Tag Archives: keep your doctor

Doctors grade Obamacare

Why doctors give Obamacare a failing grade | TheHill.

  •  You can keep your doctors – NOT
  • Medicaid, not so great
  • Deluge of paperwork and reporting requirements

So what grade would doctors give Obamacare?

The Physicians Foundation made shockwaves last month when it released its 2014 Survey of America’s Physicians. The survey’s top-line finding: Of the 20,000 doctors surveyed, almost 50 percent stated that Obamacare deserves either a “D” or an “F.” Only a quarter of physicians graded it as either an “A” or a “B.”

Let’s take a closer look as to how Obamacare has affected Medicaid. Many of my (potential) clients are delighted if they qualify for Medicaid or if their children qualify for CHP+. Perhaps CHP+ offers better services than Medicaid for adults but I’m doubtful.

No matter which option they chose, Obamacare forced my patients to make trade-offs between pricing, access, and quality of care.

Obamacare’s Medicaid expansion exacerbated this patient crisis. Arizona, the state in which I practice, expanded Medicaid in 2013 under the assumption that it would give the poor better access to medical care. Yet many of the new Medicaid enrollees—perhaps as many as 80 percent of them, according to one recent study—were merely forced off their private insurance plans and into Medicaid.

Several of my patients experienced this first-hand. They have found that Medicaid offers sub-standard health care compared to the private insurance they used to have. Their choice of doctors has been severely curtailed, even more so when it comes to specialists. Often they resort to the local emergency room rather than waiting weeks to get medical attention in a doctor’s office. An Oregon study revealed a 40 percent increase in ER visits among new Medicaid enrollees.

Unsurprisingly, patient health suffers when illnesses and diseases remain untreated, hence Medicaid’s persistently poor ratings on patient health. Unfortunately, my patients were forced into this broken system without a second thought.

Perhaps it was without a 2nd thought or perhaps it was with malice. The government creates a problem and then only they can fix it. Of course, with their recent displays of incompetence, they may have overplayed their hand.

Let me also comment on Medicaid. Under Medicaid, reimbursement to doctors is much less than that of regular insurance or even Medicare. I don’t care how you slice and dice it, from a big picture point of view, if the doctors don’t believe they are being fairly paid, the qualify of care dispensed is going to decrease.

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United Healthcare Medicare Advantage cuts doctor network

UnitedHealthcare to cut hundreds of Bay State doctors from its Medicare Advantage network – Nation – The Boston Globe.

National insurance giant UnitedHealthcare plans to cut up to 700 Massachusetts doctors from its physician network for seniors enrolled in its private Medicare plan as a way to control costs, according to company officials.

For elderly patients enrolled in the plan, the cuts mean they will have to find a new doctor or eventually switch to a new health plan that covers their current doctor.

The move, effective Sept. 1, follows similar cuts made by the insurer to its Medicare Advantage provider networks in 11 other states, including in Rhode Island and Connecticut, where the reductions drew outrage from patients, doctors, and lawmakers earlier this year.

Note these cuts are for Medicare participants who use Medicare Advantage plans. If you are using standard Medicare with a Medigap supplement you are unaffected by changes to Medicare Advantage programs. Why are Medicare Advantage benefits being cut? You guessed it, Obamacare.

The changes come amid a gradual reduction of reimbursements to private insurers that offer Medicare Advantage plans as a way to offset costs associated with President Obama’s health reform law.

Medicare Advantage provides coverage for 30 percent of Americans on Medicare through private insurers. Consumers often prefer the program over traditional Medicare because it is a one-stop shop for hospital and doctor coverage, and often includes prescription drugs, eyeglasses, and gym memberships.

For years the federal government has paid the private plans up to 14 percent more than traditional Medicare for identical services, a benefit to the insurance industry that cost taxpayers an extra $1,000 per beneficiary, according to the National Committee to Preserve Social Security & Medicare, a Washington-based advocacy group. The 2010 federal health law was supposed to close the gap, as well as provide new bonus payments to plans with the highest quality ratings.

Perhaps the decision to select either Medicare Advantage or traditional Medicare should involve a little more thought than the lowest premium?

