Obamacare plans not being taken by many California doctors

[Dan Druff]

Since I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.

This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.

I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.

I called the doctor's office and made an appointment. I verified that they took my insurance.

I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.

I called up another opthalmology group in the area. Same story.

In fact, every office I called would not take my insurance!

I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?

What was I getting for my $255/mo?

I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.

But why?

Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.

And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.

Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.

And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.



Coincidentally, a lawsuit was just filed about exactly this situation:

http://insurancenewsnet.com/oarticle...l#.VCT1PvldV7s

I think I might contact these people and ask if I can join.

While much of the fault rests with insurance companies here, some also rests with the creators of Obamacare, who foolishly didn't see this situation coming.

So basically, if you're in California, your individual plan is now relegated to a few shit doctors who are willing to be underpaid for their services. And it's 50% more expensive than your good plan from last year.

So basically Obamacare helped the people who couldn't get individual insurance, but screwed everyone else who already had it.

[jsearles22]

Like seriously what do you expect for a plan that costs $255/month? In reality thats nothing, because you are paying the entire amount. I have amazing insurance through work, but I pay more out of pocket than you do. And Im only paying 30% of the actual cost of the insurance while my job is pitching in the other 70%. So my insurance company is getting 4-5x more from me essentially than they are getting from you. And I live in bumfuck Missouri. Of course your cut rate insurance is going to be severely flawed.

I just dont understand what people think they "deserve" for $3000/year in health insurance? Like most people think they should get anything treated, anywhere, by the best medical professionals in the world, but they arent willing to pay for it. Druff, you spend more on pizza and pepsi in a year than you do health insurance. Stop bitching about what you get for that. Maybe get a real job? Why should people with real jobs have to pay such a large amount to essentially subsidize the rest of the system for the poor, needy, and the fringe people like you who just dont care to have a real job for whatever reason?

[abrown83]

Like seriously what do you expect for a plan that costs $255/month? In reality thats nothing, because you are paying the entire amount. I have amazing insurance through work, but I pay more out of pocket than you do. And Im only paying 30% of the actual cost of the insurance while my job is pitching in the other 70%. So my insurance company is getting 4-5x more from me essentially than they are getting from you. And I live in bumfuck Missouri. Of course your cut rate insurance is going to be severely flawed.

I just dont understand what people think they "deserve" for $3000/year in health insurance? Like most people think they should get anything treated, anywhere, by the best medical professionals in the world, but they arent willing to pay for it. Druff, you spend more on pizza and pepsi in a year than you do health insurance. Stop bitching about what you get for that. Maybe get a real job? Why should people with real jobs have to pay such a large amount to essentially subsidize the rest of the system for the poor, needy, and the fringe people like you who just dont care to have a real job for whatever reason?

In practice I agree with you jsearless (first time ever maybe).

In reality though, Druff has found a weird scenario where the insurance companies in an attempt to gain customers tried to figure out how to make costs as low as possible. They did this by fucking the doctors. Then the doctors pushed back and said nope, not doing it.

So are you right that insurance doesn't cost $255/month? Yes, but the insurance companies were more or less committing fraud in order to get as many people on the books as possible, fully knowing there was a chance the doctors might be like, "fuck it, not taking it." The insurance companies win because they don't have to pay any claims then.

I can fix the health care system in America in less than a year.

1. Implement a fat tax, if you are more than 10% overweight you pay 1% of your income for every percentage point above 10% you are. If you are already obese you get a 1% reduction in your taxable rate for every 1% of body fat you lose.

2. Ban all cigarettes.

3. Work on fixing the food system in schools to be fresher and healthier.

4. Include yearly nutritional education starting in grade school.

5. When people have terminal cancer don't spend 100s of thousands of insurance dollars, prolonging their life a couple weeks or months.

Diabetes accounts for 1 in 5 health care dollars spent in the United States. Less than 10% of the population has diabetes and a portion of that is totally preventable.

Also if you look at the studies, some say that the costs of obesity accounts for well over 50% of the health care costs in the United States.

This is a simple problem to solve, just nobody wants to tell the general population that they are fat because people don't vote for people who "insult" them (even though it is entirely true).

[DirtyB]

How is the government involved?

It's sounds like your insurance company is at fault for all of that.

[cmoney]

How is the government involved?

It's sounds like your insurance company is at fault for all of that.

Arent they involved by forcing insurance companies to take people with pre existing conditions thus limited the amount of money insurance companies have to pay to doctors? The insurance companies know they have to take everyone but at the same time they want to make as much money as possible. I dont think there is a stipulation how much insurance companies have to pay out to doctors. So the insurance companies simply tell the doctors we are going to pay you shit and the doctors tell the patients to fuck off.

