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Yes, it is alarming, if this is completely true. Texas Oncology centers that treat people at 135 locations in Texas and elsewhere and includes Baylor Sammons in Dallas has not yet decided whether to accept cancer patients who have ACA coverage. Why? Follow me below the orange dP fancy initials.

The women in the article didn't seem to have a junk policy since she's received treatment at a top-notch facility. Maybe her current plan was cancelled because it did not cover maternity (at her age it shouldn't be required. Or maybe it's mental health care - which she may need now!)

Here is a report from local Dallas News program about this elderly women as well as many others effected by this strange grace period provision of the ACA:

DALLAS — A pile of papers on Maria Silva's table foreshadows doom.
One says her breast cancer has spread.

Another is a cancellation notice from BlueCross BlueShield because her policy doesn't meet the new federal standards.

A third says her long-time oncologist won't be accepting policies from the new federal health care program.

"It's shocking,” Silva said. “Where am I supposed to go? Where am I supposed to go for treatment?"

Silva and thousands of Texas Oncology patients recently received the letter that says:
"Texas Oncology will not participate as an in-network provider for the HIMP (Health Insurance Market Place) ... We understand that these changes have a significant impact to our patients, both clinically and financially."

Deciding against accepting insurance offered in the health care marketplace, HealthCare.gov, might be blamed on a complicated loophole in the Affordable Care Act that could cost oncologists and countless other medical providers lots of money.

According the law, patients who haven't paid premiums are given a 90-day grace period before their coverage is dropped. But the insurance company isn't obligated to pay the claims for the last two months of that period. (auapplemac: Most health insurance policies have a 30 day grace period, I don't understand why ACA has allowed a 90 day period.)

"The doctors and hospitals could easily treat a patient for one, two, even three months, without fully understanding they are not insured...”

That might provide too much financial risk for health care providers — especially those providing expensive, long-term care, like cancer treatment.

http://www.wfaa.com/...

Sorry, when people are fighting for their lives, they should not have to go shopping for a new doctor or hospital. I've had PPO coverage for years and while insurance companies and plans were changed over time, I never had to change doctors and all local hospitals were included.

I desparatly fought for ACA and want it to succeed, but the way it was written is a total mess. The way it is managed is also a total mess. While millions of people who did not have insurance may get it now,  we can't in good conscience ignore the millions who are now in dire straights not of their doing.

Why do these people now have to be tortured? What if it was your child who was critically ill?

BTW: My friends who I've been writing about since 10/1 following their attempt to get ACA coverage received a call after finally signing up directly with the insurance company. This person asked for a list of their meds and some other info along those lines.  It turns out that this person works for a 3rd party company supposedly working with the insurance company.

My friends were too smart to give them any info and said if the insurance company needed more info, it should contact them directly by mail. Now, what was that all about?!!!

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Comment Preferences

  •  Tip Jar (22+ / 0-)

    It’s the Supreme Court, stupid! Followed by: It's always the Supreme Court! Progressives will win only when we convince a majority that they, too, are Progressive.

    by auapplemac on Fri Nov 15, 2013 at 08:00:13 AM PST

  •  What a bullshit way to try and sabotage the law... (11+ / 0-)

    The folk in Texas are really creative in trying to screw their patients, aren't they?  

    GODSPEED TO THE WISCONSIN FOURTEEN!

    by LordMike on Fri Nov 15, 2013 at 08:06:50 AM PST

  •  According to Texas oncology website (18+ / 0-)

    Most of the people taking a hard line against us are firmly convinced that they are the last defenders of civilization... The last stronghold of mother, God, home and apple pie and they're full of shit! David Crosby, Journey Thru the Past.

    by Mike S on Fri Nov 15, 2013 at 08:10:49 AM PST

    •  Which is confusing (12+ / 0-)

      The news reports did not arrive at their description of Texas Oncology's position out of thin air.