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Exchange plans worry California docs

Exchange plans worry California docs | LifeHealthPro.

Dr. Mark Dressner says California’s public exchange need to act now to keep physicians in the networks.

Dressner, president of the California Academy of Family Physicians, said doctors who treat Covered California exchange plan patients feel confused, frustrated and poorly paid.

“We have never received such an outpouring of complaints about plans’ contracting strategies,” Dressner writes in a letter included in a Covered California board meeting packet.

And the problem?

Doctors say plan reimbursement rates are 20 percent to 40 percent lower than traditional plan rates.

“Our physicians describe these payment reductions as unaffordable to their practices,” Dressner says.

In some cases, Dressner says, carriers seem to think they can change contract terms by simply sending letters to the physicians.

Physicians have trouble finding out what the plan contract terms are, or even finding out whether they’re really in a plan provider network, Dressner says.

Dressner says his group is telling physicians they have to negotiate terms with the plan issuers just as they would with any other private payers.

And the answer is quite simple. Opt out of the system.

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10 tips to make sure Obamacare works for you

A word to the wise from USA Today/Kaiser Foundabtion editorial board.

  1. Carry your membership card everywhere.
  2. Understand your plan’s doctor and hospital network.
  3. Stay in the network.
  4. Try to stay in-network even if it’s for emergency care.
  5. Avoid all emergency rooms unless it’s really an emergency.
  6. Pay monthly premiums on time and accurately.
  7. Register online with your new insurance company.
  8.  Save paperwork. Make sure you really owe what doctors and hospitals bill you for.
  9. If you don’t get satisfaction from providers or insurers, try regulators.
  10. Do read the plan’s summary of benefits and coverage.

 

Did they mention STAY IN NETWORK? GOOD. My advice to you: STAY IN NETWORK.

It’s interesting that as a rule, my healthy clients are not overly concerned with the network coverage. Clients with medical conditions have a much greater awareness. I suggest that the healthy clients learn a lesson from those with medical conditions.

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10 Top Questions Consumers Ask About Obamacare

10 Top Questions Consumers Ask About Obamacare | The Fiscal Times.

  1. How do I sign up, and is the website working better?
  2. When is the deadline to sign up?
  3. How much is the penalty?
  4. What kinds of plans are offered under the new exchanges?
  5. Do I get to keep my doctor?
  6. I heard some of the top hospitals aren’t accepting Obamacare, is that true?
  7. How expensive are Obamacare plans compared to employer-based coverage?
  8. Who qualifies for subsidies?
  9. Where can you find out if you qualify for a subsidy?
  10. How does the subsidy work?

 

Additional information on the Obamacare penalty here.

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Medicaid is a type of insurance but is their coverage?

Denver area has plenty of doctors, but few accepting Medicaid, says study – Denver Business Journal.

Adams, Denver and Arapahoe counties have the third-, fourth- and fifth-worst ratios of Medicaid enrollees to doctors who accept the lower-reimbursement insurance, all with less than one primary-care physician taking the insurance for every 2,400 enrollees.
And those numbers are likely to be exacerbated further as more people sign up for Medicaid.

If you are applying for premium assistance under Obamacare, if you fall under 133% of the Federal Poverty Level (FPL) you will be funneled into Medicaid in the states that have enacted enhanced Medicaid. Can you avoid Medicaid? Yes, you can elect to op-out of the Medicaid system. Is their a downside to opting out? Yes and it may be significant. You are NOT eligible to receive any premium assistance. That means paying full price for Obamacare coverage you want, very likely an unaffordable option.

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Articles: ObamaCare May Devastate the Real Estate and Travel Industries

Articles: ObamaCare May Devastate the Real Estate and Travel Industries.

Check your network and check your doctors. Most Obamacare plans offer restricted networks in state and you are out of network if you are out of state.

Americans are among the most mobile people on earth, but ObamaCare may soon start freezing them in place. Millions are losing their health insurance policies and being forced onto the ObamaCare exchanges, where most plans only provide local medical coverage. As Americans realize they must pay for all non-emergency medical care when they leave their home county, their decisions may have a profound impact on the real-estate market, particularly the second home sector, and on the travel business.

