Did you get screwed by an Anthem Blue Cross of California Obamacare plan in 2014?

I got my first unfortunate lesson in the FAIL of Obamacare in September 2014.

I felt an unexplained pain/scratchiness in my eye, and wanted it checked out. My Obamacare plan started in March 2014, and I hadn't had to use it during those first 6 months, so this was the first time. I used Anthem's website to look up an opthamologist in my area, and found one fairly close by.

I got to my appointment, waited for 30 minutes, and then the front desk called me over to give me the bad news.

They didn't take Obamacare plans.

:shock

They took all Anthem Blue Cross group plans, but not Obamacare. Didn't matter if I had a cheap Obamacare plan or a really expensive one, they just didn't take it, even though it was Anthem Blue Cross. They demanded $150 up front to be seen. I lol'd at them and walked out.

I then sat in my car and went down the list of other doctors in the area on the Blue Cross site. I called each one. Again, I kept getting the same answer: "No, we don't take ACA plans."

Finally I found three, but they were all terrible. One was a Doctor of Osteopathy -- the dreaded DO. No way. The other two were educated in foreign countries notorious for having medical schools aimed at students who weren't able to qualify for medical school in the US. Again, no way.

So I did nothing.

My eye problem went away by itself a few days later.

But that was my intro to Obamacare, despite paying about 60% higher in premiums than I had the year before Obamacare took effect.

Turns out that this was a common experience, and a class action lawsuit was filed.

Unfortunately, I won't get anything from it, because you need to have gotten actual treatment to get a settlement. That's bullshit, because this both wasted my time and misled me into signing up for the Blue Cross plan in the first place, falsely believing there to be lots of doctors in my area that took it. I was stuck on the plan until the end of 2014, at which point I switched companies.

But anyway, if you did find yourself in this situation and paid for the out-of-network care, go to http://www.FelserAnthemBlueCrossACASettlement.com (lol at that URL) and you'll get some money, supposedly.

I got a settlement from a Romneycare company in MA a few years back.

I bought a "cheap as balls" plan (around $121 a month) from the MEGA Life and Health Insurance and Mid-West National Life Insurance company. They reached a settlement amidst allegations that the insurers engaged in unfair and deceptive practices in their marketing and administration of health plans sold to small businesses and individuals in Massachusetts.

What did I get back? A cool $159.26. Wow, Massachusetts AG office, you really showed them on that one!

No matter what side of the isle your on when it comes to HC, the ACA is a flawed attempt to force markets to produce outcomes that markets simply don’t want to produce.

Shouldn't at least some of the blame be put on these clinics that have just decided that they won't accept these plans?

Why yes, yes I did. I let the better half sign us up and then quickly found out that none of my doctors would take it. And I've found out that the medication coverage seems to only apply to generics that have been in existence for at least 60 years. Don't even get me started on the appeals process. It's comically bad enough that i've legit been debating suing blue cross.

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Originally Posted by Hockey Guy

Shouldn't at least some of the blame be put on these clinics that have just decided that they won't accept these plans?

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That is what I was thinking. And I was also wondering whether those same doctors would not accept a similarly priced individual health insurance plan BEFORE Obamacare took effect? My guess is that they wouldn't have. Because before Obamacare, an individual health insurance plan at that price wouldn't have gotten you shit (because individual plans were priced to gouge individual consumers.)

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Originally Posted by rum dick

Why yes, yes I did. I let the better half sign us up and then quickly found out that none of my doctors would take it. And I've found out that the medication coverage seems to only apply to generics that have been in existence for at least 60 years. Don't even get me started on the appeals process. It's comically bad enough that i've legit been debating suing blue cross.

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I ditched Blue Cross and found better coverage elsewhere. But I had to tough it out until the end of 2014 and hope nothing would happen.

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Originally Posted by Hockey Guy

Shouldn't at least some of the blame be put on these clinics that have just decided that they won't accept these plans?

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Kind of.

The geniuses who developed Obamacare didn't bother to consider that, in order to make coverage of all those sick people (who previously didn't qualify for insurance) cost-effective, they would just pay doctors less than they did before.