      In fact, if you diligently search one can find the cached copy of Texas Oncology's position, as stated to their patients, from October 2013:

      To All Texas Oncology Patients:On October 1, 2013, the Health Insurance Market Place (HIMP) open enrollment begins. This initiative is a part of the Affordable Care Act (ACA). After careful consideration, Texas Oncology will not participate as anin-network provider for the HIMP. We will reconsider our decision inthe first quarter of 2014 as the payers better define their provider andhospital base; as well as insurance benefits, including drug coverage. We understand that these changes have a significant impact to ourpatients, both clinically and financially. We do not take this lightly. Ifyou have questions about your insurance benefits please speak withour Business Office staff. For information on the HIMP you may visit: www.HealthCare.govFor Texas specific information visit: www.tdi.texas.gov and chooseFederal Healthcare Reform Issues.
      This, of course differs from what you find, today, by clicking on that exact link as presented in google.

      That shows this benign sounding "no decision yet" page.

      INFORMATION REGARDING THE HEALTH INSURANCE MARKET PLACE
      Texas Oncology has made no decision regarding participation in the Health Insurance Marketplace created by the Affordable Care Act. At this early stage, it is not clear how the new insurance plans will cover cancer treatment, together with related care that our patients need.
      Knowing what is covered before, during, and after cancer treatment impacts our ability to determine and deliver the most effective overall courses of treatment to our patients. That’s why a decision about participation at this stage would be premature.
      Like many healthcare providers, we are carefully reviewing the more than 100 plans in the insurance marketplace, and will determine our approach based on what’s best for our patients and our physicians’ ability to deliver the best cancer care possible to patients in Texas.
      During the transition ahead, Texas Oncology will continue to provide financial counseling to patients – consistent with our long-standing practice – to help them understand their medical and financial options.
      Frankly, such  an indeterminate position would leave current patients worried about their options. Tempus Fugit!
    •  No doubt, they are negotiating with the insurers (4+ / 0-)

      over what discount they will offer off their rack rates.

      Some medical providers charge twelve times as much as the Medicare standard of what is a reasonable charge.

      •  Medicare underpays (3+ / 0-)
        Recommended by:
        denise b, Sunspots, auapplemac

        In many cases Medicare greatly underpays the actual full cost of the medical service.  The remaining balance is then cost-shifted to the rest of us.  Medicaid is worse.

        I support Medicare-done-right-For-All.

        •  The actual cost? Or the cost that includes (1+ / 0-)
          Recommended by:
          worldlotus

          cost shifting from uninsured care? Medical bills are grossly marked up from actual cost.

          Almost twenty years ago, my insurance company was billed $7.50 per disposable diaper when I gave birth in the hospital. Back, then you could have bought a case of Pampers for $7.50. I'm sure the rest of the charges on my bill were similarly marked up.

          It's a crazy system. ACA begins to try to bring some price transparency into it, and we're discovering that your bill might be several hundred thousand dollars higher if you have a procedure done at Hospital A rather than Hospital B, just down the street, with an equally good standard of care.

          •  Once again, welcome to the world of reimbursement. (0+ / 0-)

            Just as larger hospitals usually can charge a little less because of volume, larger insurers can reimburse a little less per patient because of the volume of patients they provide.

            People are equating billed charges with reimbursement, which isn't necessarily the same thing. Often, billed charges have little to do with the actual reimbursement that hospitals get. It is only because it is the law that they send a bill at all.

            Also, there are averages, but you cannot cost a procedure like you can a car. You may do perfectly well, and not need anything beyond what is planned....I may have a reaction to anesthesia and need critical interventions.

            Also, you have to find out more about the patients. One hospital I worked at the patients who were there for open-heart surgery were usually there for just a few days. Another hospital has patients there for over a week. You can't go by those numbers however because the latter hospital takes cases that have multiple system involvements which increase their acuity and keep them in the hospital longer.

            It is easy to scream about $7.50 diapers...but most people don't look beyond the surface to see the costs involved in healthcare.

  •  IU hospitals (Indiana University) (2+ / 0-)
    Recommended by:
    LordMike, worldlotus

    are also not going to accept ACA insurance moneys.

    They will not lose many customers as Indiana does not have its own exchange.

    I do not understand why.

    •  Whether a state has its own exchange or (4+ / 0-)

      not is completely superfluous to the issue of how many people would be affected.The ACA policies can be purchased on healthcare.gov.

      More sinister is the idea that people may purchase policies but have no providers.

      I think I read that Kaiser in California is the most expensive exchange provider because they felt they simply couldn't accommodate demand and chose that route to suppressing it.

      The policy wonk geniuses designing the ACA did factor in increased demand on providers, didn't they?!!

      “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

      by Phoebe Loosinhouse on Fri Nov 15, 2013 at 08:31:58 AM PST

      [ Parent ]

    •  Why? (7+ / 0-)

      Gee, let's see.  A clinic in Texas, a conservative southern state is going that route.

      And a hospital in Indiana, the most conservative Midwestern state is going that route.

      What's the commonality between the two, other than both being states?  

      If one can't change the politicians in the cesspool in which one resides, perhaps climb out of the cesspool and move somewhere more reasonable. Sure, it's not easy.  But people have been doing it for eons.

    •  Let's clarify here (7+ / 0-)

      As of 2014 with some specific exceptions, all insurance policies can be called "ACA policies," in that they will comply with the law.

      The money paid to medical providers will come from private insurance companies, just as it does now.

      What IU hospitals must be saying is that it is not accepting the insurance companies' policies that are being offered in Indiana on the federal exchange, just as it hasn't accepted all kinds of insurance policies previously.

    •  How are they going to tell the difference between (3+ / 0-)
      Recommended by:
      Hey338Too, suesue, worldlotus

      say, a UnitedHealthcare policy bought through the ACA exchange and one bought through esurance.com? You can buy the same damn policy through either portal. The only reason for going through healthcare.gov is to get the subsidy, and that won't be noted on the insurance cards.

      I call bullshit on the providers. They are either in a plan's network or they are not. They have no capacity to discriminate based on how premiums are paid, only on a wholesale basis against an entire plan. If they don't want to accept any individual plans that's their business, but they won't be able to tell one type of individual policy from another, so how do they expect to make good on their threats?

      "Some folks rob you with a six-gun, some rob you with a fountain pen." - Woody Guthrie

      by Involuntary Exile on Fri Nov 15, 2013 at 09:20:55 AM PST

      [ Parent ]

      •  IE - the specific plan you have can dictate (11+ / 0-)

        the providers that are accepted.  If you and your neighbor both have policies with United Health that does not mean you have the exact same "in network" physicians and hospitals. In the post ACA world each insurance product has its own network. One of the ways that the insurance companies are trying to lower costs is to develop "micro networks" where they can bundle patients and negotiate steep discounts with providers. The entire issue of in-network and out-of-network providers is just starting to be understood. This will be the next installment on the 24/7 news cycle. The same will likely happen with employer plans next year.

        "let's talk about that"

        by VClib on Fri Nov 15, 2013 at 10:04:57 AM PST

        [ Parent ]

        •  Yes, but not exactly (2+ / 0-)
          Recommended by:
          Eyesbright, worldlotus

          Insurers can limit providers in a network up to a point, but they must provide an adequate network under the law. Likewise, no provider has to agree to accept all insurance companies, but can negotiate on a company-by-company basis as to the level of reimbursement they are willing to accept. However, using my UnitedHealthcare example, while UHC may limit providers on any given plan they offer, as far as I know they are not allowed to discriminate against Exchange plans by negotiating a lower provider reimbursement for Exchange policies and a higher reimbursement for non-exchange policies. In other words, if your provider accepts any UHC individual policies her(his) reimbursement is the same regardless of the policy's acquisition source, whether Exchange, esurance, direct purchase, or agent. There is no way for providers to pick and chose a la carte. They either take UCH individual policies or they don't.

          It's possible I've got this wrong, but if I have, something major got negotiated out of the law because this was a specific concern that was supposed to have been addressed.

          "Some folks rob you with a six-gun, some rob you with a fountain pen." - Woody Guthrie

          by Involuntary Exile on Fri Nov 15, 2013 at 11:19:30 AM PST

          [ Parent ]

          •  You are incorrect. (0+ / 0-)

            No provider has to accept all networks for an insurance. You can be a provider for some networks, but not all. That is true of all insurances.

            UHC (for example) has multiple products. One provider might be part of the PPO product, but not the HMO. There can even be multiple HMO products, and different ones have different networks.

