There is some evidence that medical practices are wary about taking patients from plans sold on the marketplace. In September, the Medical Group Management Association -- a trade group for medical-practice executives -- surveyed 1,000 physician groups that collectively employ 47,500 doctors.

The survey asked, among other things, "Does your practice plan to participate with any new health insurance products sold on an ACA exchange?" Only 29 percent of respondents gave a definitive "yes." That rate is twice as high as the share that that said "no" (14 percent) but less than those that were still weighing their options (40 percent).

The top reasons? A fear of bureaucratic regulations, low reimbursement rates and the need to collect payment from patients with higher deductibles.

actual health of their patients. That's about the same percentage of the U.S. population that is hard-core right-wing.

I've had several docs tell me they are quitting their practice "because of Obamacare." In one case the guy did quit, but he was about retirement age anyway.

However, it is not just greed. When there is lower quality insurance -- requiring a high percentage of co-pay (which is the case with most of the ACA policies) a lot of patients will try to run a tab with the doctor's office, which becomes a big collection burden and risk. They see this as highly correlated with income, which is why so many of them don't accept Medicaid patients. And many of them are evidently correlating ACA coverage with bad credit risk.

By 2015, I'm not sure they will continue to see it that way because I expect they will lose a lot of good patients as people move to ACA policies.

Many times. And I myself have permanent damage from a greedy, incompetent doctor. A nurse who knew about him told me I was lucky I didn't have more damage.

I should have said "around $1500." The ones I'm looking at are

cbbg $1394
cbba $1513
cbds $1455
cbki $1480
multi-state $1480

Essentially there is one provider, Anthem. There is another very low-end outfit that basically does Medicaid, and they have one policy listed, which is $1464.96.

Having spent over an hour on the phone with two different Anthem people this morning, I learned I can keep my current policy until its next anniversary, which is September, or I can move the anniversary to December 2014. That gives me access to the big network, which is basically most PCPs, hospitals, and specialists, all in-network. But after that time (either Sep or Dec 2014,) there will no longer be a big network open to individuals, If I am not in a "cadillac" group policy with an employer, then everything will be in the tiny ACA network, which is essentially the same as the providers that take Medicaid patients. If I want to see my regular providers, they will be out of network with a much higher deductible, but they cannot tell me what that deductible is as of today.

So basically, Coulter is right if you throw out the outrageous jingoistic part of her statement. By 2014, an individual will have no options other than ACA-type policies, and at least according to my Anthem reps, you should expect these coverage networks to be tiny -- no more than 20-25% of the providers in the area. Of course, each provider has to decide whether or not they will accept the in-network terms. It is possible that after losing a lot of patients in 2014, many of these providers will reconsider and join the network for 2015. But it is what it is for 2014.

It gets worse -----------

Literally as I was typing in this post, I received a call from my Anthem agent (who was very nice, and tried to be as helpful as possible). The issue she had not been able to answer for me before was how out-of-network services would be handled under ACA. She called me back urgently to say she discovered that basically there is no limit on deductible for out-of-network. In other words, I pay 100% of everything that is out of network. Insurance covers nothing EVER (*) -- and that is true of all of their ACA policies.

Put that together with a really minuscule ACA provider network and you have a real problem. My main docs are not participating for 2014. If I want to see them, I will pay 100% if I have an ACA policy. That means a lot of customers are going to be discovering this in 2014 (probably after they have already purchased their policy. And they will be playing a game of "musical doctors" trying to find good docs that are accepting new patients on an ACA in-network basis.

Basically I am declaring Ann Coulter's statement as essentially true, even though the part about "American universities" is repulsive and outrageous.

This is going to be a wild 14 months as this all settles out.

But understand the implications here. If it goes as Anthem seems to believe it will be going, after 2014, any individual purchasing their own insurance will be forced into a very small network. All that talk about "If you like your doctor, you can continue to see him or her" is turning out not to be so true.

I would be very interested to see if others are seeing the same things in their areas. I am in a somewhat unusual case because there is basically only one insurance company serving my area. But Anthem serves many states and they think the things I described above are happening everywhere.

(*) It is possible that the insurance company will reimburse me for the amount they would have covered in-network, but I have to file a claim for each such service.

I suspect hospital systems will come in and compete if there is profit to be made.

