will be forced to except the pathway. Does anyone know anything about this? thanks
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You’re probably right. That was the writer of the Salon clip, which I would guess is more generalist than a Sara Kliff-type specialist. Part of that bad debt relief may be anticipating improved health care averting expensive (and avoidable) complications resulting from not addressing treatable conditions. What a concept, no?
In any case, hospital debts are not on my list of worries. I’m still riding the “hospitals are money-laundering centers” hobby horse.
http://pllqt.it/RINA25
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In other news, somewhat related, I just learned lately that policy-makers have quietly changed an important feature of several public assistance programs — including Medicaid, TANF, SNAP and perhaps others. The adjustment has been to tweak or even eliminate the “assets” test for such programs and measure only income to qualify. The people who study the effectiveness of assistance programs finally documented what common sense already knows — that when people are forced to “spend down” all their assets in order to qualify for assistance, the result is a forced dependency on those programs. But when they are allowed to have reliable transportation (an asset) or a place to live (an asset), a savings account (an asset) or a retirement plan (an asset) but they are in a place in life where they have lost or reduced INCOME, then it’s a nutty idea to make them piss away all their assets before giving them food stamps, temporary assistance, WIC benefits and Medicaid.
This change actually started without fanfare during the Bush years, and has been continued and expanded with Obama. It’s a secret, apparently, that is also — wait for it — bipartisan. Even Republicans in the know are on board with the idea. It must be a big secret, so don’t tell anyone.
I would offer links, but it’s probably best to let people think it’s just wishful thinking or some socialist dream. Drill around and see what you discover. If Thomas Pikkety did nothing else he underscored the difference between income and assets. I’ve waited years to see that happen.
Thanks for the additional info on the woodwork effect.
The states which are getting hit by the woodwork effect are those which, by and large, made Medicaid hard to get……….either by setting the eligibility at a repulsively low level, i.e. $8000 income a year, or by setting up bureaucratic hurdles.
Now these states, most of which are in the South, and most of which have a pretty racist legislature, are being hit with some extra costs. (The federal government still pays 40-60% of the costs for woodwork beneficiaries.)
Well it is about time!
However– I do want to question one item in your excellent email.
You state that Medicaid coverage will lead to less hospital bad debt, and therefore to lower health care costs overall.
I do not think that is true. Per Jack Hadley and others, hospital bad debt is well under $30 billion a year after various federal revenues to hospitals are factored in.
Even if this bad debt went to zero, I think that the effect on a $2.3 trillion national health care bill would be very small.
I don’t want to have a pissing contest with anybody, but this post and comments thread is nearly half a year old and has become an exercise in ACA bashing vs ACA defense. Surely by now everybody should know the answer to that question is a mixed bag from state to state, region to region and from one insurer to the next. We are like those five blind men examining and describing an elephant.
Meantime, here are a couple of items that have popped up in the last week or two that were news to me — and I’ve been paying attention since before ACA was crafted.
==> One in five Americans is now a Medicaid beneficiary.
Not all this growth is due to Obamacare; it can’t account for the slight growth in Medicaid enrollment in that didn’t participate in the health law’s expansion. But it is possible the law had an indirect effect in those places. People who were already eligible for Medicaid, but not enrolled, for example, may have heard about the coverage expansion and explored their options.
These signups by people who were already eligible for coverage are known in health policy circles as the woodwork effect. And it seems to be especially strong in some non-expansion states. For example, South Carolina, which has not expanded its Medicaid program, has seen enrollment rise by 14.4 percent anyway. Montana, another state opting out of Obamacare, has had 10.4 percent growth.
http://pllqt.it/Ru2rJf
==> This shift/change is having an impact on costs and treatments.
And it’s not just that people are signing up for Medicaid; they’re using it, and early indicators are that expanding access to healthcare is having the intended effect of reducing instances of uncompensated care. The Colorado Hospital Association released a study this week showing that “hospitals in states that chose to expand Medicaid under the Affordable Care Act saw significantly more Medicaid patients and a related reduction in self-pay and charity care cases.” Hospitals are obligated to treat and stabilize emergency room patients regardless of their insurance status or their ability to pay. If they can’t pay, the hospital gets stuck with the bill. Expanding the Medicaid rolls means that more people can seek out care and hospitals will have to absorb less bad debt, which could lead to lower healthcare costs overall.
The popularity of expanded Medicaid sets it apart from the rest of the ACA, which is still broadly disliked. That niche popularity has opened up a narrow path for Democrats to take the offensive on Obamacare and put pressure on Republicans who oppose the expansion. Senate Democrats sent a letter this week to Republican governors in states that rejected expanded Medicaid urging them to “put politics aside and do the right thing in helping to expand Medicaid coverage to the millions of Americans who desperately need it.” Among the signatories to that letter were Sens. Kay Hagan, Mary Landrieu and Mark Begich, all of whom are facing tough reelection fights this cycle.
http://pllqt.it/tnS6XR
It wasn’t long ago that the average American didn’t know the difference between Medicare and Medicaid.
I bet that’s no longer the case.
Keep calm and carry on.
I agree with you completely. It takes a level of curiosity and empathy that many do not possess. Can you imagine what it’s been like for the working poor? I had a patient who made $10 an hour full-time and had a daughter and she wasn’t even eligible for the state subsidized policies (that weren’t so cheap– she wouldn’t have been able to afford the $400+ a month she would have had to pay). I wonder if they can do math. Let’s see 40 x $10 is $400 a week, $1600 a month to support herself and her child in Manhattan.
I saw her for free because she deserved it. She was a good person who needed help. Fortunately, there are providers who do pro bono work and help but there are not enough of us. I always have at least one pro bono patient. It is an honor to be able to reach out to those less fortunate.
I am happy to see the working poor insured. These people contribute to our economy, they take jobs most educated people simply would not take, and they pay taxes. They are not a drain on the state like those who don’t work at all. And most are simply doing their best, they are not cheapskates.
Thank you for making the point, Bob.
I wonder what state you are in. I am both a provider and a purchaser of an ACA policy and I have the opposite experience as you. In New York, BCBS is a hot mess. In the event you don’t know this, differing entities direct the Blue Cross insurers across the states so you’re essentially dealing with a different company than I am (most likely).
As far as you saying I have no idea of what I’m speaking of, I wonder also how you come to this conclusion. As someone who has actually purchased a policy, I would think you would want to know, as an ACA supporter, the problems that people are having. This way, supporters of the ACA will know where the critics might be right and work to correct these issues. I find it fascinating how hostile you are and the tone you take is very similar to other supporters of the ACA. I also supported it and in theory still do HOWEVER it has its problems and the insurance companies are basically dictating how things are going.
It is disappointing to find that supporters of this legislation are so hostile to anyone having problems. I thought you