            •  There's a huge difference between HMOs and PPOs (0+ / 0-)

              In the case of HMOs the provider agrees to accept a fixed amount of reimbursement per member patient regardless of how much medical service the member patient actually uses. The incentive here lies entirely with the provider to keep the patient healthy while providing the least service possible. A PPO network, on the other hand, pays providers on a fee for service basis. The provider and insurer negotiate in advance as to the amount the provider will accept for each service. If they cannot agree, the provider is not included in the network. In PPOs the incentive to keep costs low resides with the insurer who accomplishes this by negotiating reimbursement rates as low as they possibly can and still find providers willing to accept their fee schedules.

              Your claim is that providers are negotiating individual fee discounts for multiple PPOs an insurer might offer. That means my physician is willing to accept a reimbursement of, say, $80 from UHC for an office visit for my UHC PPO, but negotiated to accept, say, $70 for your office visit under a different UHC PPO. If you are right, that's pure insanity. Each provider would then be negotiating multiple levels of discount for each of her/his services with each insurance company. In other words, insurer tells provider, "You get $90 for an office visit from our platinum PPO, $80 for an office visit from our gold PPO, $70 from our silver PPO, $60 from our bronze PPO." Repeat with every other insurer accepted by provider's practice. It would be a total and complete accounting nightmare. I can't imagine a small practice being able to handle that.

              From my understanding, it's not the way it works, at least not where I live out here on the prairie where there are really only two major PPO networks, BCBS and Midlands Choice, which is the pooled network of virtually all the other insurers that aren't BCBS including UHC. If you have firsthand knowledge to the contrary, you should write a diary.

              "Some folks rob you with a six-gun, some rob you with a fountain pen." - Woody Guthrie

              by Involuntary Exile on Sat Nov 16, 2013 at 09:45:12 AM PST

              [ Parent ]

            •  I forgot to add one thing, (0+ / 0-)

              any provider can refuse to be part of any HMO or a PPO network. Most choose not to be part of an HMO because they have to assume the risk for the amount of care the patient needs (they are paid per patient, not per service). Most do choose to be a part of the Major PPO networks in their area because that is how the bulk of patients get their insurance. However, when the provider agrees to join a PPO network, which they can decline to do, they've agreed to provide services to network patients based on the fee schedule negotiated. BCBS PPO may provide a different fee schedule for services than Midlands Choice (UHC PPO), but as far as I know, within each company the fee schedules for each network provider are fixed and do not vary from plan to plan. Instead, the insurer adjusts it's various and sundry plans costs through premium rates, deductibles and co-pays.

              "Some folks rob you with a six-gun, some rob you with a fountain pen." - Woody Guthrie

              by Involuntary Exile on Sat Nov 16, 2013 at 10:28:18 AM PST

              [ Parent ]

  •  This is could not have been forseen (1+ / 0-)
    Recommended by:
    DeanObama

    Besides, it's not a big deal to change doctors. I'm sure she can find a doctor who's in network for her without too much hassle.

    She has cancer but at least she'll have access to affordable health insurance.

    Look, I tried to be reasonable...

    by campionrules on Fri Nov 15, 2013 at 08:12:26 AM PST

  •  Providers are not going to be able to (7+ / 0-)

    determine from which pot they are being paid. Which is as it should be. All dollars originate in the U.S. Treasury. The route they take to get into individual or corporate accounts is really irrelevant, as long as they get there.

    •  ^^^This^^^ (3+ / 0-)
      Recommended by:
      greengemini, auapplemac, worldlotus

      A provider is either in an insurer's network or they are not. They would have to refuse to be a part all the networks on the exchanges to make good on their threats. How are they going to tell which plans were purchased through healthcare.gov and which were purchased through an insurance agent if you can buy the same damn plan either way? Are they going to refuse to take small group insurance as well, because a lot of people will be getting coverage through the small group exchanges?

      I call bullshit on these threats. As a practical matter these providers will not be able to tell which plans are which unless the insurers issue cards with Healthcare Exchange emblazoned on them.

      "Some folks rob you with a six-gun, some rob you with a fountain pen." - Woody Guthrie

      by Involuntary Exile on Fri Nov 15, 2013 at 09:57:12 AM PST

      [ Parent ]

    •  Actually, they can (0+ / 0-)

      The insurance company can, and will, have policy names and codes that make it quite clear what is private insurance, what obtained on the ACA exchange, from an employer, or etc.