And then, of course, most doctors said, "WTF? We're not working for peanuts here. We just won't accept these plans."

And that was their right to do, and that's what happened.

The problem was the fact that the architects of Obamacare got so obsessed with the concept of "exchanges" (basically making individual plans mimic group insurance) that they overlooked the obvious situation that adding a lot of sick people to individual insurance plans (at the same premium as healthy people) would be a major financial burden on insurers. They engaged in a mental shell game, believing that the increased number of healthy buying insurance (young people who before just skipped having it) would somehow offset the sick people. It didn't. It didn't come close, especially with some young people just opting to pay the penalty for not having insurance.

I don't blame the providers for refusing to accept inferior payment for people on those plans.

I do blame them for not making this REALLY CLEAR to every new patient who comes in. Some of them just let you come in, and inform you of the bad news moments before you're about to be called in.

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Originally Posted by Hockey Guy

Shouldn't at least some of the blame be put on these clinics that have just decided that they won't accept these plans?

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My guess is that most of the new ACA plans went at doctors the same way as Medicare does i.e. "we'll pay you x amount and that's it take it or leave it". This amount is usually way below the market rate for services rendered thus causing the doctors to say "go fuck yourself". Before now, at least in my understanding, the insurance companies would negotiate a better rate with the doctors, but not issue ultimatums like the federal government.

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Originally Posted by shortbuspoker

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Originally Posted by Hockey Guy

Shouldn't at least some of the blame be put on these clinics that have just decided that they won't accept these plans?

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My guess is that most of the new ACA plans went at doctors the same way as Medicare does i.e. "we'll pay you x amount and that's it take it or leave it". This amount is usually way below the market rate for services rendered thus causing the doctors to say "go fuck yourself". Before now, at least in my understanding, the insurance companies would negotiate a better rate with the doctors, but not issue ultimatums like the federal government.

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Can doctors, who are government-protected oligopolisitic suppliers, turn away patients who have Medicare? Seems like those fuckers want it both ways! ("Keep medical school enrollment limited to create an artificial shortage, them let us cherry-pick the higher paying customers! Cha-ching!")

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Originally Posted by Dan Druff

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Originally Posted by rum dick

Why yes, yes I did. I let the better half sign us up and then quickly found out that none of my doctors would take it. And I've found out that the medication coverage seems to only apply to generics that have been in existence for at least 60 years. Don't even get me started on the appeals process. It's comically bad enough that i've legit been debating suing blue cross.

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I ditched Blue Cross and found better coverage elsewhere. But I had to tough it out until the end of 2014 and hope nothing would happen.

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Could you please pm me which company you went with? Knowing you it's probably really good insurance. I've stuck with BC because I can deduct all medical costs through my biz but it's time to move on to something better (it's one thing to write off a few grand here or there but totally different if major medical was needed)

https://www.youtube.com/watch?v=69yx0grmKMo

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Originally Posted by shortbuspoker

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Originally Posted by Hockey Guy

Shouldn't at least some of the blame be put on these clinics that have just decided that they won't accept these plans?

---

My guess is that most of the new ACA plans went at doctors the same way as Medicare does i.e. "we'll pay you x amount and that's it take it or leave it". This amount is usually way below the market rate for services rendered thus causing the doctors to say "go fuck yourself". Before now, at least in my understanding, the insurance companies would negotiate a better rate with the doctors, but not issue ultimatums like the federal government.

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Ding ding ding winner...it's all about the reimbursement from the plan itself for care. My GF who processes claims showed me one today where the bill was over 300k and they cut a check today for 12 grand. It's ridiculous how little gets paid out to doctors hospitals and clinics on the reimbursements from ACA plans

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Originally Posted by lvpkr1009

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Originally Posted by shortbuspoker

My guess is that most of the new ACA plans went at doctors the same way as Medicare does i.e. "we'll pay you x amount and that's it take it or leave it". This amount is usually way below the market rate for services rendered thus causing the doctors to say "go fuck yourself". Before now, at least in my understanding, the insurance companies would negotiate a better rate with the doctors, but not issue ultimatums like the federal government.

