If you liked your neighbor’s health care plan…
…you can’t buy it, if it was grandfathered in.
Not for any amount of money.
Or anything like it. At least, in California, and probably in many other states.
We already knew that Obamacare has led to many cancellations of individual policies, and that people were complaining about it because many liked those policies. We also knew that the Obamacare exchanges (especially in California, but in many other states as well) feature what’s known as “narrow networks.” That is, counter to Obama’s promise about keeping your doctor and your hospital, many (in fact, most in California) doctors and hospitals will not be covered on the plan. So it is insurance that’s offered on the exchanges, but you won’t be able to go to many of your favorite and customary doctors and hospitals, often the ones with the best reputations. If you purchase insurance on the exchanges, you will be shut out of them unless you want to pay completely out-of-pocket, which almost no one can afford.
What I didn’t know, though—and what I’ve just learned from some research I did for a relative who lives in California—is that even individual insurance policies sold off the exchanges in California feature very narrow networks. Insurance companies have had to revamp their policies to cover pre-existing conditions plus those mandatory things (maternity, etc.) that many people don’t want, and so they’ve had to cut corners somewhere, and that “somewhere” is in choice and doctor reimbursement levels, resulting in narrow networks.
That’s not unexpected. What is unexpected is that companies are not offering the choice of buying more expensive individual policies with wider networks. No such animal exists anymore, except that policies that were grandfathered in still have the wide networks of old.
So you have a curious two-tier system where people in the individual market who bought policies in 2013, right up to December 15 (retroactive to December 1), have a lot of choice of doctors and hospitals. But a person who buys a policy after that date—or even before it, if that person didn’t want the policy to start until January 1, 2014—will find that his/her choice will be sharply reduced. It that person wants to go to a non-participating doctor or hospital, he/she won’t just pay a little bit more or have a higher deductible, as often happened in days of yore, either. That person will pay entirely and completely out-of-pocket.
You can’t buy any other type of individual policy in California. You can’t even pay more for more choice, as you used to be able to do, although the networks were wider then to begin with.
Health insurance could have been reformed without restricting or even ending choice this way. But that’s not what they were after, was it? They were after what Churchill called “the equal sharing of misery,” and by gum they will get it.
[NOTE: The individual market is mostly for the self-employed. Those who have group insurance (small or large) through their employers still have access to the old wide networks for the most part, creating a system of health-insurance proles (the self-employed) and health-insurance aristocrats (the group folks).
For now, anyway. Watch out, groupies. Are you next? If that happens, the doctors who are boycotting the exchanges and the individual market right now might be forced into them—and lower reimbursement rates—just to survive. And that’s probably part of the plan, too.]
[ADDENDUM: I was just on the phone with an insurance company in California (been doing a lot of that lately), and the person I was talking to contradicted what other people had told me. I don’t know who’s right and who’s wrong, but this person said that there are still deductibles and out-of-pocket maximums for out-of-network coverage, although the figures for them are at least double the in-network figures for deductibles and out-of-pocket maximums, and it’s hard to find the figures on websites. In addition, health care providers can do what’s called “balance-billing”—charging patients for the difference between what the insurance company considers the customary cost and what the provider considers the actual price, so that those out-of-pocket maximums for out-of-network providers are not really maximums at all, and the patient can be liable for much more.
My guess right now? Nobody really knows how it will go, even the insurance companies themselves. But most people don’t know enough to even ask the questions about networks. They just assume the new networks will resemble the old ones, and they assume wrong.
Plus, the agents themselves really have no idea who’s in the networks. They look it up online just like the rest of us, and the online lists are incorrect in both directions (too many or too few doctors).
What a farce, except not a very funny one.]
[ADDENDUM II: I’ve added lots more information here about my understanding of how out-of-network works, including what happens with out-of-state providers, and in emergencies.]
Neo said: Health insurance could have been reformed without restricting or even ending choice this way. But that’s not what they were after, was it? They were after what Churchill called “the equal sharing of misery,” and by gum they will get it.
Lefties prefer a society where everyone is poor (Cuba) to one where there are lots of rich people even in the latter case (U.S.) where poor people have a higher material standard of living.
I recall a speech Maggie Thatcher gave in Parliament wherein she pointed out that Labor would prefer a society where no one did better over time to one in which the poor did better but did not do as well as the rich.
In the high and far-off times, O best beloved, “networks” worked differently.