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Fri Nov 15, 2013 at 02:14:06 PM PST

      [ Parent ]

  •  If you have insurance, you have insurance. (13+ / 0-)

    How does the provider know where you got the insurance?

    Serious, but maybe dumb, question.

    There is no higher achievement in life than to make a child laugh.

    by Fiddler On A Hot Tin Roof on Fri Nov 15, 2013 at 08:14:13 AM PST

  •  Perhaps they need a little incentive in research (5+ / 0-)

    funding.  If these institutions want federal grants they shouldn't be able to opt out of all ACA provider networks.  I suppose not all procedure mills get grants but then I'm not so sure they're a great place to get treatment.  But universities?  Nope, I'd just stop funding their research scientists.

    •  Then you can watch the headlines "Democrats refuse (2+ / 0-)
      Recommended by:
      VClib, auapplemac

      to fund Cancer Research!" everywhere.

      Plus, it sounds more like the providers are opting out of networks, which is standard practice. Not all providers can absorb Medicare and Medicaid reimbursement levels.

      There is already grumbling because with the ACA indigent care is being cut (as it shouldn't be needed). If it turns out that the ACA plans do not make up for the lack of funds there will be a true crisis in the safety-net hospitals.

      •  It's both but I'd focus on the hospital and clinic (4+ / 0-)
        Recommended by:
        VClib, terabytes, auapplemac, worldlotus

        systems.  If an individual doc doesn't want to participate or his small group practice, swell.  But if you've got large systems raking in other public dollars they better participate.  I mean I do get that they have to be adequately compensated and that has always been one of my suspicions about this centrist cost cutting b.s.  You can't squeeze the quality providers so much that they refuse to take any but concierge care centrist elitists and not the rest of us slobs.  

        And whether it's politically correct or not to say it, the middle class isn't going to put up with being treated like free clinic Medicaid patients.  I mean that is the great fear of government healthcare  - that you get treated like some homeless person when you're sick.  

        •  There is nothing to compel a provider to accept (1+ / 0-)
          Recommended by:
          auapplemac

          insurance reimbursement, and the system would go up in flames if it was suggested.

          Should large groups accept it? Safety-net hospitals and providers will.

          Will for-profit hospitals? Maybe yes, maybe no. The problem is that for-profits are a big part of the system and provide a lot of care.

          This puts an even greater financial burden on the safety-net hospitals which are no longer getting subsidized directly for their indigent care.

          •  If ACA is limited to safety net hospitals it will (1+ / 0-)
            Recommended by:
            auapplemac

            collapse with the middle class.  One problem with this law is that it's apples and oranges.  It's mixing Medicaid patients with that 62 year old middle class person who needs a few years of coverage till Medicare or that young professional who for whatever reason lacks an employer paid plan.  

            This makes the ACA particularly confusing for the middle class.  Is it a poverty program?  Is it for me?  Does it only deliver care to me if I go to a clinic on the wrong side of town?  What is it?  What is it going to become?  Are my premiums going up?  Will I lose my doctor?  People are very unclear about how it is going to impact them.  

            And our politicians seem to be utterly incapable of explaining it because I'm not so sure they know how it's going to impact the middle class either.  

            Dangerous business fooling with stuff that is important to the middle class.   This is why I think they were crazy underfunding the roll out.  They needed to ease the pain for everyone for the first few years until they figured out how it will impact the market.

            •  In theory it should act simply as insurance. (1+ / 0-)
              Recommended by:
              worldlotus

              If you are not on Medicaid, then you can buy an insurance policy that acts, well, just like any insurance policy.

              To some extent, providers opting out is not an ACA issue. Providers opt out (or are excluded) with many insurances. There does need to be better public education.

  •  Now that the policies are actually in existence (8+ / 0-)

    the public and the providers are getting a good look at what's really under the hood.

    There will be any number of "fixes" that will have to be written to fix the flaws as they arise. This looks like a major one. Now that this gap in responsibility for payment over a three month period has been exposed to Texas providers, I would fully expect other providers in other states to follow suit, and who will say if it will be contained to only oncologists - what about heart surgeons and the like?

    I would say that the fix would be to rewrite the cancellation policy to 30 days to conform with other policies in existence with a government guarantee on the full premium in the last 30 days of the policy in the cancellation window. This means that the providers will be paid and the government's guarantee is confined to the cost of the premium and not the services provided. I don't see why this wouldn't work.

