I hear that in many places the ACA is doing what it is supposed to. But where I live it is not. Oh, we have insurance, we just don't have access to use it with any health care providers.
Someone recently notified me about a February 26 article from the Salinas Californian newspaper entitled "Salinas patients left out of healthcare." Today, June 21, nine months after the exchanges opened, six months after many purchased a health insurance plan from the Covered CA exchange, nothing has changed for the better. Those of us with plans purchased on the exchange still have almost no providers to choose from, and no way to know who is and who isn't a provider without calling each individual doctor or clinic. Because the insurance companies are reimbursing at a lower rate for exchange plans, there are few providers willing to take these plans. The plans not purchased on the exchange are basically the same cost, and are widely accepted in the county. However, in order to get a subsidy, you have to buy an exchange plan. (In my county there were only two options: Anthem Blue Cross and Blue Shield. It may be that in counties where there are available HMOs and/or more competition, this may not be such a big problem.) My silver exhange plan is billed at nearly $800 per month with the government paying a significant portion of that amount. We, the taxpayers of this country, and exchange plan buyers, are being badly defrauded. Before today, I had heard only a few gripes and groans from others who actually have exchange plans. It's been me doing most of the griping and groaning. I'm surprised by how little this is being talked about.
Here's how the article, by Dennis L. Taylor of the Salinas Cailifornian starts:
"Ernesto Sanchez has several medical conditions that require him to follow up regularly with his doctors. But when the Salinas resident tried to schedule appointments, he was told his providers no longer accept his insurance.
The 58-year-old Sanchez did all the right things. He went to the Covered California website, chose an Anthem Blue Cross policy he could affor d — $578 per month – enrolled and expected to continue with his follow-up treatment for his gastric bypass surgery at Monterey County Surgical Associates, his cardiology follow-up for an occluded coronary artery at PrimeCare in Salinas, and a 90-day checkup to ensure his diabetes is being managed appropriately, also at PrimeCare.
Strike one, strike two, strike three."
Below the fold, you can find out more. Please do read this if you love the ACA.
And from Natural News website:
"Doctors unwilling to participate in Covered California Obamacare exchange
Tuesday, February 25, 2014 by: Jonathan Benson, staff writer
"Unlike doctors who are associated with large medical groups, and in turn have more clout in negotiating higher reimbursement rates, independent physicians are getting the short end of the stick. "
"We were astonished because we hadn't signed anything yet," stated Dr. Marie President, a doctor from Redwood City, to KPIX 5. Dr. President is one of many California doctors who was added to the Covered California exchange website without notice or permission, a move by the government that she says is completely unsustainable. "We can't [take these patients], or we'll be out of business."
"As a case in point, Dr. President explained to reporters that a doctor bill totaling $134, for instance, would only receive $59 in reimbursements under Obamacare, or less than half of the actual cost. A standard, pre-Obamacare insurance policy, on the other hand, would generate a reimbursement of $87, with the rest typically being covered by the patient.
"We can't maintain operations at that level of reimbursement," lamented Dr. President. "What's needed is a standard reimbursement rate for physicians so there are incentives to accept those patients. If not, I'm not really sure what's going to happen to those patients."
Back to The Californian:
"And it went downhill from there. He {Mr. Sanchez} filled out the application in December; he received his insurance card about 10 days ago. He could have gone onto the Covered California website to see a provider directory of physicians who take his Anthem Blue Cross plan, except it doesn’t exist.
Nearly two months after the Affordable Care Act went into effect in California, there appear to be continuing snafus in the information Covered California delivers its members. For example, on Feb. 8 the website had to take down its list of physician directories because it was riddled with mistakes and was unreliable.
The lists described doctors as fluent in languages they did not speak; obstetricians were labeled as ophthalmologists; and physicians were falsely listed under insurance plans that did not cover care at their offices."
This is me writing again. I can find a list on the Blue Cross website that tells me there are 240 doctors within a 20-mile radius who are providers for my plan, but calling at least some of the doctors on that list, I've been told they don't take my plan. No way I'm going to call all 240 of them. Looks to me like things are still being misrepresented. And I think the confusion could become even greater July 1. See below.
