Congress threatening to shutdown unless ACA is defunded/repealed immediately.

[archibaldcrane]

http://www.whitehouse.gov/health-car.../titlei/keepit <--this is a monumental load of shit

[tyven]

Sounds like California insurance providers are a bunch of child hating fascists

[archibaldcrane]

I can't imagine that it's any different than any other state lol. What plan would normally cover pediatric dental?

[kuronosan]

A dental plan.

[archibaldcrane]

. . .

[Ksandra]

My wife's work HMO options all say

You must use Anthem BC HMO providers or care will not be covered (except in an emergency).

That's seriously like every doctor ever, you know that right?


I've don't it all at this point: PPO, HMO, w/e Kaiser is. Gonna agree with Soa that the hmo hate is severely outdated. When I had BC HMO, I think I could pretty much go to anyone. BC is like the biggest provider out there.


HMO really just means area/city nowadays. You have a coverage area where your in-network is, but that's going to basically include all doctors.


Also, I know I keep mentioning it, but have you never been to a Kaiser facility before? Even in Panorama City, which is in butt fuck Van Nuys area, the centers are top notch. As well I will be paying a ton less with my next pregnancy. BC charged a percentage for delivery with a max of 1k I believe (turned out to be about $500 since no issue birth). Kaiser is a $250 copay flat.

As well as having no copays for pregnancy office visits, which I had with BC.

Seriously, if you are thinking of pregnancies, I can't stress enough to take a tour of the facilities near you and see for yourself.

You should ask them as well about outpatient fees. I know we were initially concerned since Kaiser is only in Cali, and since we travel to CT/FL every other year I was concerned. They cover out-of-state emergencies as in house.



Even if you really wanna stick to BC, I would still start now looking for OBGYNs, not later. Because as soon as she does get preggo, she's gonna wanna start going for check ups straight a way, and it's good to have already shopped.

[archibaldcrane]

That's seriously like every doctor ever, you know that right?

Um, the private networks are not the same as what you're getting through your husband's group plan.

http://articles.latimes.com/2013/sep...works-20130915

The doctor can't see you now.

Consumers may hear that a lot more often after getting health insurance under President Obama's Affordable Care Act.

To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state's new health insurance market opening Oct. 1.



New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law.

These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation's biggest healthcare expansion in half a century.

Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.

"These narrow networks won't work because they cut off access for patients," said Dr. Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles. "We don't want this to become a roadblock."

To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc.

Across Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases. That will make it a popular choice among some of the 1.4 million Californians expected to purchase coverage in the state exchange next year.

But Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data.



In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That's less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, there are only 204 primary-care doctors to serve Health Net patients.

Other major insurers have pared their list of medical providers too, but not to Health Net's degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network.

In response, California officials have been pressing Health Net and other insurers to add more doctors since companies filed their initial rosters in May. The state exchange, Covered California, says it will monitor enrollment closely once it begins next month and it's prepared to step in if problems arise.

"Our interest is in assuring everyone enrolled in a plan has ready access to the clinicians they need," said Peter Lee, executive director of Covered California. "That means if a plan can't serve patients, we'll close it down from taking new enrollment. That is in some ways the nuclear option."

Rather than mere head count, officials say they are scrutinizing what capacity physicians have to accept new patients. And to assist consumers, California will enable people to search for specific doctors online during enrollment to determine what, if any, health plans they will be part of in Covered California.



"Does the doctor have room for one more patient or 40 patients? It's about available seats," Lee said. "We want to make sure every network has enough doctors."

Health Net says price will probably matter most to the uninsured and people who buy their own health insurance now, so it built a narrow network to serve those "value seekers."

"We have more than enough doctors for our projected enrollment through 2014, and we have time to adjust if it becomes necessary," Health Net spokesman Brad Kieffer said. "We continue reaching out to providers, and we are bringing more on board."