    Isn't Medicare for All suddenly looking a lot simpler and better option?

    “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

    by Phoebe Loosinhouse on Fri Nov 15, 2013 at 08:20:16 AM PST

  •  is there any stretch that would give CFPB some (5+ / 0-)

    jurisdiction or leverage over insurance?

    it seems to be as much about "consumer financial protection" as credit cards and loan agreements are.

  •  ok i don't get it (8+ / 0-)


    what the heck is HIMP?  There are no "Health Insurance Market Place" plans, as far as I know - all health plans offered on the federal or state exchanges are commercial insurance policies.  Is this Republican propaganda?

    "Kossacks are held to a higher standard. Like Hebrew National hot dogs." - blueaardvark

    by louisev on Fri Nov 15, 2013 at 08:27:31 AM PST

  •  It looks like the issue here is the rates (7+ / 0-)

    that the exchange plans are paying to providers. These plans are HMO type arrangements that require you to use providers in the network. To be a network provider you have to agree to accept the plan's established rates of payment. Providers are declining to participate at those rates.

  •  MD Anderson is taking ACA plans (11+ / 0-)

    MD Anderson Cancer Center in Houston is accepting the BlueCross BlueShield PPO plans sold on the exchange.

    •  Accepting or in network. (2+ / 0-)
      Recommended by:
      auapplemac, worldlotus

      The difference is night and day to the patient. If they are in network and accept what the insurance pays as payment in full, then good. If they are out of network and accept the patient, then they will receive what the insurance pays as partial payment and bill the patient for the difference. Every plan I've looked at in MN has out of network patient liabilities of 50 - 60%.

      Growth for the sake of growth is the ideology of the cancer cell. --Edward Abbey

      by ricklewsive on Fri Nov 15, 2013 at 10:45:39 AM PST

      [ Parent ]

  •  It can't possibly be true (9+ / 0-)

    The ACA includes ALL of the private insurers licensed to provide policies in the state, plus medicaid.

    Claiming they will "not accept ACA patients" is patently absurd - it would mean accepting only uninsured patients, which would be a fantastic way to instantly go out of business.

    •  It's also silly to fret about 90 day grace period (1+ / 0-)
      Recommended by:
      worldlotus

      What it means is that the hospital gets a better chance of being paid for treatments, since the patient has a better chance of getting "back on their feet" and restoring payments before cancellation. I am sure the 90 day grace period was based on statistics showing that there's typically one missed payment, and occasionally two, after which people tend to catch up.

      I know when we were paying out the nose (and every other orifice) for COBRA, we had to go to insane lengths to not lose our policy - cashing in our 401ks, borrowing from relatives, etc. A little breather once in a while might have saved us from losing everything we'd worked so hard to build up over decades of working.

      You can't, for example, control when your car's transmission cooler is going to decide to disintegrate inside the radiator, thereby flooding your transmission with a foamy mix of coolant, bits of metal, and motor oil (did you know that transmissions slip and self destruct when filled with motor oil?). Having the ability to prioritize the payments for a month or so can make all the difference in the world when you're on the financial margins.

    •  Not really. (1+ / 0-)
      Recommended by:
      auapplemac
      The ACA includes ALL of the private insurers licensed to provide policies in the state, plus medicaid.
      ACA only includes all private insurer plans that offer individual coverage.  That's not even the majority of them.

      I imagine they're just not in the network of any of the Texas ACA plans.

  •  How can they even tell? (5+ / 0-)

    The policies come through the usual list of insurers. When the patient goes to the doctor, their insurance card says "Cigna" or "Aetna" or what have you. There is no "Obamacare Insurance company" or "ACA Insurance company".

    So how, exactly, are the care centers supposed to know if a patients signed up through an exchange? Start asking inappropriate questions?

    This whole thing reeks of Obama-hating wingnuttery.

    "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

    by nosleep4u on Fri Nov 15, 2013 at 08:46:37 AM PST

  •  I call BS (4+ / 0-)
    Recommended by:
    raincrow, TooFolkGR, brn2bwild, worldlotus

    Obamacare is a marketplace e.g. a store that sells services - in this case insurance.