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Ding ding ding winner...it's all about the reimbursement from the plan itself for care. My GF who processes claims showed me one today where the bill was over 300k and they cut a check today for 12 grand. It's ridiculous how little gets paid out to doctors hospitals and clinics on the reimbursements from ACA plans

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I've seen glimpses of that as a customer.

We switch carriers almost annually. Kid will go to doctor or hospital and give the old card. Claim denied and first I see of it is a dunning letter with a huge number for something routine.

Connect the new insurance company with the hospital and it all goes away. However, I have shared my shock and outrage at the crazy number with the insurance person and they just laugh, "it'll get settled at a far lower figure".

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Originally Posted by Sanlmar

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Originally Posted by lvpkr1009

Ding ding ding winner...it's all about the reimbursement from the plan itself for care. My GF who processes claims showed me one today where the bill was over 300k and they cut a check today for 12 grand. It's ridiculous how little gets paid out to doctors hospitals and clinics on the reimbursements from ACA plans

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I've seen glimpses of that as a customer.

We switch carriers almost annually. Kid will go to doctor or hospital and give the old card. Claim denied and first I see of it is a dunning letter with a huge number for something routine.

Connect the new insurance company with the hospital and it all goes away. However, I have shared my shock and outrage at the crazy number with the insurance person and they just laugh, "it'll get settled at a far lower figure".

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What you're seeing is known as "charge offs", and it's not as nefarious as it seems.

But it's something really stupid about our health care system, and results in monstrous bills for anyone unfortunate enough to either not have insurance or to go to a non-preferred provider.

Basically most doctors and hospitals bill outrageously high, and then large amounts of it are "charged off" when the preferred provider processes it and reverts it to the contract rate.

For example:

You go to the doctor's office, they bill $300 for just the visit.

If you don't have insurance, or you're out of network, you actually owe that $300, unless you negotiate with them.

If your insurance provider is on their network, suddenly $230 of it gets "charged off", the insurance company ships them a check for $30, and you owe the remaining $40 for the co-pay. So that $300 bill became $70, just because you happen to have a certain insurance company.

At hospitals it's even more extreme. I have seen $3000 bills become less than $300.

This bullshit needs to be outlawed. Insurance shouldn't work that way, and it doesn't work that way in many other industries.

For example, if I wreck my car and take it to a body shop to get fixed, my auto insurance company will cut them a check for the cost of the repairs. It doesn't matter which insurance company I have -- the body shop gets paid the same. (Yes, I know there are "preferred" body shops for certain insurance companies, but those are invisible to the consumer, and you are not required to go to them.)

Health care providers should not be able to negotiate with specific insurance companies for lower rates. It should be the same price whether you do or don't have insurance, with the only difference that your insurance foots part (or all) of the bill if you have it.

That would also solve the nonsense about having to find doctors "on your plan".

So basically if the doctor is going to take insurance he commits to charge everyone the same price. And if he doesn't like having to do that, he can be a doctor who doesn't take insurance at all.

This is one of many really stupid issues involving the overly and needlessly complex world of medical billing.

An even bigger problem is that it's very difficult (or impossible) to know your cost of procedures or tests when going in, and you get the bad news later in the form of a shockingly high bill. Bullshit. This is the only industry where you buy something first before you know what you're paying for it, and there's no reason for that.

Quote:

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Originally Posted by Dan Druff

Quote:

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Originally Posted by Hockey Guy

Shouldn't at least some of the blame be put on these clinics that have just decided that they won't accept these plans?

---

Kind of.

The geniuses who developed Obamacare didn't bother to consider that, in order to make coverage of all those sick people (who previously didn't qualify for insurance) cost-effective, they would just pay doctors less than they did before.

And then, of course, most doctors said, "WTF? We're not working for peanuts here. We just won't accept these plans."

And that was their right to do, and that's what happened.

The problem was the fact that the architects of Obamacare got so obsessed with the concept of "exchanges" (basically making individual plans mimic group insurance) that they overlooked the obvious situation that adding a lot of sick people to individual insurance plans (at the same premium as healthy people) would be a major financial burden on insurers. They engaged in a mental shell game, believing that the increased number of healthy buying insurance (young people who before just skipped having it) would somehow offset the sick people. It didn't. It didn't come close, especially with some young people just opting to pay the penalty for not having insurance.