With that said, this is also a case of you get what you pay for. 235 a month for insurance is really not a lot to pay. I have a 250 a month policy with deductibles so high the only reason this policy is worth having is in the event of some catastrophe event and for basic annual checkups (which still have some deductible of like 50-100 dollars).

if you want good coverage, you need to pay the same rate that employers pay for their employees. So if you start paying 400-600 a month I am sure you will not have any issues finding a specialist.

I personally think that health care should be free for everyone and then have secondary market for rich people that want to just pay cash or buy premium insurance so that dont want to wait in line with the rest of the herd.

[Dan Druff]

I think I need to explain this a little better, because it seems some people believe that I chose a cut-rate plan and am now whining about the lack of doctor coverage.

But that's not what's happening here.

This situation applies to all individual plans in California, regardless of how much you pay.

The difference in monthly premiums has to do with deductibles, co-insurance, and the existence of certain benefits (such as whether or not maternity is covered).

It does NOT have to do with the number of doctors taking the plan. So even if I had bought a $700/month version of this plan, I would be in the exact same boat.

jsearles is asking what I am expecting from a $255/month plan.

I know exactly what to expect, because I've been buying my own health insurance for 11+ years.

In 2012, I paid $144/month, got about the same benefits (actually slightly better), and nearly all doctors/facilities took it.

In 2013, same thing, except I paid $172/month.

Now in 2014, I'm paying $255/month (about a 50% increase), and barely any doctors take my insurance.

So it's false to say that you can't get decent coverage for $255/month. I got good coverage for $144/month as recently as 21 months ago.

The difference today is obviously coming from the fact that Obamacare forces insurance companies to take patients with preexisting health conditions, whereas prior to 2014 they were shut out. So now with the influx of these new costly members in the individual plans, the overall cost of keeping an individual health care system in place has gone WAY up.

However, the insurance companies were not honest with people about the situation. Consumers were not aware that the payments to doctors were going to be severely reduced, likely resulting in the doctors listed at enrollment time dropping off the plan. Consumers bought these plans believing those doctors to be on the plan, and then found the bad news out when they actually needed care. Furthermore, as you are now only allowed to switch plans for each calendar year, everyone was stuck.

Insurance companies were also at fault for not keeping an accurate and updated list of doctors (thus wreaking havoc upon people trying to find one of the few doctors still taking their insurance), as well as failing to staff properly in order to prevent hours-long hold times.

So why am I also blaming Obamacare?

This new health care law was promoted and pushed through as compassionate legislature to get insurance for millions of Americans who couldn't get it before. Of course, this caused concern for the many more millions of Americans who had existing individual insurance, worried that their plans would degrade or multiply several times in cost. In order to ram this legislation through (as well as get reelected in 2012), Obama insisted, "If you like your plan, you can keep it", assuring Americans wih existing insurance that they would not be negatively affected by the new law. He said it at least 36 times over 4 years, as shown in the video I posted.

Except Obama was either lying or ignorant to the reality of the situation.

Everyone's worst fears about Obamacare have come true. The existing individual plans have turned into garbage. The cost has gone up, but the plans themselves are no longer accepted by most good doctors.

It didn't take a genius to foresee this problem. I wondered this myself. "If all of the sick people are going to flood into the individual plans now, how are they going to be able to pay for them without boosting everyone's rates by several times?", I wondered. My rates went up by 50%, but I still felt that wasn't enough, and the system was likely to go bust. Sure enough, it wasn't enough, so the insurance companies adjusted by just cutting payments to doctors, and the doctors dropped coverage of these plans.

You can't entirely blame the insurance companies. They were forced to pay a fortune to cover the medical needs of lots of sick people. The money had to come from somewhere. Obamacare ignored this huge financial shortfall, and just figured somehow everything would work itself out. Well, it worked itself out, all right!

What if Obama had told the truth?

"If you have an individual plan you like, your premiums will rise 50%, and it will no longer be accepted by most doctors. You will need to change several doctors, as well as accept the fact that most of the doctors taking your plan will be the ones with the least impressive credentials, such as ones who went to foreign medical schools. But these sacrifices will allow millions of Americans without insurance to get insured now, albeit with the same crappy plan you'll be stuck having."

Would there have been any support for this?

Would Obama have been reelected?

Many Republicans criticized Obamacare as unrealistic, hastily-designed, and naive, but they were dismissed as heartless and partisan.

I'm not saying that the situation in 2013 was ideal. There was definitely a need for reform, but this model wasn't it.