Basically I have to skip the ACA exchange for now. I would have liked to get a tax credit to help with my costs, but the crap that is on the exchange in my case makes that impossible. And Anthem is offering to extend my current policy to December 2014. So I'll just keep paying that I guess.

But if it isn't any better for the 2015 plan, I am really hosed.

We do have a teabagger governor who is doing everything possible to make this a failure. And he will still be Governor next year (unless fate intervenes in some unexpected way.) So the State is not going to do anything to encourage a better solution. But I do hold out the hope that market forces will come into play. That can work 2 ways:

1) another big insurance company or 3 could decide to enter the market, adding to the competition

2) The providers who have shunned the Anthem ACA provider network could see that was a big mistake if they lose lots of patients during 2014. And they might be more inclined to join the network for the 2015 plan.

not qualifying to Medicare or Medicaid. So it is only about 10% of the population, and some providers currently view the ACA demographic as being like the Medicaid demographic -- i.e. low income and a bad collection risk.

The majority of the market will still be in company-provided group plans, so the upper tier of providers may be inclined to just go after those customers and not deal with the "ACA trash", so to speak.

I'm assuming Reimbursement and requirements aren't ridiculous.

Of course, our guv did not accept Medicaid expansion. Alaska is basically a one-insurance state, too. Ours is Premera blue cross-blue shield.

My current plan, which is a high deductible HSA, is under $600/mo for two people, even after the price increase they are offering to commit an extension to December 2014.

There is not an exact match for this policy on the ACA. But the closest thing is what the company calls their "cbbg" policy. This is an HSA with a lower deductible, but it has a tiny provider network, and covers NOTHING out of network except for emergencies. So basically I consider my current policy to be better coverage. The cbbg is quoted at $1394/mo for the same two people.

And please note, my current policy will never be offered again after December of this year. I can extend it one year to December 2014, but then I HAVE to go into the exchange, which will more than double my costs if the prices for 2015 don't drop radically. I might be able to rig my finances such that I get a sizable tax credit, but that is to miss the point. Most people are not in a situation where they can adjust their reported income levels to that degree. Many are covered by generous subsidies, but many people are not. And those people are looking at HUGE increases if they live in Indiana. MORE THAN DOUBLE.

My current plan will be under $600/month for 2 people with high-deductible HSA and the full Anthem network which has anybody I would ever want to see in-network.

That plan goes away once the plans reach their anniversary. My anniversary is Sep 14, but I can make a move now to change the anniversary to Dec 2014. But either way, that is the end of the line. After that, the only think I can get will be ACA plans.

There is not an exact comparison with plans on the ACA exchange for 2014, but the CHEAPEST plan on the ACA exchange for the same two people is over $1300/mo. And that has a TINY provider network that does not include ANY of the docs I am seeing today. To continue seeing those docs, I would have to pay 100% out of pocket.

So being forced from a decent plan at $600/mo into a POS plan at $1300/mo or more? What kind of increase would you call that?

I don't even need insurance for the daily stuff. The only reason I have insurance is to make sure I have my best medical options available to me in the even I have a catastrophic illness or injury. And that ain't happening with the ACA network that Anthem has in my area. If I have a certain form of leukemia, I want to see a doc who is very knowledgeable about that particular disease. Those people are not in the Anthem ACA network, by and large. There are pages of RNs and Chiropractors, but very few of the respected specialists. As long as Anthem has a "Dr. Nick Riviera" in the network who says he knows something about leukemia, Anthem will force me to go there or else pay my own way. No freaking way.



The only real solution is to forgo the tax credit for 2014 and stick with my current policy, and hope that by 2015, the options are a lot better than they look like today.

Analysis: Obamacare exchanges will push Anthem's premiums lower
J.K. Wall
September 9, 2013

Anthem Blue Cross and Blue Shield of Indiana expects the premiums it charges on the health insurance exchanges being created by Obamacare to be slightly less than they would have been without the law.
...

The HealthCare Options analysis shows that Anthem’s exchange customers will actually pay nearly $5 per person per month less, on average, than they would have if no elements of Obamacare went into effect next year. That's a savings of $60 per year, even before any of Obamacare's subsidies for low- and moderate-income Hoosiers are factored in.