I recently interviewed a woman I’ll call Sue, whose story may become increasingly common. Sue, a 60-year-old retiree, and her husband bought a second home in South Carolina to escape the Connecticut winters. “I had a Blue Cross Blue Shield policy in Connecticut, and I used it with no problem in South Carolina. I found an internist and ophthalmologist and dermatologist down here, and kept the rest of my doctors up north.”

“The price was reasonable. It cost me $450 a month, with a $2,500 deductible. It was slightly more for out of network; there was no co-pay, and I got my prescriptions filled in both states with no problem.”

“Then I got the letter telling me that my policy would no longer exist, because it didn’t comply with the new health care law. They wanted to transfer us into a new plan that doubled my premium to $900 a month. The deductible went up to $3,500, and it covered zero out of network.”

In Colorado, the only companies offering plans with nationwide networks are:

  • Rocky Mountain Health Plans
  • Cigna (only available for purchase in the immediate Denver metro area)
  • Assurant Health

In fact Assurant Health offers plans with nationwide networks in 42 states. HOWEVER, you won’t find them on any Federal or State “Exchange or Marketplace”. That means their plans are not eligible for premium assistance but they are still the same Bronze, Silver, Gold and Platinum plans required by Obamacare.

One issue that bothers me in the above article is this paragraph:

“My husband looked around and finally found a policy that has out of network coverage, but it comes with a very steep price. It’s $900 a month, with a $7,000 deductible and a co-pay on everything. Basically, it’s catastrophic insurance, and I’ll be paying my South Carolina doctors out of pocket.”

The maximum out of pocket per person for any ACA compliant plan is $6350. Either this plan is not ACA compliant (i.e. not a true major medical plan) or Sue is confused about the deductible.

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An Obamacare supporter’s misadventures with HealthCare.gov

An Obamacare supporter’s misadventures with HealthCare.gov | The Daily Caller.

Our troubles may strike some as trivial and particular, although they wouldn’t if it happened to them. And anyone who wants a successful system – as we do – must understand that these nightmares are happening across the nation to the very people who want Obamacare to work.

This story appears to be the Deliverance version of signing up for Obamacare.

Unfortunately, having dealt with many clients, it’s all to believable.

  • Restricted provider networks
  • Restricted formularies
  • Complicated subsidy eligiblity
  • Possibly higher premiums

All of the above are gifts of Obamacare.

If you don’t qualify for a subsidy or it is very small, my recommendation is:

  • Do NOT use the exchange
  • Contact a broker
  • Purchase directly from the carrier, which will also avoid security issues with the exchange websites.
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You better check once, better check twice

Can you keep your doctor? Healthcare.gov can’t tell consumers whether they can keep their doctors | WashingtonExaminer.com.

 Waltman said federal cost-cutting pressures on insurers are forcing them to reduce the number of doctors and other providers in their networks.

The result is that consumers must choose among provider networks with fewer doctors and hospitals.

That means many consumers who join the Obamacare exchanges won’t be able to keep their doctors despite President Obama’s repeated promise to the contrary.

Dave Berman, an independent insurance broker in Indianapolis at the brokerage firm Neace Lukens, said people could become confused if they expect their current insurance firm to offer the same network through Obamacare.

“It’s going to be very confusing to consumers who may be used to an insurance company and not knowing that they are going into a restrictive network,” Berman said

You must, must, must check your network. Not just the insurance company but the netowork that is being offered with the plan being purchased. If you are purchasing a plan from healthcare.gov or a state exchange this is critically important.

 

 

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Policy cancellations

Obama accused of breaking promise to consumers as health plans cancel policies – The Washington Post.

This about sums it up…

“The real problem is that people weren’t told the truth,” New Jersey Gov. Chris Christie (R) said Tuesday on “CBS This Morning.” “You can remember, they were told that they would be able to keep their policies if they liked them. Now you hear hundreds of thousands of people across the country being told they couldn’t.”

But perhaps the truth isn’t so important if you’re going to get a better policy…

Administration officials say the canceled insurance will be replaced by better policies.

Well, you get to be the judge.

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Rate Shock seques into “Provider Shock”

New “glitch”: If you like your hospital, you might not be able to keep your hospital « Hot Air.

Turns out you can’t expand coverage, cap patient costs, and expect providers to work for less, just like you can’t create the conditions for a major adverse selection problem and expect insurers to flood into the new market. “Some hospitals and doctors don’t even know if they are in the network,” says one expert, a point also made in the WSJ story I flagged this morning about consumers often having no idea who’ the providers are in each plan offered on the state exchanges.

I spoke with a client today and her daughter is in the process of being diagnosed for a blood disorder under the care of Children’s Hospital in Aurora, CO. Shopping on the Colorado Marketplace, Connect for Health Colorado, the number of available plans shrinks from 78 to 13 if Children’s Hospital is required to be in-network.

An additional complication is the client is planning to move in July to another State. If she takes ANY Marketplace plan, she will have to get a new plan with a new deductible in the middle of the year.

Fortunately, there’s a solution with an off the marketplace insurer that will allow her to “keep her plan” when she moves. Well, that’s a helluva lot better then Obama can do.

 

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Top Hospitals Opt Out of Obamacare

Surprise! – Top Hospitals Opt Out of Obamacare – US News and World Report.

“This doesn’t surprise me,” said Gail Wilensky, Medicare advisor for the second Bush Administration and senior fellow for Project HOPE. “There has been an incredible amount of focus on the premium cost and subsidy, and precious little focus on what you get for your money.”

Regulations driven by the Obama White House have indeed made insurance more affordable – if, like Health and Human Services Secretary Kathleen Sebelius, you’re looking only at price. But responding to Obamacare caps on premiums, many insurers will, in turn, simply offer top-tier doctors and hospitals far less cash for services rendered.

Not to mention that insurance is in many cases NOT more affordable.

Chances are the individual plan you purchased outside Obamacare would allow you to go to these facilities. For example, fourth-ranked Cleveland Clinic accepts dozens of insurance plans if you buy one on your own. But go through Obamacare and you have just one choice: Medical Mutual of Ohio.

And that’s not because their exchanges don’t offer options. Both Ohio and California have a dozen insurance companies on their exchanges, yet two of the states’ premier hospitals – Cleveland Clinic and Cedars-Sinai Medical Center – have only one company in their respective networks.

A good local example here is Colorado is Children’s Hospital is not in he Anthem BCBS network.

When looking at ACA/Obamacare plans, you must be concerned about the network. Also, if you are near a state border, travel a lot or have two residences, keep in mind that with a vast majority of the plans you are out of network for non-emergency care performed out of state.

 

 

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White House admits the obvious

WH: ‘It’s True’ Some Americans Won’t Be Able to Keep Their Health Care Plan Under Obamacare

White House spokesman Jay Carney explained at today’s briefing that “it’s true” some Americans will not be able to keep their health care plan under Obamacare:

It’s good to know that now that every paper in the nation is runing stories about people losing their coverage that the White House can actually admit it’s happening.

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Dropped Coverage: One Cancer-Surviving Doctor’s Story in the Age of Obamacare

The PJ Tatler » Dropped Coverage: One Cancer-Surviving Doctor’s Story in the Age of Obamacare.

And now, Obamacare is costing his own family its insurance.

What the article doesn’t make particularly clear is that Dr. Carpenter does have access to Obamacare where they don’t care about his pre-existing conditions. That is ASSUMING healthcare.gov is fixed. Which is a “Mythical Man Month” thing and may or may not happen.

But the implication of the article is “spot on”. He had insurance he liked, it covered his situation and suddently he’s losing it thanks to Obamacare and has to pay more for the replacement coverage with its 10 essential health benefits.

Why more? Because Dr. Carpenter most likely doesn’t qualify for a subsidy. He pays the full price.

Remember. President Obama promised us we could keep our plan and our doctor if we liked it? He also mentioned reductions in annual premiums too. Not just once or twice either. Dr. Carson and many others are paying the price.

Some companies are extending their current plans through 2014. Assuming Obamacare survivives, another group of individual policy holders will have to face the music of paying higher premiums.

… I’m not obivious to those Obamacare helps. I just got off the phone with potential clients who will benefit from the coverage. There is no easy answer, but there’s a better answer than this complex cluster…

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