In the June 2014 Archives of the California Medical Association, it states there have been 1.4 million sign-ups for Obamacare. Confusion reigns:
CMA June 2014 Archives: "Survey: Physician confusion over Covered California plans has negatively impacted patient care
"The California Medical Association (CMA) recently surveyed physicians about their contracting experience with Covered California plans. Eighty percent of respondents reported that they were confused about their participation status in a Covered California plan and that this has negatively impacted patient care.
"The survey, which resulted in an unprecedented response from over 2,300 physicians in less than two days, showed that health plan contracting practices, such as all products clauses, vague and confusing contractual language and silent amendments, are the primary contributors to the current state of network confusion for providers. Survey respondents also report that the confusion has negatively impacted patient care in their practice and has led to the loss of patients.
"With roughly 1.4 million Californians newly enrolled in Covered California products since January, it has been difficult for both physicians and patients to find out who is in and out of the narrow provider networks offered by Anthem Blue Cross and Blue Shield of California.
"Much of the uncertainty over whether a physician is in a Covered California panel or not has been caused by intentionally vague “all products clauses” in provider contracts that bind them to participating in unspecified current and future products offered by the health plans.
"Also contributing to the confusion, is a loophole in California's law, which gives health plans the ability to make unilateral changes to providers PPO contracts and consider a provider’s lack of response as acceptance of the changes, also known as a “silent amendment.” This is unlike the laws governing health maintenance organizations (HMOs), which require any change to a contract to first be negotiated and agreed to by the provider.
"With the rollout of Covered California, some health plans have used the PPO loophole to push many physicians unknowingly into additional product networks without their knowledge. The result has been that many physicians do not realize they have been added to lists of Covered California providers – this has caused mass confusion for both patients and physicians about participation status in the new products.
"Findings of the CMA survey include:
"Eighty percent of physicians report that they were, at some point, confused about their participation status in a Covered California plan. Almost 20 percent of physicians are still unclear about how they became a participating provider in the plan network(s).
"More than half of the physician respondents report that their confusion about participation status was because they were automatically opted into the network without their affirmative sign-on. Another 41 percent reported they never received notice that the plan was adding them to its exchange network, and 20 percent report the plan mistakenly listed them as participating in the exchange network.
"One in five doctors remains confused about their participation status in a Covered California plan.
Due to the confusion in participation status, more than half of these physicians report they lost patients. The number one reported reason for the loss was due to the patients believing the physician participated in the plan they selected.
"The potential long-term impact of such contracting practices is also troubling. The market power of certain health plans in parts of California give them the ability to effectively force physicians into accepting exchange products by making participation in all of their broader commercial products contingent on exchange product participation. Half of the physicians surveyed believe that, if forced to be part of an exchange network at significantly discounted rates, their patients’ access to, or continuity of, care will be endangered, and almost a quarter report they may have to either sell or close their practice if forced to accept the new products."
This is me again. Apparently, providers have only until June 30 to opt out of exchange plans without also having their status as providers for non-exchange plans automatically cancelled if they try to opt out of Covered CA plans. I can imagine a new wave of confusion sweeping us shortly. Perhaps those who have non-exchange plans will find themselves without a doctor and hospital too, as doctors don't realize they are giving up their preferred provider status for non-exchange plans.
The CMA 2014 Archives also comment that impending cuts threaten to make Medi-Cal the lowest paid Medicaid program in the country, after 1 million new sign-ups since January 2014. It already isn't easy to find a Medi-Cal provider, but it's so far less difficult than to find an exchange plan provider. Recently, I became aware that Medicare providers were very hard to find in this region too, because reimbursements did not match the actual cost of care. I do know this is a very expensive region to live in. I don't know why it's so much more than elsewhere. Perhaps we are all looking at having no providers. And providers having no patients who can afford care if the patients have Blue Cross or Blue Shield plans.