    This or any other provider can not discriminate against the private insurance plans bought on the Federal (TexASS dont ya know) exchange.

    A given firm's plan might or might not be in network with the facility.  If a insurer is not in network with the facility I guess the facility is walking away from revenue for each and every insured patient they decline.

    How many businesses walk away from business?

  •  There is NO such thing as an ACA member. (2+ / 0-)
    Recommended by:
    TooFolkGR, worldlotus

    The ACA is an exchange for private insurers.  For a provider to even know that a member obtained their private health insurance plan through the ACA exchange would require the private insurer to reveal that information.

    Is BC/BS saying that their limited networks for plans provided through the exchange exclude Texas Oncology Centers?  If that's the case, it is a BC/BS decision...not Texas Oncology.

    Outside Medicare/Medicaid, I can't see any way for Texas Oncology to know where their patients purchased their health plan, only which private insurance company is underwriting it.  If those private insurers want to create networks that exclude specific providers, then that is their problem, not the ACA's.

    •  It depends on how the insurance network is set up. (4+ / 0-)

      If the ACA network is different from its other policies, then the reimbursement could be less than what providers are willing to accept.

      This is common among HMO's which have very strict networking guidelines. A provider might accept POS, PPO, or EPO policies, but exclude HMO or even certain HMO policies.

      There should be enough "other" providers to make up for those who do not.

  •  This Doesn't Even Make Sense (1+ / 0-)
    Recommended by:
    worldlotus

    The "Health Insurance Marketplace" (HIMP) isn't an insurance company or a Health Plan.  Nor do all plans on the exchange that are "In Network" plans refer to the same network.

  •  This is a PR effort by the provider group (1+ / 0-)
    Recommended by:
    worldlotus

    to sabotage the ACA. (And in the meantime scare the Hell out of their patients. Nice choice for people supposedly devoted to healing!)

    Providers contract with insurance companies, not patients; insurance companies sell policies (both on and off the Federal HBX) but providers don't get to rule on coverage decisions for individual patients based on where (or how) they bought their health insurance. it doesn't work that way.

    It's true the insurance companies, vultures that they are known to be, may be offering a reduced payment for the policies they are selling on the Federal HBX.  Or they may be skipping this provider network when making up the provider network for the Federal HBX policies they choose to offer. Or the providers, vultures as they being revealed to be, may be demanding too much from the insurance companies for policies to be sold through the Federal HBX.

    I wonder if there is a fix for this: Perhaps providers who already accept Medicare payments could be prohibited from refusing to treat any particular class of patients' based on the purchasing point (the Federal HBX) for their insurance policy. I betcha cancer-care providers wouldn't want to be removed from Medicare's payment stream.

    But I suspect, that after the anti-ACA propaganda is disregarded, what you get down to is a simple payment-rate dispute between insurance company negotiators and providers' business managers.  In other words a cage-match fight between two amoral sickness profiteers.

    Araguato

  •  Anyone concerned with this in Texas (1+ / 0-)
    Recommended by:
    worldlotus

    can simply purchase an insurance policy not offered on the exchange, one that is accepted by Texas Oncology Centers.

    By the way, this doesn't appear to be a nonprofit organization, so that might be one reason they're refusing to accept the rates offered by the insurers on the exchange.

  •  you need to change your title (2+ / 0-)
    Recommended by:
    VClib, worldlotus

    this comment has all the links to what they are currently saying.

    They are backtracking.  They are no longer saying they "will not" but are now saying they haven't made a decision.

  •  Third hand report of third hand report? (1+ / 0-)
    Recommended by:
    worldlotus

    I find it hard to believe that a major oncology center will actually refuse to treat patients depending on what their insurance coverage is -- and that the insurance companies will be able to avoid having a major medical center in their network. I do anticipate some litigation / regulatory nonsense around what an "adequate network" means under the ACA, but surely it will include oncology treatment reasonably close to the patient's home.

    Given the third-fourth-fifth hand nature of this report, I would not give it much credence.

    (BTW reprinting an entire report from another news site is considered plagiarism and is a violation of this site's policies -- and doesn't allow us as readers any way to assess whether it's a reliable source. It could be yet another right-wing talking point.

