Posted on 03/20/2014 11:18:40 PM PDT by lowbridge
Obamacare patients are discovering that many doctors, hospitals, and top cancer centers do not accept the plans they purchased.
"It's so frustrating," Terri Durheim of Enid, Okla.,told CNN. "It's not doing me a lot of good."
Durheim is not alone. Obamacare's so-called "narrow networks" are designed to limit customer choices to push patients into cheaper choices in an effort to control costs. Earlier this year Washington Post health writer Sarah Kliffwarned that "Obamacare's narrow networks are going to make people furious – but they might control costs." A McKinsey and Co. study finds that more than one in three (38%) Obamacare plans permit patients to select from just 30% of the largest 20 hospitals in their geographic region.
For patients like Durheim, the reality of Obamacare's slender options is forcing hard choices. Her son's serious heart condition means she needs a pediatric cardiologist nearby. However, the nearest doctor her Obamacare plan covers is over an hour away.
"Obviously we'd have to pay out of pocket and go here in town, but that defeats the purpose of insurance," says Durheim.
Cancer patients are also waking up to the realities of Obamacare's narrow networks. According to an Associated Press analysis, only four of 19 nationally recognized comprehensive cancer centers offer Obamacare patients access to their facilities through all insurance plans in their state Obamacare exchanges.
(Excerpt) Read more at breitbart.com ...
Preexisting conditions are by and large what people traditionally insured themselves for, such that if they came down with such they would be covered in the future. Obamacare proponents propagated that against state insurance laws insurance companies merely dumped from coverage anyone who became sick.
Thnx
I’ll look into this later.
This whole Obamacare is a mess.
I wish I lived in Tulsa so I could run around and take care of this whole but, I can’t make it there and am relying on my sister to help.
Well, we passed it, Nancy, and we found out what’s in it.
You are exactly right.
In addition, rates for existing plans went up significantly between the time that Obamacare was passed and when it took effect, so lots of people who didn’t have to move into Obamacare were hurt because of Obamacare.
I’m not advocating for any kind of healthcare. What I’m saying is that the insurance companies are going to price their product right and “stay in business” at the same time.
SO ... if ... people don’t want to be excluded from getting coverage because of pre-existing conditions, and if they don’t want to have “caps” put on their policy, and if they want the ability to get insurance no matter what, and they don’t want the insurance company to be able to “cherry pick” the population for just the right type of client that they want, and if people don’t want to have a huge segment of the population permanently excluded from insurance — then — people are going to have to “pay the price” for “that product”.
NOW ... I think it’s entirely feasible and possible for our society to let the insurance companies exclude people, price according to pre-existing conditions, put caps on your policy, exclude coverage for certain things, and have a permanent uninsurable population that will never be able to, et insurance — then — the costs would go back to where they were before.
People just have to know that and choose that.
I don’t think your “ONE TIME in your entire life” statement is accurate.
But each year you delay, you pay a penalty on the cost of Medicare B (which, of course, you need in order to sign up for a Medigap plan).
I’m sorry to tell you this, but the Medigap policy (and there are various plans - but “Plan F” is the best) — is only guaranteed available during the one-time Open Enrollment period - which is the first six months when you turn 65.
That’s why I want to warn others about this and tell them to GET IT no matter what, during their Open Enrollment at age 65 (it’s only once in your lifetime).
Also, for Part D (which is prescription coverage) ... you might check on the AARP Plan, which is underwritten by UnitedHealthCare.
It’s once in your entire lifetime to be considered for Medigap - without pre-existing conditions factored in, without the insurance company being able to reject you and without your “current health” being a factor.
Otherwise, you can get Medigap at any time. At those other times, you may be rejected, you may have pre-existing conditions excluded, you may have the policy priced higher than the average ... and so that’s the ONCE IN A LIFETIME factor - you see ... :-) ...
I’ll add to this ...
If you have Social Security prior to age 65, you’ll automatically be enrolled in Medicare Part A and Part B. The Medigap policy itself is simply a supplemental policy to supplement Meidcare Part A and Part B. You can apply for the Supplemental Policy (Medigap) at any time you want (after you have Medicare), but you may be excluded by the insurance company in the future, if you don’t get it when you turn 65.