If you had a network policy, you paid less. If you went to a network provider, you got better compensation (lower co-pay and deductible) because the network providers had contracted lower reimbursement schedules with the carrier.
If you went to a non-network provider, you got the usual comp, still not a bad deal.
There were a few plans whose eligible provders were restricted by geography (three counties or something)I heard of but never saw. Don’t know what went on if you were outside that area.
So my question is what is the arrangement with non-network providers? No coverage at all, or reduced coverage?
If no coverage, that’s going to be a Biden Freaking Deal.
Richard Aubrey:
Almost certainly no coverage at all, and certainly no coverage if you buy on the exchanges.
However, if you look at the addendum to the post, I spoke to one person who said some limited coverage (I believe he meant half of their usual and customary reimbursement) that might start only once you’ve paid double your deductible out-of-pocket to non-network providers. How many people can afford that, in addition to what they pay to network providers, and how many people will ever get above that sort of figure?
And that was only true of Anthem, and he wasn’t sure, and it wasn’t clear whether it was true for Anthem on the exchanges, too (I do not think so) or only if you buy it at full price from Anthem off the exchanges. That’s in California, by the way, and the networks are different in different states and even in different counties in California (it would take several thousand words for me to explain this more completely, so a brief summary will have to do in this comment—although I will add that Anthem calls all out-of-state providers out-of-network, even those who are in the Anthem network for the same type of insurance you have; Cigna allows you to go to providers in other states as long as they’re in the national narrow network in your category).
Cigna, which is not on the California exchanges at all, is still selling policies that offer very limited out-of-network coverage. The deductible for out-of-network coverage is $12,500, and after that they’ll pay 50% of their usual and customary coverage, and the hospital/doctor can bill you for the rest, which you must pay by yourself. That figure that you pay is added on to the $12,500 you’ve already paid to meet the out-of-network deductible, and it’s only after the figure you’ve paid out-of-pocket for out-of-network services reaches $25,000 that Cigna will kick in for 100% of their usual and customary payments. Even then, when you’ve paid 25K out-of-pocket out-of-network, you are liable for the balance, if the hospital or doctor wants more for the service than Cigna was willing to pay them.
It’s complicated. What it means is that if you are very ill, and want to go for extensive treatment (for example, for special cancer treatment) to someone out-of-network, you will at some point get Cigna to pay for some of it. But it’s different from the way it used to be, because the out-of-network deductibles are higher, and at no point will the insurance company pay 100% of what the doctor or hospital might bill you, even if you’ve paid your full out-of-pocket maximum. Some hospitals will negotiate with you to accept a lower payment from you, but I imagine some want the full fee from you, which could be practically astronomical depending on how little the insurance company decides it will pay.
One more thing I forgot to mention: bona fide emergency services, even to an out-of-network provider, are still treated as in-network. But the definition of “emergency” (impossible to predict ahead of time except in the most clearly dire circumstances) is probably quite narrow.
All this and he had the unmitigated gall yesterday at his “poor wittle me” press conference to say that “because of my presidency, we are now a country that takes care of one another”.
He is without a doubt, the biggest piece of crap to ever hold the office of president. And probably the biggest piece of crap in American history.
By the way, Merry Christmas everyone!
southpaw:
It depends on what the meaning of “takes care of” is.
Remember, he’s a Chicago-type guy.
Even with a wider (old) network you have to be careful. Just had a situation where the surgeon was covered, but her assistant (who’s a member of the same group practice) was not. So I may end up having to pay the asst surgeon’s fee (or at least any negotiated amount…still under discussion) out of pocket. We HAD confirmed with the insurance the week prior to surgery that everything was covered. Guess not…
Those special plans were designed for the elites and those born with the right to rule. Peasants and other riff raff will never be allowed to merely “buy it”. What kind of sumptuary law over preserving health resources do people think they live under here?
How is a health resource going to be preserved if just anyone can buy it?
The Left would rather equalize the differences. If, say, you earned 6 units of wealth and they earned 9 units of wealth, they would rather make it so that you earned 0 and they earned 7.
You see, in the first case, the difference is 3. That’s not enough to highlight the Left’s elite status in being the only “real” humans around. Instead, if they reduce you to a Zero, their advantage over you is 7. A full 7 points. That’s more than twice their advantage over you in the first case.
So the Leftist alliance of evil will always prefer such a scenario, even when given a choice to have even more resources at their command. They don’t want more resources for everyone, and even at the cost of reducing their “stash”, they will hammer you for being the nail that sticks out.
In a few weeks as the new year begins the excrement is going to hit the rotary ventilator. Large numbers of people will try to use Medicaid for the first time. Large numbers of people will be without health insurance for the first time in many years. Insurance companies will be swamped as people try to pay premiums. Doctors and hospitals will try to determine if a person has insurance and what it covers. People will resort to telephones and paper to get information, but the insurance companies will be too backed up to help.
I’m trying to see how this thing ends and not too badly.
Aside from offering Medicare products, word on the insurance street is that Humana, Aetna and United Healthcare have all pulled out of California. Can anyone here verify?
In an age of increasing information and training and technology, the power of the black market increases.
See Kevin D. Williamson,
http://en.wikipedia.org/wiki/The_End_is_Near_And_It%E2%80%99s_Going_To_Be_Awesome)
Remember the movie “Minority Report?” The protagonist gets a new set of eyeballs!
In other words, in twenty years, a revolution equal to the Industrial Revolution is going to change all the rules.
Wait for it.
The truth be told though; aren’t we going to “uncovering” things about Obamacare for a long time to come?
I mean, really, no one read the law before it was passed; and they included a paragraph or two which allows the President (read that as Obama the Supreme) to change any aspect of it as he sees fit.
The law as applied to one person (or person of a certain group) will not be applied to another person in the same manner.
This doesn’t fit the definition of law as I learned it years ago in civic class. Does that make me old-fashioned and out-of-touch with the 21st Century America?
Neo
It depends on what the meaning of “takes care of” is. Remember, he’s a Chicago-type guy.
Good point. 🙂
Leeches and bloodletting at your friendly neighborhood barber shop will soon define quality healthcare for the 99%. Let the misery and frustration multiply. Burn it all down, salt the earth, and let the game begin. May the odds always be in your favor.
We are nearing the tipping point. This is a good thing.
Neo,
I dont expect any of these issues will be worked out any time soon. How can they be?
The administration is currently just making thing up as it goes along. Even if some of these things get hashed out not only is the law contradictory in places. But simply changes on the whims of the President.
This mass confusion, and inconsistency keeps allowing the proponents to claim the law is whatever they want it to be whenever they want it to be.
And this entire mess will HAVE to continue until the next election. The Dem’s dont dare change anything in writing because it will be admitting how bad the law truly is
To make matters worse I see that even if the Democrats lose hugely the next election. It will continue. Obama will dig his heels in even harder in that case and will continue to pump out false numbers to cover up the whole disaster.
In my lifetime I never thought I would see anything like this. The entire power structure lying from the President on down the lowest bureaucrat. Every level and every step showing such massive and downright corruption. And not only not even displaying a bit of shame, but not even bothering to hide their hand and when caught simply doubling down on the initial malfeasance. Bringing more and more into the lie until it collapses under its own weight. Our government massively resembles the mess the Soviets were in in the early 80’s. With slightly better PR.
Back when the health insurance system was broken, the company I used most often would provide a phone-book-size index of network providers for the state. If you were out of state, you could call them and get the network providers in the state where you happened to be and get the same bennies as if you were home.
And out of network was comped as their conventional plan in state or not.
Yeah. That had to be fixed.
I foresee that a lot of Ancient Chinese “heal thyself” methods are going to get suddenly a lot more popular, and cost effective. Chi gong, Taiji Chuan movements, all the good stuff.
Since most of the instructions and training is in a foreign language, unregulated like the MMA too, people will have an easier time staying under the IRS and ATF “radar’.
To Mr. Frank , on December 21st, 2013 at 3:49 pm:
Here’s a link to a short (2:33) video of Lady Thatcher’s classic comments about the Left’s true preference.
I would guess that most of the folks here have seen this clip before, but it never hurts to see it again. IMHO it was one of her greatest moments.
Thanks carl. That is the quote I had in mind. Lady Thatcher had a way of getting to the heart of an issue and she did not suffer fools gladly. You can make a good argument that she saved modern Britain which was the sick old man of Europe when she came into office.
Even if someone can figure out the state of affairs at this particular moment, it would be dangerous to plan on it because the Administration is flipping like a weather vane in a tornado.
Apart from that, I get that Chief Justice Roberts essentially re-wrote the law to make the individual mandate a tax to pass constitutional muster, but I still don’t get how the federal government can order insurance companies in the states to provide a specific level of coverage. Where does that federal authority acquire legitimacy?
I travel throughout the US as an IT consultant. I can’t find ANY policy available to me which will provide coverage when I am outside of my home area. All of the policies I’ve examined so far (at least 50) restrict coverage only to a small network in my home area, and any medical care required when traveling must be paid out of pocket, as if I have no insurance at all. Any out-of-pocket payment for such care applies neither to the deductible nor to the maximum out-of-pocket limits.
Apart from the compliance aspect of ACA, why should I (be forced to) purchase a product which provides little or no benefit to me?
LudditesBane:
Obamacare is a travesty in so many ways, and restricts freedom of choice in so many ways, that I weary of listing them and ranting about them. However, you have my sympathy/empathy.
I don’t know about other states, but in California, in the individual market (off-exchange market) Cigna allows you to go to people in their network who are out of state, and it’s considered in-network. Is Cigna in your state? Have you called them?
In addition, in a really serious emergency (as defined ex-post-facto by the insurance company) emergency treatment can be gotten anywhere and is considered in-network.
“In my lifetime I never thought I would see anything like this,” said Mythx. Oh, me too. In the early 1980s one of my law professors (wish I could remember which one) cautioned us that all that kept the Constitution going was the choice of our lawmakers and citizens to continue to respect it and continue to observe it — that whenever that choice ceased, so would the Constitution cease, and so would cease our greatness as a country. At the time, I listened uneasily and told myself that of course that respect would continue, that Americans would never be dumb enough to toss aside what made us great. Of course not. Only I was wrong, we are that dumb –and here we are.
You can make a good argument that she saved modern Britain which was the sick old man of Europe when she came into office.
Modern Britain isn’t saved, hasn’t been saved, and doesn’t deserve to be saved.
All leaders at the top can do, is to slow the corruption. As with Ancient Rome, they will fail to stop it entirely.
The Left are enemies of humanity for a reason. And it’s not due to their politics.
People have been pandering the Left for decades, if not centuries. It scares them, this Leftist alliance. It’s bigger than they think. It’s bigger than they can handle, so they deny it. They told the rest of us that were just right wing idiots or crazy wingers or Bush puppet wannabes. They told us that there was no such thing as the Left, Democrats will always be “moderate” because of elections.
They told us we’re just in a conservative echo chamber, that we’re grouping the Leftists up unfairly, that it’s just us calling them names like liberal or Leftist or socialist or communist. It doesn’t represent their Real Values.
Well, eventually even illusions die off. That mirage of water in the desert is only good for so long.
Rachelle Says:
December 22nd, 2013 at 4:55 pm
It doesn’t. You put your finger on it.
We no longer have a legitimate federal government; just a gang of criminals intent on imposing their will on us.
Think I’m kidding?
Gangs and Politicians in Chicago: An Unholy Alliance
I don’t believe for a minute that this sort of thing is merely restricted to Chicago.
If you like your neighbor’s boy, you can keep his boy as a sex slave.
http://ymarsakar.wordpress.com/2013/12/22/gay-activism-anti-humanism/
That’s in the works already by gay activists.
Don’t believe it? You don’t have to. Just sit back and let the Left do the convincing. They are very convincing and persuasive, whether people like it or not, they will come to believe in it one way or another.
Collectivism is an overwhelming juggernaut unless individuals as uncollectivized singletons stand up to it (most getting blown away).
That day and time has passed, Mrs. Whatsit.
If you like your doctor, you can keep him… unless he’s in another state…
Americans already know that ObamaCare means higher premiums and a shrinking roster of doctors. But they have not yet realized that ObamaCare plans are not portable and will impede their ability to travel.
Welcome to the reduced mobility elements of Teh Onederous Health Care Plan…
ObamaCare May Devastate the Real Estate and Travel Industries
}}} They were after what Churchill called “the equal sharing of misery,” and by gum they will get it.
Don’t be silly. There will be no “equal sharing of misery”. There will be simply “enhanced misery” for everyone… unless you’re already rich and well-to-do, and/or thus well-connected, in which case such problems will magically disappear… Like that pro basketball player that was playing for a Canadian team who somehow got moved up on the list for knee surgery a half-dozen or so years ago.
The rich get richer, the average joe gets involuntary anal sex. This is at the heart of the Government solution pretty much every time.