Posted on 11/11/2016 5:02:27 PM PST by ColdOne
A consumer group has asked a judge to immediately stop Anthem Blue Cross from switching 500,000 Californians to health plans offering no coverage for out-of-network care.
The dispute is over a change Anthem made to its 2017 plans known as preferred provider organizations, or PPOs, throughout much of the state.
In court papers filed this week, Santa Monica-based Consumer Watchdog said that Anthem broke the law by not properly informing consumers that it had changed the plan to one that no longer pays for any portion of care provided by out-of-network doctors and hospitals.
Anthem told The Times on Friday the case is without merit.
The consumer group said the renewal notices the insurer sent over the summer were misleading and could result in people automatically renewing policies that they believed would be the same next year.
(Excerpt) Read more at latimes.com ...
Wow, this could end up in the lap of Roberts at the Supreme Court!
Only the most parasitic and most power hungry of voters will miss Obamacare. All decent people, whether they are paying for the subsidies or being forced into the plans against their will, despise that evil program. Its death will not be mourned.
The entire point of joining a PPO vs. an HMO is so that you can get coverage for out-of-network providers!
Roberts will just say it’s a tax and it’ll continue...
HMO’s and PPO’s are not insurance. They are exempt from insurance laws and tests because Ted Kennedy specifically exempted them from being subject to insurance regulation in his legislation, the HMO’act of 1974.
The solution is to change the policy name from PPO to HMO. Anyone who chooses PPO and pays a higher premium for it, does so because they want the freedom to chose their own doctor, in network or out.
My company is switching from Aetna to Anthem this coming year. Both dental and medical coverage not changing. A few rejiggering of plans so far.
Most pay a lot less for out of network, but I’ve never heard of a PPO plan that wouldn’t pay anything out of network.
Obamacare in a nutshell.
Forcing people who don’t want it to buy it and forcing companies who don’t want to provide coverage to provide it...
not true. you just don’t need a pcp to refer you. networks are the pricing mechanism for the insurance companies.
Hold Harmless
An agreement with a provider not to bill the subscriber for any difference between billed charges for covered services (excluding coinsurance) and the amount the provider has contractually agreed with a BCBS Plan as full payment for those services.
Aetna to BCBS cannot afford this ill conceived handout to so many people who pay nothing. Think of all the damn foreign students who are covered. Try going to Mexico or Saudi Arabia and demand free healthcare. These SOB’s who have come here from the far east have been sharing printouts of every freebie the USA has plus how to get them free.
Many are illegal Mex going to college on student loans have no intention of paying off. White America and many older and responsible blacks took this country back. We are not giving handouts anymore.
So, no out of state coverage. Federal law requires coverage. Next step, no out of state travel allowed without coverage. Starting to sound like Soviet Russia. Time to repeal ObamaCare now.
The only individuals that lose money on out-of-network benefits are generally the patients, not the insurance carrier. Patients generally have a higher deductible for out-of-network. Once the higher deductible is met, the insurance carrier usually pays at a lower percentage than in network, and they allow the same rate to apply to the deductible as if the patient were seeing an in-network doctor. So it takes substantially longer to meet the OON deductible. So the doctor collects their full fee and the insurance carrier continues to collect monthly premiums without paying out any money to anyone.
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