Remember President Obama promising “You can keep your doctor“, well he’s not the first politician to blatantly lie to the public to get his bill passed and he won’t be the last. Unfortunately, health insurance changes impact millions of Americans. When this “hits the fan” and people visit their doctor only to find out their doctor is no longer in-network, the outrage will set in about the time the Dr.’s assistant asks for a credit card before the doctor will see you. Blue Cross cancellation sends consumers scrambling
Right now, most people have no idea what has happened. Insurance companies were put in a terrible position by this law (forcing them to offer every benefit under the sun in every policy) and were forced to offer ridiculously low reimbursements to doctors through their PPO plans. Many hospitals decided not to accept the low reimbursement rates being offered by Exchange plans. Insurance companies are also forced to take anybody that signs up for their plans (no paying extra if you are ill) and to no surprise their risk pool became much worse as people with serious preexisting conditions jumped on the offer like bees to honey.
Approximately 173,000 BCBS insurers alone will lose their doctor in IL starting 1/1/2016. If you signed up for a Gold, Silver or Bronze Exchange offered health insurance plan I suggest you get online right away and look for your doctor. I found out about this when a client was outraged when his individual premium was raised to about $900/month. When we looked to change from his current policy to a cheaper option within the Exchange we found out that his doctor was not in the Exchange plan network. Upon further review, we noticed that most major hospitals in Illinois were not in the limited Exchange network. No wonder it was a much cheaper premium! The BCBS PPO (large network) is not offered with Exchange Plans. United Healthcare may discontinue offering insurance through Exchanges all together (“We could not sustain the eroding level of losses on our exchange products,” CEO Hemsley said during its annual meeting with investors). Humana is no longer even offering healthcare for individuals in Illinois. Many insurance plans are no longer being offered, forcing individuals on to Exchange plans, meaning they will lose “in-network” access to their doctor.
The outcome is that insurance companies are offering very small networks in their “Exchange Plans” or not offering the Exchange plans at all.
If you go to an “out-of-network” doctor, your co-pay won’t apply, nor will you get the negotiated discount you were used to getting from seeing an “in-network” doctor. Not just in IL: In parts of California, for example, low reimbursement rates have resulted in a doctor rebellion, as nearly seven out of 10 doctors refuse to participate in the exchanges.
For now, these changes are focused on individual or family policies and does not effect employer health insurance plans. However those could be next.
For my family of five: If I wanted a Bronze (cheapest high-deductible Exchange plan with BCBS) Exchange plan with BCBS, my monthly premium would be $1,025. My deductible of $13,100 (in-network) would be applied for everything other than one basic checkup for each family member. This plan’s out-of-network deductible is $45,000. This is critical because most majors hospitals are OUT-OF-NETWORK!!!! Central DuPage Hospital, Good Samaritan, Rush, U. of Chicago, Northwestern, etc. are not in-network for the BCBS Exchange plan!
So I am being asked to pay $12,000 (family) per year in premium and then my family deductible of $13,000 in-network or $45,000 per year out of network. Really? Can most people afford the cheapest plan out there, with a terribly small doctor network? What’s the point?
Medicare doctors could be next as their reimbursement rates are ridiculously low and they may opt up as well.
Watch this whole system implode in 2016.
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