Page 1 of 2 12 LastLast
Results 1 to 10 of 16
  1. #1 (Some) Fancy pants doctors won't accept PPO from the exchange 
    Senior Member
    Join Date
    May 2008
    Location
    midwest
    Posts
    2,058
    link

    flamingdem (26,849 posts)

    (Some) Fancy pants doctors won't accept PPO from the exchange

    So I'm all happy thinking that I can get great care with Blue Shield or Anthem PPO in California on the Silver plan. I used to pay these companies so much money for large deductible policies that were just a step above catastrophic coverage.

    However today I called an orthopedist who was recommended to me. The receptionist admits that none of the doctors in the group will accept ACA policies because the payments to are too low. They are "in negotiations" but have pretty much made this decision.

    She advises me to use Kaiser's HMO program because her sister apparently finds it great but then I don't get to see my doctors! What's the point?

    Then I realize that this may be true with other specialists or expensive doctors as well and it could cause major problems. Why isn't an Anthem PPO policy bought on the exchange as good as Anthem via a business plan from before? How can they use the same name for it? This will perpetuate a two tier, multi-tier treatment program that doesn't benefit those of us who want to access the best doctors. I'm pissed.

    It seems like this was an oversight, not forseen?, greed driven and unexpected? or that it was always part of the plan to have expensive specialists bow out.

    Opinions? Experiences?
    Hmmm. Who could have predicted this? Doctors that have loans and big bills aren't willing to see patients that they can't make a profit on. (Making a profit=being able to pay your business costs and have enough left over to pay your school loans and have enough to live on. Not to mention that with mainly sick people buying into Obamacare they might not get paid at all...or have to accept even less money.

    Liberals are SHOCKED, SHOCKED I tell you, that the concerns and arguments against Obamacare from the beginning from Conservatives is really TRUE.

    But pie in the sky liberals think that it's all the greedy insurance companies and doctors fault and if everyone had just bowed before Obama it would all be just perfect.

    No Republicans voted for it. Obama didn't allow any input from Conservatives. All of the yammering liberals have done about how Obama has tried to work with Republicans=I won, live with it. That's how liberals define "bipartisanship" when they have the presidency and congress.

    It's just too bad we can't limit the effects of Obamacare to liberals and democrats.
    Star Member NYC_SKP (54,830 posts)
    12. I think "many more in the system" is a red herring. I think non-PCPs are edgy about being paid.

    I had an issue for which I needed elective services and cannot find a provider to save my life.

    No excuses, actually one receptionist said something about insurance and then backpeddled that during a second call.

    So I think they're in a "wait and see" mode.

    Everybody is probably up to date on their boat and Porsche and vacation home payments.
    Yea, those rich greedy doctors.
    Hoyt (14,384 posts)

    3. Docs want to get their share just like other greedy participants in health care system.

    Personally, I like going to doctors who take Medicaid because you know their heart is in the right place. A good number of the others are in it for more than just a decent living.
    flamingdem (26,849 posts)
    6. Here's the crazy thing - these fancy doctors DO take Medicare

    so I guess that implies that ACA is paying less than that.

    I really hope they can resolve this because that should not be happening.

    Does point to Medicare for all as a better solution.
    Star Member notadmblnd (17,753 posts)
    5. Well I guess if they think the 1% will take care of them, then I say go for it Doc.

    personally, if I were a Dr. I think I would want a piece of the pie that 40 million+ newly insured people are going to bring to the table. Hell with the lower payments, I'll make it up in volume.
    Yea, that's the thing. Either refuse to give anyone more than 10 minutes of your time or work 120 hours a week instead of 60-80.
    flamingdem (26,849 posts)
    24. I'm more pissed at the doctors than ACA

    but I think there are many issues cropping up here.

    I used to be able to see any doctor that took PPO -- almost all doctors do.
    Now I'm limited to a narrower group of doctors. Not every doctor fits the
    bill.

    Speaking of bills, that IS the point. Why waste money on a doctor who is
    NOT up on my issue when I've gotten a clear recommendation for one who
    IS up on it - but I can't see him now. THUS it will cost me more CASH so
    what's the point of saving money via ACA when I'll end up spending as much
    because I only want to see certain specialists, not an up and coming specialist
    because I know from experience that is a waste of time and money.

    This is not a good thing for patients in my opinion. We'll see how it shakes out.
    Reply With Quote  
     

  2. #2  
    Senior Member
    Join Date
    Jun 2008
    Posts
    9,802
    The DUmmies aren't reading the papers. And I can guarantee that none of them even looked at the actual legislation three years ago.
    Reply With Quote  
     

  3. #3  
    Fabulous Poster
    Join Date
    Mar 2010
    Posts
    10,161
    What a whiny load of crap. I switched to an HMO years ago both to save money and because it didn't have a maximum benefit. My GP at the time said that he didn't accept my new plan. Much like the poster in this thread, when I checked the list of available doctors, it said that my then doctor did accept the HMO. Well it turned out that there were different plans with the same name and not all doctors were with one or the other.

    So I went with the new doctor on the new plan. No big deal, and he was closer to my house. Now I could bitch and moan about "can't see MY doctor" but in reality, the only reason he was my doctor was because he was in the United PPO directory and was near my house.