Unfortunately, this "narrow network" idea and lower reimbursement for providers was never communicated adequately to the public--consumers or providers. The Covered CA website and the Obamacare roll-out promised all kinds of benefits from the exchange plans which have not turned out to be the reality. There is also no access to communication with the Covered CA people or with Anthem Blue Cross. It took me until the end of March to obtain a copy of the actual plan I bought, which differs widely from what I read my plan would cover on the exchange website. My personal experience is full of frustration and outrage as I have tried to access either people or information regarding my plan. I've been sent letters from both Covered CA and Anthem Blue Cross that threaten cutting me off (because they want something from me I was never told I needed to do) but without being told what to do to prevent it or find out how to find out what to do. But both threats seemed not to mean anything as I'm still geting bills for insurance that subtract the government subsidy. The Covered CA website referred me to a phone number that referred me to the website--no human interaction involved.
I made efforts for two months to get an actual written copy of the plan I'd been sold after I found out they wouldn't cover my prescription medication. At the same time I was planning a physical and to get a renewal of my prescription, I was finding that no doctors or clinics would take my exchange plan. I had no idea what was covered, what wasn't, and at what cost, co-pay, deductible, etc. because nothing appeared to be corresponding with what the Covered CA site said regarding benefits and deductibles.The documentation for the plan I purchased wasn't on the Covered CA website, it wasn't on the Anthem Blue Cross website. My insurance agent didn't have it and couldn't give me details. Meanwhile, I got a booklet for a "Pediatric Dental Plan" that I threw away, thinking it was a mistake, as it covered only children. Later I found out that Blue Cross expects me to pay an additional monthly fee for that plan even though I can't use it and I have no children. Okay, I don't mind subsiudizing childrens' dental care in my monthly premium, but really, you want to send me a bill and expect a check for a plan that overtly has nothing to do with me? I havent' heard about that one lately. Perhaps they have ceased and desisted in that idea.
So there you go. The story from where I live, which may explain why I get annoyed whenever I read the cheerleading articles about how successful Obamacare is. I feel extremely fortunate not to be in Ernesto Sanchez' position--in the middle of some kind of treatment, or needing treatment for something. I generally go two years in between doctor visits, so I'm not hurting right now because I can't access health care. Yes, I realize that the exchanges are start-up and there are kinks to be worked out. However, it's a pretty big kink when you have been sold an expensive and misrepresented insurance policy, and the government is chipping in big bucks for it, and you still have no access to any health care providers. The most outrageous thing of all is that there are non-exchange plans that can be bought for approximately the same price and that, at least for now, are widely accepted by providers. Does this sound like the insurance companies are no longer considering pre-existing conditions? Who are buying exchange plans? Those who need the economic assistance and those who have pre-existing conditions, who therefore have not been able to get health insurance in the past, or had lousy cheap plans. This is the insurance company's way of excluding the same people who have been excluded before. And the "all products clauses" that physicans don't know about may mean they opt out of all Anthem Blue Cross and Blue Shield plans without understanding what they are doing when they formally opt out of exchange plans after June 30. This is a kind of extortion on the physicians--serve exchange patients at what we pay you or we'll cut you off of reimbursement for non-exchange patients.
Frankly, my previous lousy "cheap" plan at least got me in the door to a cllinic, and those provisions of Obamacare that were already in place meant my lifetime caps were already removed and my preventative care covered. Since the exchange, well I'm paying $130 less out of my pocket for a plan that costs almost $400 more than my 2013 "crappy" insurance plan, but the goverment is paying most of that increase, and I've got only catastropic or emergency room health care access. Definitely a crappier plan than I had before the exchanges came into play.
It seems to me that for-profit insurance companies have proven for years that they cannot be trusted, that they have no interest in the public good or an individual customer's good, and a reform program that counts on them as partners can never work. Have we learned nothing from the repeated instances of "creative" bookkeeping and other kinds of corporate fraud? How much longer do we have to wait for something a thousand times simpler for providers and consumers and that has potential to contain costs and actually improve access to health care for the entire population--which in itself would bring down costs? How do we get to it when it seems our government doesn't care what the people think or what the people want or what the people need? How are we going to develop the medical resources and resource people that we need in order to provide health care to all?
I've waited a few days to publish this article as I've continued to look for information. I'm including a link to an article written June 28 from the LA Times that doesn't suggest any fix is on deck.
http://www.latimes.com/...