I hope that makes it more clear ... :-) ...
If ... in the past ... you went on the open market and purchased your health insurance ... it was absolutely guaranteed that if you did have pre-existing conditions - one of three things were going to happen. (1) There would be a refusal to sell you a policy, (2) there would be a much higher premium to include that in the policy, (3) they would “write it out” of the policy and give you a very much limited policy.
On the other hand, if you happened to get into a job that had a group policy for all its workers ... then pre-existing conditions were covered and you weren’t excluded or charged more. However, that only lasted as long as you had that job and if the employer decided to keep the policy for all it’s workers. There was no guarantees in that.
I wish that were true. From what I have seen the insurance providers are moving to narrow networks for all of their policies available to individuals. In New Hampshire, for example, Anthem, the only insurance provider with a presence on the exchanges, does not offer any individual policies that cover doctors outside of their very narrow network.
Regardless of how much you are willing to pay in premiums they won't cover care from the nearby research hospitals in Boston which provide care for seriously ill New Hampshire residents.
Put bluntly, if your kid is sick enough to need care at Children's Hospital in Boston you are uninsured.
In another example of government "solutions" causing problems, Obamacare got rid of coverage limits expressed in dollars, so your insurer might only cover $1,000,000 in care at a place like Children's Hospital and replaced it with a policy that provides no coverage at all for care at the same hospital.
To rely on Boston is indicative of living in the wrong place.
Boston and Massachusetts in general should not be relied on for anything. They are no longer America
You’re talking about major preexisting conditions. And, of course, the problem you are describing is really tied to the problem of us subsidizing employer-provided insurance. It certainly wasn’t justification for us to socialize the entire market as we have.
You could get that kind of policy IF you wanted to pay for it. The problem is ... no one wants to pay for it, you see ... :-) ... so why is the insurance company going to put out a product that they know NO ONE will buy?
Now, on the other hand ... If you let the insurance companies exclude people, price according to pre-existing conditions, put caps on your policy, exclude coverage for certain things, and have a permanent uninsurable population that will never be able to get insurance — then — the costs would go back to where they were before.
We can get what we want (as a society) as long as we know what is involved and we “choose it” (as a society). The cost is simply going to be according to what we choose ... that’s all.
Except that "coverage" by itself is of little use. There are few situations where the combination of high premiums, high deductibles, and limited networks actually work in favor of the patient. Can't you see that the insurance companies and the government have just tilted the playing field in their favor?
For most people, even people with chronic conditions, paying thousands of dollars a year for a policy with a $10,000 deductible is not a good deal. Particularly when you find that your specialists aren't in the network and you are back to being uninsured with them.
You can be sure that in any market where customers are legally obliged to purchase a product, that the providers, namely the insurance companies and the doctors, hospitals, and other medical providers, will profit handsomely, and the customers will suffer.
Have you ever wondered why hospitals who are supposedly always suffering financially are usually building fancy new buildings and have highly paid staff and management?
The same narrow networks, and geographic concentration of specialists in cities exists all over the country. If you don't like New England, that's your choice. But the same problems with narrow insurance networks exist everywhere.
Well ... actually ... I’ve always marveled at the insurance company buildings and bank buildings and not so much the hospital buildings ... :-) ...
Not true. First off any small group plan would have to take you regardless of prior conditions. And most states, ours included, have high risk pools for people who were denied coverage due to pre-existing conditions. So in New Hampshire, for example, before Obamacare you could have gotten insurance at least two ways.
First, by simply starting a one or two person group. Any business, even a sole proprietorship run out of your house could get a group plan. Expensive, but no prior condition exclusions.
Second, by enrolling in the state run high risk insurance pool.
So in our state at least your contention is wrong. The small group option is based on federal law, so it used to be possible nationwide. Of course those options will fade away courtesy of Obamacare.
Uh, you forgot the small group plans, which of course were exactly that kind of plan until Obamacare came along, and still are until the group mandates kick in. They are probably the largest market for the insurance providers.
So the "no one" you refer to is actually millions of small businesses and their employees.
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