I don't blame the providers for refusing to accept inferior payment for people on those plans.

I do blame them for not making this REALLY CLEAR to every new patient who comes in. Some of them just let you come in, and inform you of the bad news moments before you're about to be called in.

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It is a bit silly to think no one realized it. One might say arrogant. While what you say is true, it is folly to think they didn't forsee any of this.

The system was broken and still is broken and will always be broken in some regard. There really is no way getting around the economics of people who were sick without coverage increasing costs when they all at once have coverage. Obamacare was another attempt at sticking it to generations who did not have the benefits of the wonderous mid 1900s economy by having the young subsidize the old. The young subsidize the old and the young have opted out it appears. Well good for them.

Healthcare is way too expensive in this country and that needs to be addressed through some very different type of legislation.

Allstate Auto Insurance has an ad campaign that pitches mailing you a check if your driver history is favorable. They call it "Safe Driver Rewards".

Your rates are a reflection of your risk. Kinda radical.

Most Americans are insured through there employers. This is were things started to go wrong. Like most problems in our country you can find that government laws and light regulation were responsible. Unintended consequences.

I swear I had a stretch of 20 years where I never went to the doctor. Like I would get a routine physical every 10 years. I come from a family of nurses and the stories at dinner were prolly responsible for my basic cynicism regarding medical care. As well, I have been just plain fortunate health-wise.

Is there any incentive or reward for my small contribution toward keeping medical expenses lower? Zero.zero Intuition tells you this is fucked up free-market shit.

The wage and price controls during World War II created a problem for employers who couldn't lure workers through increased wages. They could add fringes without consequence. Hospital beds were empty and were eager for business. Employers started offering health insurance to new hires to dodge Washington's laws.

In the early 1940's the IRS ruled employer provided health insurance was tax free. The genie is now out of the bottle. Risk experience and rates are divorced. Free market incentives are removed.

Our current health care explosion and corruption is the unintended consequence of tax law.

In a free market, I pay $50 a year in health premiums and someone with a pre-existing condition prolly just ends up effectively uninsurable and dies. Social Darwinism and good genetics for the win.

Melissa Meyer provides free food and medical coverage and the Walmart worker smoking a cigarette in front of the store on break dies early. The proper order is in place. Society naturally becomes smarter and healthier.

Nobody buys into this, I guess. Instead we feel an obligation toward our brother. Yet we don't have national health care. It will still be bloated and mismanaged either way.

The goal is to somehow clean up the corrupt two party political process that governs us. You can start by telling the GOP to go fuck themselves and die then vote for Trump.

There might be a decent thought above. It's a volume business.

I am a believer in market solutions but healthcare a completely different thing.

Patents work to the point of having drugs created, but then they create situations where people are gouged and have no other life choice except to die. Completely free market (aka no IP laws) would have us never see the drugs that take a lot of research. I don't know how to fix that.

Prices need to be made more transparent. Doctors do not have the job of trying to save you $$.

Somehow the price of medical care has steadily went up in relation to everything else. I believe it has even outpaced college costs.

At times I think the requirement to become a doctor is just too much. Then I deal with shitty doctors or worse, physicians assistants. Then I'm no longer sure.

When you are deathly sick you don't really have the option to shop around and/or negotiate.

I do see things where people are given better deals by proving their healthy life choices. No smoking. Reduced costs if a level of activity is demonstrated. These are steps in the right direction.

At the very core though the US needs to figure out how to reduce costs across the board without hurting the quality of healthcare. When healthcare is too expensive, it is also hurt. Solutions approaching it from a different angle don't seem to be as useful, but I do believe we need something a lot closer to universal healthcare than not. I know staunch Republicans who are for socialized healthcare because they are immigrants from Europe. A lot of what we're fed about the long lines etc is a crock or no worse than paying out the nose all your life.

Smart people have started going overseas and buying medications overseas. The other countries (specifically India) can save you so much money. For a middle class person, a major surgery can set one back for many years. Maybe thats part of the solution, have more competition for major surgery internationally?