Instead of paying an average of nearly $412 each month for every member of an Anthem health plan, Anthem expects to charge its customers $407 per member per month. That’s an average savings of $60 per year over what customers would have paid without the benefits of the law, formally known as the Patient Protection and Affordable Care Act.

These averages will be far different from customers’ actual premiums, which will vary widely based on their age and smoking habits, and a small amount based on the part of Indiana where they live.
...
http://www.ibj.com/analysis-obamacare-exchanges-will-push-anthems-premiums-lower/PARAMS/article/43420

I still can't see how Ann Coulter's comment is correct.

All of the articles that argue "premiums are going lower" are playing this same bullshit game. Premiums are going HIGHER in a big way. Maybe not everywhere, but that is the broad direction. This is being obscured by the fact that the majority of people who are being forced into the exchange will qualify for government subsidies, and these can be EXTREMELY large -- $17000 a year in my ares if a family of 2 has an income of $20,000.

It is the NET cost AFTER SUBSIDIES that is lower. The actual premiums are going way up on most cases.


And what hit me like a load of bricks is the fact that I will not have the option to continue to pay for my old policy after it expires. By 2015, I will be forced into the exchange and whatever tiny network of doctors decides to participate in that network.

You are absolutely incorrect if you are arguing that premiums are going down. They are not. But you are probably correct if you are saying that the NET COST after subsidies is lower ON AVERAGE. Yes, if the government wants to throw $17,000 at each person, that can certainly cover a lot of cost increases.

So yes, I agree the people really hammered by the rate increases is a small minority. It is the elf-employed accountant making $80,000 a year (although she will probably know ways to rig her tax return to qualify for subsidies.) It is the independent tradesman who has developed a nice clientele, but is not part of a larger business or union that provides a group policy. It is the RN who works his ass off free-lancing and brings in $60K and lives alone. These are the people who really get hammered by the price increases.

--

On edit, I note that Anthem is claiming the ACTUAL premiums are lower. They do business in a lot of places. IN my county, they are effectively the only competitor. I assume in places with more competition they are not able to get away with more than doubling the prices.

will be paying more, while most will be paying less.

She is not right to imply that people not trained at American universities are the only ones who will be in network. But she is right to the extent that:

a) I have essentially only one company (Anthem) offering policies on the ACA exchange

b) When my current (Anthem) policy expires, I will be forced into an ACA policy

c) And the network of doctors accepting ACA policies is a tiny fraction of the network I have pre-ACA. That's a fact. And it is a fact that none of the doctors I have seen in the past 3 years are joining the ACA network in 2014. I hope they will be there in 2015.

Obama said: "If you already have a policy, you can keep it. If you like the doctors you are already seeing, you can keep seeing them."

Coulter said: "no doctors who went to an American medical school will be accepting Obamacare"

Bottom line, Coulter is a lot closer to the truth than Obama is in this instance. I cannot keep my policy and I cannot continue seeing the same doctors unless I want to pay that 100% out of pocket. I really hate to say that. And I don't think Obama was intentionally lying. I just think he didn't know all the details and he didn't know how this would play out as the insurance companies got their strategies together.

anything makes for a horrible customer experience. I will read the longer articles later, but I can't imagine only one provider will stay in the network. Incomes up to 400% of poverty level are pretty high. In most areas it's over 100k for a family of four. That's hardly medicaid type income. We'll see. I do wish the ACA would allow us to pay the difference between their flat rate payment for a service and what a provider we want charges. I have a feeling that is more a result of industry practices over the years than anything new with ACA. We'll see. Thanks for the info. it's important at this stage for us to learn as much as we can.

when I purchased my current plan. But they are nowhere to be found in the exchange. Of course, it is possible that they are serving other counties, other age groups, or whatever, but for my circumstances, there is basically one supplier.

One certainly has to wonder if this is the result of collusion among the big players. "You take Marion County and I'll take Tippecanoe and Bartholomew counties, and we'll each enjoy no competition." With this being an all-red State House, nobody would ever question that.

Re: "I do wish the ACA would allow us to pay the difference between their flat rate payment for a service and what a provider we want charges", the documentation I have from Anthem is ambiguous. In one place it flatly says there is no reimbursement for out-of-network, except for emergency services. In another place it almost implies that you can make a claim to Anthem for a reimbursement of the ACA's in-network payment, but you have to settle directly with the provider and then make your own claim back to Anthem for each item you want reimbursed. Of course, your supplier will charge you for the fully marked up retail price, which is a lot more than they would charge the insurance companies where they are in-network. So as a practical matter, this would probably not be much of a solution.