[PuTTY]

Like seriously what do you expect for a plan that costs $255/month? In reality thats nothing, because you are paying the entire amount. I have amazing insurance through work, but I pay more out of pocket than you do. And Im only paying 30% of the actual cost of the insurance while my job is pitching in the other 70%. So my insurance company is getting 4-5x more from me essentially than they are getting from you. And I live in bumfuck Missouri. Of course your cut rate insurance is going to be severely flawed.

I just dont understand what people think they "deserve" for $3000/year in health insurance? Like most people think they should get anything treated, anywhere, by the best medical professionals in the world, but they arent willing to pay for it. Druff, you spend more on pizza and pepsi in a year than you do health insurance. Stop bitching about what you get for that. Maybe get a real job? Why should people with real jobs have to pay such a large amount to essentially subsidize the rest of the system for the poor, needy, and the fringe people like you who just dont care to have a real job for whatever reason?

I'm sure you know that the monthly premium isn't all that is needed to receive services.

[Dan Druff]

Here is a small example demonstrating that the writers of Obamacare had no idea what they were doing.

It's not a major issue, but it's a microcosm of the bureaucratic and naively-designed mess that is the Affordable Care Act.

Common to many left-supported political laws, Obamacare started from a well-meaning, compassionate premise. It aimed to get health care for the millions of Americans who either couldn't afford it or couldn't qualify due to preexisting conditions.

However, it also attempted to address another issue. Some existing health plans at the time were basically scams. Poorer Americans would buy the cheapest form of coverage, and often these plans were BS and provided almost zero benefits. They were health plans in name only.

So Obama's people were like, "No way we're going to let these scam companies continue this crap in the new Obamacare market. We are going to require several basic areas of coverage, and it will be illegal to offer a plan that doesn't meet these basics."

Made sense, and it was a good idea. But like many good ideas from the left, they failed to implement it properly.

These basic areas of coverage were required for all individual plan members, even if their age or gender made these areas impossible for the member to use.

So now I'm covered for maternity care and pediatric dental care.

You might say, "Wait! That sounds great! If you get your girlfriend pregnant, she will be covered under your plan! And little Benjamin will get pediatric dental care as part of your plan!"

No.

Read it again. I am covered for maternity care and pediatric dental. So if I get pregnant, I am covered. Otherwise, it's useless. And if I somehow find a way to transport my 1980s self to the present, that 1980s version of me will be able to use pediatric dental.

I can already read some of the lefties trying to answer the concerns expressed above.

"But those are just basic requirements. Why does it matter if you can't use them? It doesn't cost anyone anything."

Wrong.

I pay $5.36/month for pediatric dental care. Not for Benjamin. For myself. Being over 19, I cannot use these benefits, but I am still required to pay for them.

You might think that perhaps the $5.36/month goes toward covering individual plans purchased for children, where I am essentially subsidizing the dental plans for needy kids.

But no, that's not where the money is going.

The $5.36 is used to keep up the administrative side of my pediatric dental plan. This includes mailing me thick packets regarding my pediatric dental plan benefits (they are required by law to do this), maintaining records of my coverage in the system, and reporting to the federal government that this 42-year-old man has pediatric dental coverage for himself.

The entire $5.36/month goes into administrative costs.

Is it a tragedy that I am wasting $65/year on this?

No.

But this just shows how clueless the people writing Obamacare actually were. They couldn't insert a simple exception into the "basic coverage" part of the law to where people who physically cannot use the benefits are exempt from needing the coverage. So this resulted in adults paying $5-$6/month to maintain dental insurance that they're not allowed to use.

This was a minor gaffe, but unfortunately the entire law was also filled with major holes, and now it's all coming home to roost.

The moral of the story: Reforming a troubled health care system is a noble venture, but it can't be rushed, and it has to be drafted by knowledgeable people within the health care industry, rather than career politicians. And you can't try to do too much at once.

[BHS]

In reality though, Druff has found a weird scenario where the insurance companies in an attempt to gain customers tried to figure out how to make costs as low as possible. They did this by fucking the doctors. Then the doctors pushed back and said nope, not doing it.

So are you right that insurance doesn't cost $255/month? Yes, but the insurance companies were more or less committing fraud in order to get as many people on the books as possible, fully knowing there was a chance the doctors might be like, "fuck it, not taking it." The insurance companies win because they don't have to pay any claims then.

I can fix the health care system in America in less than a year.

1. Implement a fat tax, if you are more than 10% overweight you pay 1% of your income for every percentage point above 10% you are. If you are already obese you get a 1% reduction in your taxable rate for every 1% of body fat you lose.