Donk, healthcare can be expensive. That is the free market. You can chisel around the edges with cost reduction but some people will generate death defying expense regardless of whatever efficiency you can imagine.

When Americans are put to the test regarding free market pricing of health care based on risk experience they puss out. The system becomes convoluted and perverted in the aversion toward nationalized health care.

It is a forked question. A free market wearing Fitbits or nationalized health care. The rest including the OP's experience is noise.

We do not trust our government enough to execute health care reasonably. We need to fix government before we can fix health care.

We are a growing society hemorrhaging badly. We need a revolution. We won't choose it freely. We are not that strong. Some calamity will cleanse us. Privately, you need to root for such a thing.

Forest fires have occurred naturally since before the time of man. Lol, the Fort McMurray thing. These fires serve a natural purpose and are in fact good for forest ecology. We choose to fight them instead. It is a strange analogy offered by a strange poster.

Again, American society needs such calamity to fine tune our shit. Pick your poison.

Druff this is a network issue with Anthem and not specifically an "Obamacare" issue. Any time a health plan comes out with a new product (ie medicaid, Medicare Advantage, group health, etc) they need to contract with providers for their network. FYI what you experienced in 2014 is pretty much a non issue today.

Also just to clear something up - when you see these outrageous bills it is because of the way the contracts are written. Most out of network providers get paid a % of charges billed - 35% is standard in my industry. So if you want to recoup the money you basically just fronted an insurance company, you bill more. SOP. It doesn't mean that an aspirin cost anybody any extra or that there is some sort of scam going on.

:lgwc

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Originally Posted by Sanlmar

Donk, healthcare can be expensive. That is the free market. You can chisel around the edges with cost reduction but some people will generate death defying expense regardless of whatever efficiency you can imagine.

When Americans are put to the test regarding free market pricing of health care based on risk experience they puss out. The system becomes convoluted and perverted in the aversion toward nationalized health care.

It is a forked question. A free market wearing Fitbits or nationalized health care. The rest including the OP's experience is noise.

We do not trust our government enough to execute health care reasonably. We need to fix government before we can fix health care.

We are a growing society hemorrhaging badly. We need a revolution. We won't choose it freely. We are not that strong. Some calamity will cleanse us. Privately, you need to root for such a thing.

Forest fires have occurred naturally since before the time of man. Lol, the Fort McMurray thing. These fires serve a natural purpose and are in fact good for forest ecology. We choose to fight them instead. It is a strange analogy offered by a strange poster.

Again, American society needs such calamity to fine tune our shit. Pick your poison.

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Healthcare in the US is a "free market"? LOL!!! That is one of the great right-winger myths of our day successfully peddled to the American masses by the medical-industrial complex and their political water carriers!

US Section: The Myth of Health Care's Free Market
http://www.newsweek.com/2014/01/03/m...et-244994.html

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Originally Posted by Dan Druff

I got my first unfortunate lesson in the FAIL of Obamacare in September 2014.

I felt an unexplained pain/scratchiness in my eye and wanted it checked out. My Obamacare plan started in March 2014, and I hadn't had to use it during those first 6 months, so this was the first time. I used Anthem's website to look up an opthamologist in my area, and found one fairly close by.

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Druff, it just occurred to me: Did you explain how long you had this pain in your eye before wanting it checked out by a doctor? And just because it seemed "unexplained", are you aware that unless you live your entire life in a "clean room", such as those used to grow silicon wafers for computer chips, random irritants kicked up by pets and children(1) can occassionally land in your eye and scratch the cornea. And that be quite painful until it heals. And you probably wouldn't know where it came up.

Meaning, unless it persists for over a week or, and gets worse over that time, you are likely wasting your money, and the healthcare system's time and money, going to a doctor before then. Especially first going to a much higher cost specialist!(2)

Footnotes:

(1)

 

Also from rough sex in a dirty truck, but that prolly doesn't apply to your situation.

(2)

 

The next time you have such scratchiness, try washing your eye with whole milk. My mom used to do that when we'd get dirt in our eyes playing outside. Somehow it worked much better than water, which oddly seemed to make the eye feel drier/scratchier.