You need to rethink things.

HSA simply provides some tax savings.

If you are trying to argue that I am somehow contributing to the movement from public to private, that is an absurd argument.

...they got exempted and lots of people are using them as the "more affordable" option (yeah, when push comes to shove and you don't pay your insanely high deductible costs sure are going to drop).

By right HSAs shouldn't even qualify as plans because they don't have the same coverage at all.

HSAs are a right wing way to do health care: http://thinkprogress.org/politics/2006/01/30/3430/the-truth-about-health-savings-accounts/

Forgive me if I don't pity you one bit for demanding one.

It just has a higher deductible and allows you a tax-free account for handling the smaller items. It is like buying a car insurance product that doesn't cover a dead battery. I can buy a new battery on my own. I can't handle the potential risk from third party injury on my own, because that could be millions.

Likewise with health insurance, I can pay for my own dentist visits and the HSA simply allows me to do that tax free. I can't handle the the costs of fighting a brain tumor on my own. That's why I need insurance. By having an HSA account that I can't spend on beer and pizza, it is more likely I will take care of the normal preventive care.

There are HSA-enabled policies on the exchange. HSA isn't at odds with the ACA. Those policies meet all the ACA minimum standards just like all the other policies on the exchange. Of course if he had a true nationalized program of health care, I wouldn't need any accounts at all. We would just all be pooled together. But that isn't the system we have today.

And a huge chunk of preventative care is now free with no deductible or co-pay.

That is the nature of for-profit corporations. They run right up the edge of the laws (and then some).

The HSA feature doesn't change the fundamental insurance proposition. It just means that the policy-holder will pay for routine items himself rather than running all that junk through the bureaucracy of an insurance company.

Was that true, too?
[hr][font color="blue"][center]You should never stop having childhood dreams.[/center][/font][hr]

How would doctors know where you got your insurance? ACA provides info on the exchange. Once you have purchased your insurance and have a providers there some special notation on your card the shows it was purchased through the exchange?

I don't understand this concern.

The point is that, at least in my area, and at least for 2014, providers are treating ACA policies like the Medicaid network, and most of them have elected not to accept that insurance.

How would they know? That's why they always ask for your insurance card every time you go into any provider's office. They run the policy to determine what the financial transaction will be. If you come in with an ACA policy and they have elected not to participate in the ACA network (as apparently 80-90% of the providers in my area have done, then I assume they will only see you if you agree to pay in full out of pocket on the day of the visit.

Don't make assumptions that this is just like health insurance has always been. It isn't. ACA is turning a lot of stuff upside down.

-Laelth

for the great metropolitan area. And when I go into the exchange there is only one real insurance company (Anthem). There are a couple of policies from a company nobody has heard of that is a local outfit that has been doing nothing but Medicaid processing prior to now.

And because there is no competition, the premiums are sky high.

how much the state supports the ACA and how good the system in working.

Shocking, I know.

The SC decision in favor of 'states rights' is coming to fruition.

is that nearby states like Kentucky and Ohio will be so successful that Indiana residents will demand that we get some of that.

?

All I can say is that for my particular circumstances, there are 18 policies listed. 16 are from Anthem with that same minuscule provider network. The other 2 are from a company I have never heard of. They are a local "non-profit" that has until now served only the Medicaid market. Basically friends of the Governor, as far as I can see. Probably a vehicle for him to launder Medicaid money into the pockets of friends and campaign contributors.

Sound's like if you did'nt have insurance it will be a good deal.

But if you did, it's to be higher with a worse coverage.

All the policy's I have looked at have huge ($6000-$7000) deductables.

One good thing about the ACA is that they do make sure there's a variety of coverage options in each state. Yes, the cheapest plans have high deductibles, but if you look closely you can find ones that have office visits, ER visits, and prescriptions covered with a copay. I was very scared when my old insurance through my company raised the deductibles, but I rarely had to touch it.

You have to shop smart to find the best coverage for you and your family, but that's pretty much like everything else in life.