2. Ban all cigarettes.

3. Work on fixing the food system in schools to be fresher and healthier.

4. Include yearly nutritional education starting in grade school.

5. When people have terminal cancer don't spend 100s of thousands of insurance dollars, prolonging their life a couple weeks or months.

Diabetes accounts for 1 in 5 health care dollars spent in the United States. Less than 10% of the population has diabetes and a portion of that is totally preventable.

Also if you look at the studies, some say that the costs of obesity accounts for well over 50% of the health care costs in the United States.

This is a simple problem to solve, just nobody wants to tell the general population that they are fat because people don't vote for people who "insult" them (even though it is entirely true).

Haha Abrown, this is pretty solid imo.. Fat fucks messing everything up..

Druff my company pays over $900/mo for my health insurance.

What's crazy is that it would cost even more than that (for same benefits) if we were not using this special Barney & Barney ponzi health insurance trust that rates people working in biotech to be supremely healthy. The point is that baller coverage costs A LOT.

Given that you're sedentary, over 40 and chugging a pepsi (lol) for breakfast and before bed, I would strongly consider anteing up a larger portion of your jew gold to ensure that you can get decent health care when you need it.

For a guy that is willing to go the distance to make sure the asst manager gets fired over toilet paper, you seem to have your priorities mixed up.

Your physical health is so critical to your overall life and easily your biggest leak imo..

Pay the money and go to a real doctor who will tell you that pepsi should be used for cleaning your golf clubs.

[Dan Druff]

In reality though, Druff has found a weird scenario where the insurance companies in an attempt to gain customers tried to figure out how to make costs as low as possible. They did this by fucking the doctors. Then the doctors pushed back and said nope, not doing it.

So are you right that insurance doesn't cost $255/month? Yes, but the insurance companies were more or less committing fraud in order to get as many people on the books as possible, fully knowing there was a chance the doctors might be like, "fuck it, not taking it." The insurance companies win because they don't have to pay any claims then.

I can fix the health care system in America in less than a year.

1. Implement a fat tax, if you are more than 10% overweight you pay 1% of your income for every percentage point above 10% you are. If you are already obese you get a 1% reduction in your taxable rate for every 1% of body fat you lose.

2. Ban all cigarettes.

3. Work on fixing the food system in schools to be fresher and healthier.

4. Include yearly nutritional education starting in grade school.

5. When people have terminal cancer don't spend 100s of thousands of insurance dollars, prolonging their life a couple weeks or months.

Diabetes accounts for 1 in 5 health care dollars spent in the United States. Less than 10% of the population has diabetes and a portion of that is totally preventable.

Also if you look at the studies, some say that the costs of obesity accounts for well over 50% of the health care costs in the United States.

This is a simple problem to solve, just nobody wants to tell the general population that they are fat because people don't vote for people who "insult" them (even though it is entirely true).

Haha Abrown, this is pretty solid imo.. Fat fucks messing everything up..

Druff my company pays over $900/mo for my health insurance.

What's crazy is that it would cost even more than that (for same benefits) if we were not using this special Barney & Barney ponzi health insurance trust that rates people working in biotech to be supremely healthy. The point is that baller coverage costs A LOT.

Given that you're sedentary, over 40 and chugging a pepsi (lol) for breakfast and before bed, I would strongly consider anteing up a larger portion of your jew gold to ensure that you can get decent health care when you need it.

For a guy that is willing to go the distance to make sure the asst manager gets fired over toilet paper, you seem to have your priorities mixed up.

Your physical health is so critical to your overall life and easily your biggest leak imo..

Pay the money and go to a real doctor who will tell you that pepsi should be used for cleaning your golf clubs.

You don't understand individual health insurance.

Read my second post. This isn't about paying a low rate per month. It affects all individual plans.

[Wiganer]

Capitalism works for lots of things. Not this.

[Hockey Guy]

Asking companies to go from a for profit concept to something for the common good will never work. Greed will always win out.

As a Canadian I shake my head @ a doctor turning patients away because they won't make quite as much $. I've been on this board long enough to realize I shouldn't be surprised that this finds support here but to me this is just wrong with a capital W. The hypocratic oath means nothing to them I guess.

Do you really think some of these doctors & especially the insurance companies aren't doing everything they can to fuck this around & make sure it doesn't work?

[BHS]

I think I need to explain this a little better, because it seems some people believe that I chose a cut-rate plan and am now whining about the lack of doctor coverage.

But that's not what's happening here.

This situation applies to all individual plans in California, regardless of how much you pay.

The difference in monthly premiums has to do with deductibles, co-insurance, and the existence of certain benefits (such as whether or not maternity is covered).

