Insurers Push Plans That Limit Health Choices

[saracat]

Isn't this special? They always come out ahead of the game.This is exactly why HCR isn't going to work! JMHO. No wonder they brought in a Wellpoint Exec to administer the plan!


http://www.nytimes.com/2010/07/18/business/18choice.html?_r=1&th&emc=th


As the Obama administration begins to enact the new national health care law, the country’s biggest insurers are promoting affordable plans with reduced premiums that require participants to use a narrower selection of doctors or hospitals.

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The plans, being tested in places like San Diego, New York and Chicago, are likely to appeal especially to small businesses that already provide insurance to their employees, but are concerned about the ever-spiraling cost of coverage.

But large employers, as well, are starting to show some interest, and insurers and consultants expect that, over time, businesses of all sizes will gravitate toward these plans in an effort to cut costs.

The tradeoff, they say, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks. That could come as a surprise to many who remember the repeated assurances from President Obama and other officials that consumers would retain a variety of health-care choices.

More at link

[notadmblnd]

1. Can you imagine the wait to see a Dr. it going to create?

When several thousand people can only see a few hundred Drs.? Isn't that why everyone was against the single payer or public option to begin with?

[saracat]

3. And the "class system" in medical care will get only worse. I have a condition

that despite,what some on a nameless conservative site have mocked me for, can genuinely be treated by only one doctor. Others have not been successful at treating me. I have to travel out of state for treatment several times a year. My insurance is already sky high and this is a doctor who is listed as one of the top in the nation. They could refuse to allow me to see him. This is frightening.I am very much afraid we took a bad situation and made it worse. We needed a single payer. We might have settled for a public option.We got mandated insurance and no guarantee of health care.

[ThomCat]

5. Any of us who depend on specialists with rare knowledge,

are going to suffer and/or die under these plans. :(

Will the insurance companies deliberately exclude those specialists as an intentional strategy for getting rid of customers like us who cost them money by actually using our insurance on a regular basis?

I think they will.

[Xipe Totec]

4. Imagine the nightmare if you get sick on vacation - outside the network's geographic area

You are pretty much without insurance altogether.

[ThomCat]

6. This is ALREADY a very real risk with most insurance policies.

:(

You are right that it would get far, far worse. But insurance policies have been set up and limited by geographic area for decades already, so anyone who travels and gets injured or sick outside of the area covered by their insurance is probably in for one hell of a hospital bill.

Typically an emergency room visit is covered as long as you report it to your insurance company as soon as possible. But if you need to see a doctor, especially specialists, for any kind of follow up care then you are automatically out-of-network and paying for everything, or almost everything, out of your own pocket.

My insurance policy says I have to pay for everything myself and submit bills to the insurance company. They will reimburse me 20% of the costs incurred while I was out of network.

Paying cash to see a doctor, and cash for x-rays and MRIs, and blood-work, I could be expected to out tens of thousands of dollars even for something relatively minor! Who has that kind of money available? How many people know that they might Need to have that kind of money available if they get hurt or sick while they are on vacation?

[eilen]

9. My husband has this problem

he travels out of state for his job frequently. If he has a problem, the insurance he has from his local union basically does the same thing-- he has to pay a higher rate, it is subject to a higher deductible.

When he was in Michigan

He went to the ED once with sever flank pain d/t kidney stones. He didn't know they were kidney stones until after he went to the ED. The ins. co. was telling us they had to determine if the ED visit was "medically necessary" and required "emergency care" before they would accept it as a coverable medical expense and ended up charging us the entire bill anyway to apply to our deductible.

Thing is he went to an urgent care clinic first and they refused him care there and told him to go to the ED.

I think the IBEW should have a national plan as these guys are "journeymen".

[Xipe Totec]

14. Hi ThomCat!

I have heard horror stories of people being taken, unconscious, to an emergency room and having the insurance company deny benefits because there was an "in network hospital" just a few hundred miles away.

I had hoped that HCR would make these practices illegal. :(

On a more pleasant note, it is always a treat to hear from you!

:hi:

[ThomCat]

18. Thank you.

:hi:

Yes, one of many categories of horror stories we had hoped might go away if Obama was willing to flex his political muscles for People instead of Corporations. :(

It's a shame that we were wasting our time expecting anything more than a big show.

[laughingliberal]

2. K & R nt

[Selatius]

7. See, when you pass bills with a huge amount of pages of language, you can bet there are loopholes.

This looks like one of them.

[xchrom]

8. I'm guessing this is NO surprise to those lobbyists

Who helped write this bill - hello Liz?

[HughMoran]

10. “What this does is eliminate the Gucci doctors,”

“What this does is eliminate the Gucci doctors,” said Peter Skoda, the controller of the Haro Bicycle Corporation, a Vista, Calif., business that employs 30 people. Facing a possible 35 percent increase in its rates, Haro switched to an Aetna plan that prevents employees from seeing doctors at two medical groups affiliated with the Scripps Health system in San Diego. If employees go to one of the excluded doctors, they are responsible for paying the whole bill.

“There wasn’t any pushback,” Mr. Skoda said. Haro’s employees are generally young and healthy, he said, and they rarely go to the doctor. Instead, they want to make sure they have adequate coverage if they go to the emergency room.

The company’s premiums average $433 a month, Mr. Skoda said, with employees paying one-fourth of the expense. A few employees opted for more traditional coverage, enabling them to go where they please. But they are paying significantly higher deductibles and out-of-pocket costs that could add thousands of dollars to their medical bills.

...

The insurers are betting these plans will have widespread appeal in the insurance exchanges as individuals gravitate toward the least expensive options. “We think it’s going to grow to be quite a hit over the next few years,” said Mr. Goulet of WellPoint.

The new health care law offers some protection against plans offering overly restrictive networks, said Nancy-Ann DeParle, head of the office of health reform for the White House. Any plan sold in the exchanges will have to meet standards developed to make sure patients have enough choice of doctors and hospitals, she said.

...

______________________________________________________


Sounds like some people are voluntarily choosing these plans over traditional plans to save money. It also sounds like the government has some flexibility in limiting this option. :shrug:

[cordelia]

11. K&R

[nashville_brook]

12. just like with the abortion/high risk changes, there's going to be more of this

b/c there law is so heavily weighted to industry.

[Gormy Cuss]

13. Classic model HMO redux.

HMOs worked when the pools were largely young, healthy people with few chronic conditions. Far from just eliminating "Gucci" doctors such limited networks limit access to health care and that's the point -- it saves money for the insurer.

[Name removed]

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[ibegurpard]

16. no worries...the tough new regulations will take care of all this

or something...

[saracat]

17. Unreccing this isn't going to make this fact disappear! What is liberal

about suppressing information on the plans of health insurance companies?