    I have been predicting for several weeks that as soon as the "OMG my insurance has been cancelled" narrative ran its course, the very next volley would be "OMG my doctor isn't in the ACA network disaster disaster!" Looks like it's coming along right on schedule.

    •  They may not refuse to treat them. (0+ / 0-)

      However, if they are not in-network providers for the insurance they do not have to accept the reimbursement levels that the insurance pays. So they can balance bill the patient, and that will not only not go towards deductibles and out-of-pocket maximums.

      That is one way that the ACA can completely fail. If the patient does not choose to use participating providers, there is no way to put a cap on the patient's liability.

  •  If this 90 day grace period (0+ / 0-)

    is a serious problem, then this is what Congress should work on fixing.  Instead, the Republicans keep placing squirrels in the way which accomplishes nothing.

  •  It is difficult (1+ / 0-)
    Recommended by:
    worldlotus

    to believe how many people on a liberal website are fine with health insurance plans not covering maternity care.

    Maybe her current plan was cancelled because it did not cover maternity (at her age it shouldn't be required.
    Yes, it should be required for health insurance plans to cover maternity care. They are not marketing plans solely to people over 50.

    Despite what a lot of people seem to believe, younger people's medical needs matter too.

  •  Ask Rand Paul (1+ / 0-)
    Recommended by:
    worldlotus

    RP accepts medicare.  Otherwise his eye clinics would have no patients.  A lot of this discussion is really about other issues.  "Someone" has to pay the overhead.  One person offices are expensive.  If two doctors share the office staff voila cheaper costs.  Ask any larger business.  The entire system needs overhaul. Everyone knows it.  I'm sure nostalgia is rife, but there are better ways. The days of the home visit via bicycle are over. So probably is the single proprietor un computerized medical office.  Such is progress. I don't see anyone begging to get rid of dial phones to have operator connections. They bitched for years.  Now we realize that is is not possible. Autos were sneered at by horse users. I don't see the tea party asking to return to the horse. This is all silly.  

    Simply put, more expensive doctors cost more.  Buy insurance direct at a higher price to get them. But, allow the rest of Americans to get access to health care too.  I'd rather change doctors than have no insurance at all.  People with pre existing conditions or cancelled policies are faced with that. Ie no doctors.  I'm sure the GOP plan addresses all this.  Just show me the line number.  Oh yeah. They have no plan. Or, it's too secret to tell us about. LOL

  •  Well, well, well (1+ / 0-)
    Recommended by:
    worldlotus

    Looks like a new press release

    Texas Oncology Addresses Misstatement by Sen. Ted Cruz

    Sen. Ted Cruz has misstated Texas Oncology’s position on the Health Insurance Marketplace.
    We have made no decision regarding participation in the marketplace, because it is not clear how the new plans will cover cancer treatment, together with related care that our patients need. We also have concerns about parts of the law that could put patients at significant financial risk.
    We spoke with Sen. Cruz and explained that we have not completed our assessment of the plans and no decision has been made.
    Texas Oncology supports policies that give more people access to healthcare, including many of the insurance reforms in the Affordable Care Act.
    We are working constructively with policymakers, insurance companies, and others to address flaws in the ACA for the benefit of our patients, and in the interest of advancing cancer treatment for all who need it.

    http://www.texasoncology.com/

    “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

    by Catte Nappe on Fri Nov 15, 2013 at 02:04:58 PM PST

    •  "Independent oncology practice"- (1+ / 0-)
      Recommended by:
      Catte Nappe
      An independent oncology practice with more than 345 physicians and 135 sites of service throughout Texas and southeastern Oklahoma, we’re a pioneer in community-based cancer care.
      -your news update indicates big time damage control.  Gee, I wonder why.

      I now tend to see red flags with regards entities such as Texas Oncology. Along with their fellow clones, I'd always follow the money (investigate thoroughly) before using.  A hard lesson learned in the midst of dealing with my mother's healthcare needs in Texas some years ago....

      •  Yes (1+ / 0-)
        Recommended by:
        worldlotus

        There presentation looks an awful lot like Cancer Centers of America that advertises endlessly. That much marketing means somebody sees a big profitable pay off.

        “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

        by Catte Nappe on Sat Nov 16, 2013 at 08:08:16 AM PST

        [ Parent ]

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