It does NOT have to do with the number of doctors taking the plan. So even if I had bought a $700/month version of this plan, I would be in the exact same boat.

Hmmm. I see what you're saying but don't really believe it. Can you provide a link or something to verify this?

[Dan Druff]

I think I need to explain this a little better, because it seems some people believe that I chose a cut-rate plan and am now whining about the lack of doctor coverage.

But that's not what's happening here.

This situation applies to all individual plans in California, regardless of how much you pay.

The difference in monthly premiums has to do with deductibles, co-insurance, and the existence of certain benefits (such as whether or not maternity is covered).

It does NOT have to do with the number of doctors taking the plan. So even if I had bought a $700/month version of this plan, I would be in the exact same boat.

Hmmm. I see what you're saying but don't really believe it. Can you provide a link or something to verify this?

I can't provide a link, but I'm telling you that's how it works.

When you shop for an individual plan, you do so based upon deductible, coinsurance percentage, ER co-pays, and other benefits. I have a cheaper plan because I chose a $5600 deductible and 25% coinsurance.

There is no option of, "I'd like to pay more money and have more doctors accept my plan."

In fact, it would be very difficult to offer this because the doctors ultimately choose which plans to accept. So they can't sell you a plan with the promise that it will be accepted by more doctors, only to have doctors reject it anyway.

Now, yes, they could pay the doctors more on the more expensive individual plans, and pretty safely assume that overall it would result in wider coverage, but they would run into tons of headaches from people who buy the more expensive plans expecting their doctors of choice to take it, only to find out that they don't.

I have heard that it does vary from company to company, as some individual plans pay the doctors better than others, but this is a universal problem right now.

Some doctors are being nice about it and letting existing patients stay (and just accepting the cut rates), but most are kicking these individual plans to the curb completely.

You might say the solution is to simply raise health insurance rates to what employers pay -- like $900/month, or whatever. But that would be a huge burden upon people buying individual insurance, and a gigantic departure from what they were promised by Obama. I think they will scrap Obamacare before something like that happens, because it would cause a major political revolt and the Democrats would get clobbered if something like this happened.

Incidentally, I am surprised there hasn't been more public discussion of this matter, especially near midterm election time.

[LLL]

Hmmm. I see what you're saying but don't really believe it. Can you provide a link or something to verify this?

I can't provide a link, but I'm telling you that's how it works.

When you shop for an individual plan, you do so based upon deductible, coinsurance percentage, ER co-pays, and other benefits. I have a cheaper plan because I chose a $5600 deductible and 25% coinsurance.

There is no option of, "I'd like to pay more money and have more doctors accept my plan."

In fact, it would be very difficult to offer this because the doctors ultimately choose which plans to accept. So they can't sell you a plan with the promise that it will be accepted by more doctors, only to have doctors reject it anyway.

Now, yes, they could pay the doctors more on the more expensive individual plans, and pretty safely assume that overall it would result in wider coverage, but they would run into tons of headaches from people who buy the more expensive plans expecting their doctors of choice to take it, only to find out that they don't.

I have heard that it does vary from company to company, as some individual plans pay the doctors better than others, but this is a universal problem right now.

Some doctors are being nice about it and letting existing patients stay (and just accepting the cut rates), but most are kicking these individual plans to the curb completely.

You might say the solution is to simply raise health insurance rates to what employers pay -- like $900/month, or whatever. But that would be a huge burden upon people buying individual insurance, and a gigantic departure from what they were promised by Obama. I think they will scrap Obamacare before something like that happens, because it would cause a major political revolt and the Democrats would get clobbered if something like this happened.

Incidentally, I am surprised there hasn't been more public discussion of this matter, especially near midterm election time.

People would rather debate what should be non-issues like gay marriage and women's rights instead.

[shortbuspoker]

How is the government involved?

It's sounds like your insurance company is at fault for all of that.

Going to go out on a limb here and say that if the ACA had not taken effect Druff would not have had to change insurance plans. So yes the government was involved. It is causality (I looked up a fancy word to try to impress you).

Since I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits.

[DJ_Chaps]

God it's great to be Canadian.

[Wiganer]

God it's great to be Canadian.

http://www.forbes.com/sites/danmunro...her-countries/

[DutchDoDo]

Believe you mentioned on radio before, that your spouse/girlfriend has a regular job. Can't she add you (and Benjamin)to her plan?

[DJ_Chaps]

God it's great to be Canadian.

http://www.forbes.com/sites/danmunro...her-countries/

Is that a list of free healthcare countries, aside from the US? That was my only point lol.