    Most doctors have a huge patient load and always have. Mercedes isn't giving away cars.
    Reply With Quote  
     

  4. #4  
    Sin City Moderator RobJohnson's Avatar
    Join Date
    Apr 2006
    Location
    Nevada
    Posts
    16,973
    Several doctors are changing their alignment with health plans. In higher populated areas it might not be a huge deal, but it's a very big deal in rural areas. Choices with some plans have became very limited.
    Reply With Quote  
     

  5. #5  
    Sin City Moderator RobJohnson's Avatar
    Join Date
    Apr 2006
    Location
    Nevada
    Posts
    16,973
    Increased patient load, more paperwork, higher overhead, larger staffing requirements all with less reimbursements from the insurance companies for services rendered. I don't blame doctors switching to cash only. It will get worse in the next 12 months.
    Reply With Quote  
     

  6. #6  
    Destroyer of Worlds Apocalypse's Avatar
    Join Date
    May 2008
    Location
    Locked in a Dungeon, being tortured and LOVING IT!
    Posts
    5,180
    Quote Originally Posted by Elspeth View Post
    The DUmmies aren't reading the papers. And I can guarantee that none of them even looked at the actual legislation three years ago.
    Their reading the papers.

    NYT's
    SF Gate
    SF Times
    Boston Globe
    Chicago Sun-Times

    You know, sources that will parrot the liberal line and way of thinking.
    Rest In Peace America
    July 4, 1776 - January 20, 2009
    Reply With Quote  
     

  7. #7  
    Resident Grandpa marv's Avatar
    Join Date
    Jul 2009
    Location
    Shell Knob, MO
    Posts
    3,035
    Are the DUmmies on the verge of learning about socialized medicine?

    http://members.socket.net/~mcruzan/images/allen-west.jpg

    Four boxes keep us free: the soap box, the ballot box, the jury box, and the cartridge box.

    THIS POST WILL BE MONITORED BY THE NSA
    Reply With Quote  
     

  8. #8  
    Senior Member txradioguy's Avatar
    Join Date
    Apr 2005
    Location
    Bavaria
    Posts
    7,815
    Quote Originally Posted by Elspeth View Post
    The DUmmies aren't reading the papers. And I can guarantee that none of them even looked at the actual legislation three years ago.
    Nope. Because if they HAD read the actual legislation...or even done a little nadin'ing on the innerwebs they'd have discovered this little hidden jewel in Obamacaare:

    ...many major hospitals are being excluded from Obamacare coverage altogether, which means that millions of previously covered individuals will have to settle for subpar care at other "in-network" facilities.



    most of the nation's top hospitals, including renowned facilities like Case Medical Center in Cleveland, Ohio, will only be accepting insurance from one or two companies included as part of Obamacare. This means that all the other insurance plans offered on the Obamacare exchanges will be ineligible, and many patients will be required to go to other facilities, even if their previous insurance plans were accepted by these same hospitals.

    "Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies," explains U.S. News & World Report about the report's findings. "Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare."

    Included in the survey were 18 revered medical centers across the country, as ranked by U.S. News for 2013-2014. Investigators contacted each of these hospitals to inquire about their contracts with insurance companies, how plans would be handled under Obamacare and who would be covered. They found that almost every hospital would not be accepting the vast majority of insurance plans offered under Obamacare, because the carriers are considered "out of network."
    http://www.naturalnews.com/042831_Ob...ce_plans.html#
    In Memory Of My Friend 1st Sgt. Tim Millsap A Co, 70th Eng. Bn. 3rd Bde 1st AD...K.I.A. 25 April 2005

    Liberalism Is The Philosophy Of The Stupid

    To Achieve Ordered Liberty You Must Have Moral Order As Well

    The libs/dems of today are the Quislings of former years. The cowards who would vote a fraud into office in exchange for handouts from the devil.
    Reply With Quote  
     

  9. #9  
    Sin City Moderator RobJohnson's Avatar
    Join Date
    Apr 2006
    Location
    Nevada
    Posts
    16,973
    Quote Originally Posted by txradioguy View Post
    Nope. Because if they HAD read the actual legislation...or even done a little nadin'ing on the innerwebs they'd have discovered this little hidden jewel in Obamacaare:



    http://www.naturalnews.com/042831_Ob...ce_plans.html#
    The same hospitals that turn away Medicaid patients after emergency care was administered PRN (as needed to get the patient stable for transfer) will be turning away Obamacare patients as well.
    Reply With Quote  
     

  10. #10  
    Fabulous Poster
    Join Date
    Mar 2010
    Posts
    10,161
    Quote Originally Posted by RobJohnson View Post
    The same hospitals that turn away Medicaid patients after emergency care was administered PRN (as needed to get the patient stable for transfer) will be turning away Obamacare patients as well.
    What do you think of as "Medicaid level care"? The last time I was in the hospital, the man in the next bed was indigent. He got the same level of medical care that I did, better actually because he needed more care. Had he been eligible for Medicaid then he might not have had to be admitted to the hospital in the first place. He was a diabetic whose kidneys had stopped working. Had he had routine medical care, then he would have known this was coming, and he could have been prepared for outpatient dialysis. As it were, he was admitted through emergency, remained in crisis for a week, and had to have a dialysis catheter while his arm got ready for dialysis. A very expensive way of doing things.
    Reply With Quote  
     

Bookmarks
Bookmarks
Posting Permissions
  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •