Vegas Free-for-All - I had a delightful conversation with a health Insurance company rep this morning

I had a delightful conversation with a health Insurance company rep this morning

hoops2

Mar 18, 2014
12:22am

In order to work within the parameters of obamacare (keeping it affordable) the insurance companies had to set rates & based on those rates could only afford to pay doctors certain amounts. Based on those reimbursement rates (based on obamacare parameters) doctors are not accepting the insurance.

We are also seeing cases where obamacare says doctors are in a plan but in reality are not.

Remember when obama said we had to do this in order to cover the 40+ million uninsured? Now we are seeing maybe 1 uninsured million signed up (less than that have paid) and obama now says there still will be 30+m uninsured.

So what was the point?

A key funding of this was the medicare cuts to doctors which congress just changed back.

alanleroyII

Mar 18, 2014
12:46am

Block User

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Originally posted by: pjstroh

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Originally posted by: alanleroyII
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Originally posted by: pjstroh
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Originally posted by: alanleroyII
A front page story in my local paper 'The Fresno Bee' recently pointed out a major flaw in Obamcare and it's California implementation 'Covered California'. Local Doctors are just not accepting those plans.

https://insurancenewsnet.com/oarticle/2014/03/16/some-calif-doctors-rejecting-aca-plans-a-475154.html#.Uyg3sy3n99A

"Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low."

"The 160-doctor Central California Faculty Medical Group -- one of the largest private physician groups in Fresno -- decided not to accept patients with PPO plans through Covered California.

"We would be paying to see patients, and we just couldn't afford to do that," said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group, which is affiliated with the University of California at San Francisco-Fresno Medical Education Program."

So, although these particular doctors are not leaving the profession, I can see why many doctors might conclude that physicians 'paying to see patients' is not a sustainable business model.

Is there something in Obamacare that tells insurance companies how much they pay doctors for their services? I dont believe there is. Feel free to correct me by posting that aspect of the law below.

...Oh wait...from AlanLeroy's link....
" Doctors who are not participating in plans through the exchange also are not participating in comparable plans sold in the private, individual marketplace.

But it's been a struggle getting word out to consumers that there is no difference in the providers for a private PPO plan and the equivalent plan through Covered California. "

Ah..but riddle me this..You go to all the time and money and effort to create a massive state run insurance exchange and then the plans that are offered are not being accepted by the a very large percentage of physicians (at least in my city). Remind me what good that is....remind me how funneling a whole lot of new patients to a very few low end providers is going to improve medical care. I guess that may work until it bankrupts them.

Is the exchange the problem? No. Your own link says as much. The private insuance companies set their own prices..not the law, right? But then you blame the law.

Ypuir original post says there is a flaw in Obamacare but Obamacare has nothing to do with the flaw you cite. But thanks for stopping by.

Ok..Let me get this straight. We have spent untold billions implementing a new healthcare insurance scheme. Now, the products actually being offered are not being accepted by a large percentage of physicians because doing so will bankrupt them.

Was this an intended feature of Obamacare...that is it something the Architects planned for or is it a surprise? How does this improve medical care if so many of the actual people doing the real work of medicine decide not to participate? What was the point? Sure PJ can blame the Insurance Companies 'not the law', but doesn't the success of Obamacare depend on, you know....doctors actually participating?

Hey, maybe Fresno is an anomaly. Maybe other areas are more successful. Around here, the largest private doctor groups are opting out. That doesn't bode well for Obamacare in these parts. Spin it any way you want, but the Obamacare enrollees that can't find a doctor or have incredible waits to see a doctor are going to start wondering why they are paying those premiums....subsidized or not.

pjstroh

Mar 18, 2014
12:52am

Block User

Quote

Originally posted by: hoops2
In order to work within the parameters of obamacare (keeping it affordable) the insurance companies had to set rates & based on those rates could only afford to pay doctors certain amounts. Based on those reimbursement rates (based on obamacare parameters) doctors are not accepting the insurance.

We are also seeing cases where obamacare says doctors are in a plan but in reality are not.

Remember when obama said we had to do this in order to cover the 40+ million uninsured? Now we are seeing maybe 1 uninsured million signed up (less than that have paid) and obama now says there still will be 30+m uninsured.

So what was the point?

A key funding of this was the medicare cuts to doctors which congress just changed back.

I'm sorry, what parameters are you speaking of? I've asked three times for someone to show me how the government sets payment rates for doctors. And I see you responded with your usual source.

Insurance companies are free to charge whatever rates they want so long as they dont go beyond 20% profit margins for the care they provide. They can pay a doctor $1000 or $1 for a bandaid. Thats their business..and that was true both before Obamacare and now.

What you are seeing in california is what Conservatives pretend like they advocate....the Free Market in action. Insurers are competing with each other on price. Some of them may have priced their payments to doctors too low in the process of trying to lower their rates to attract customers. They have complete freedom to alter that. Does Hoops think the government should tell insurers what to pay doctors? If not, then Hoops' compalint is completely disingenuous. I guess there's a first time for everything.

snidely333

Mar 18, 2014
12:54am

Block User

If doctors won't accept my obamacare insurance then why should I pay for it. I'll just go back to being uninsured and have more money in my pocket. Why pay for something with no benefits.

hoops2

Mar 18, 2014
12:56am

Block User

I believe HHS had to approve the plans and rates before being accepted into obamacare. Since HHS approved the premiums, the insurance companies had to set rate schedules to fit those premiums. Some doctors cannot provide a high quality of care based on those reimbursement rates

pjstroh

Mar 18, 2014
12:59am

Block User

Quote

Originally posted by: alanleroyII
Ok..Let me get this straight. We have spent untold billions implementing a new healthcare insurance scheme. Now, the products actually being offered are not being accepted by a large percentage of physicians because doing so will bankrupt them.

Was this an intended feature of Obamacare...that is it's something the Architects planned for or is it a surprise? How does this improve medical care if so many of the actual people doing the real work of medicine decide not to participate? What was the point? Sure PJ can blame the Insurance Companies 'not the law', but doesn't the success of Obamacare depend on, you know....doctors actually participating?

Hey, maybe Fresno is an anomaly. Maybe other areas are more successful. Around here, the largest private doctor groups are opting out. That doesn't bode well for Obamacare in these parts. Spin it any way you want, but the Obamacare enrollees that can't find a doctor or have incredible waits to see a doctor are going to start wondering why they are paying those premiums....subsidized or not.

No, low reimbursement prices were not an intended feature of Obamacare...because Obamacare has NOTHING TO DO WITH THEM. Low reimbursement prices are not a feature of Obamacare in any way shape or form. You keep pointing to a "cause-and-effect" relationship between what insurers pay doctors and the ACA which has nothing to do with that process..

I suspect the insurance companies want to stay in business so they will likely raise their payment rates to doctors in your area in time. I would expect that will be necessary if they want people to buy their plans.
Thats the free market way, isn't it? If you can show me how Obamacare interferes with their ability to do this I will concede your point. Otherwise you dont have a point.

drmilled

Mar 18, 2014
1:03am

Block User

And the truth about Obamacare just gets more ugly every day. Implementation of Obamacare has set into motion ALL of the aforementioned results. Stay tuned for more of the same.......

forkushV

Mar 18, 2014
1:05am

Block User

Quote

Originally posted by: alanleroyII
Ok..Let me get this straight. We have spent untold billions implementing a new healthcare insurance scheme...

Nope, you didn't get that straight, you made it up.

forkushV

Mar 18, 2014
1:10am

Block User

Quote

Originally posted by: snidely333
If doctors won't accept my obamacare insurance...

The Mayo Clinic accepts Obamacare. The Cleveland Clinic accepts Obamacare. Johns Hopkins accepts Obamacare. UCLA Medical accepts Obamacare.

And a doctor cartel in....Fresno! - doesn't.

snidely333

Mar 18, 2014
1:42am

Block User

Quote

Originally posted by: forkushV

Quote
Originally posted by: snidely333
If doctors won't accept my obamacare insurance...

The Mayo Clinic accepts Obamacare. The Cleveland Clinic accepts Obamacare. Johns Hopkins accepts Obamacare. UCLA Medical accepts Obamacare.

And a doctor cartel in....Fresno! - doesn't.

Years ago when I had crappy insurance, they'd say that xyz hospital accepts my health insurance. But that didn't mean that every doctor in the hospital accepted it. Lots of doctors didn't accept it. Do all the doctors at the Mayo Clinic (for example) accept Obamacare or just some of them.

I'm very happy I'm insured by my company sponsored plan via Cigna and I don't have to deal with Obamacare.

Being ill sucks enough without getting screwed over by the doctors or insurance company.

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