In recent months, the top priority for state officials and insurers has been affordable premiums. A smaller panel of doctors and hospitals generally yields lower rates because insurers can negotiate better discounts with providers who receive more patients.

Insurers and some consumer advocates think people are willing to trade some choice in order to pay less. More employers have been adopting these narrower networks in recent years to trim their own healthcare bills.

The California Medical Assn., which represents more than 37,000 doctors statewide, thinks the state is underestimating the difficulties ahead.

Based on its research, the organization is skeptical of the state's claim that its health plans will cover about 80% of all California physicians. Other doctors worry about the effect on certain Latino and African American communities that have been historically underserved.

Covered California says it's still compiling a list of all providers for the 12 health insurers in the exchange.

Supporters of the healthcare law say these types of problems are inevitable in rolling out such a massive program. Overall, they say, millions of consumers stand to benefit from guaranteed coverage regardless of preexisting medical conditions and the protection from financially crippling medical bills.

I'm conflating issues here a bit - private vs. work plans, HMOs vs. PPOs, but yeah.

[Ksandra]

Yet another reason to get fucking kaiser. failarchi

[Suvhater]

Not a fan of kaiser ._. They almost killed my dad and myself through misdiagnoses. Getting a chest xray when I was pretty sure I had pneumonia was out of the question. Not to mention I wasn't ever allowed to see a real M.D. only nurse practitioner.

Is an R.N. even allowed to diagnose patients? And has kaiser completely fired the older administration staff and replaced them with more gracious overlords?

[kuronosan]

No. not legally.

[Melena]

Kaiser is a luck of the draw. I love my doctor. Wife went through 3 till she found one she trusted, and don't even get me started on woman's health over there. They really pissed me off today though. Wife had a psychiatric appointment and they asked her last week if she wanted someone licensed or unlicensed. she said licensed. Guess what they gave her.

[Suvhater]

brb applying for a job in Kaiser mental health, i have a powerful psychiatric tool.

[Cantih]

Sorry, Kaiser doesn't hire in the veterinary fields.

[Meresgi]

So i'm still completely lost why Congress is still being paid during all of this. They should be the first ones stuck with an IOU until they get shit working, to put a fire under them to not fuck around.

[Niiro]

Congress decides what gets paid for, do you really think they would ever pass a bill that would suspend their own pay in any situation?

[ringthree]

Congress decides what gets paid for, do you really think they would ever pass a bill that would suspend their own pay in any situation?

Actually, Congress doesn't decide. It's determined by department. Congress would decide for themselves, but not for other department. It's a delegated power.

Also, if you think that for most of them Congressional pay is their main source of income, you are deluded.

[ringthree]

just imagine if the people at the DMV were in charge of this shit.

DMV are state employees, not federal. Imagine if USCIS was in charge? I would spend days in the DMV over working with USCIS.

[Day]

Apparently basically every private plan in California is getting scrapped at the end of the year, since they don't include "pediatric dental" in the health insurance, which is a requirement for Obamacare.

Yeah this is what the wifey is finding out too. Don't think it's just Cali.

[ringthree]

http://www.whitehouse.gov/health-car.../titlei/keepit <--this is a monumental load of shit

Nothing in the bill is forcing you to change. Why is this hard to understand?

It's like most of you are just noticing that the health care system in this country fucking sucks, and so by proximity you are blaming the only thing that is trying to improve the system.

[ringthree]

Not a fan of kaiser ._. They almost killed my dad and myself through misdiagnoses. Getting a chest xray when I was pretty sure I had pneumonia was out of the question. Not to mention I wasn't ever allowed to see a real M.D. only nurse practitioner.

Is an R.N. even allowed to diagnose patients? And has kaiser completely fired the older administration staff and replaced them with more gracious overlords?

If you think an R.N. or an N.P. knows less than a doctor in a modern doctor's office you are living on another planet. If I walked into a new doctor's office and they asked if I wanted to see the N.P. or the doctor, I would pick the N.P. every time.