The ACA/ Obamacare Website Fiasco Thread

[JBS]

It won't matter if you have insurance or not, all of the mid range and higher doctors are bailing out on the exchanges. The payments to the provider are too low to cover the cost of doing business. It won't be very long and we'll only have third world medicine here. We really need a landslide election in 2014 to have any hope of unwinding ACA, 2016 will be too late.

We have no chance of unwinding it anymore, in my opinion.

Once you give away free things to people (or ridiculously inexpensive subsidized versions of things), you can't take it away from them again. If you do, NPR will report on it night and day calling it "austerity", and the Left will orchestrate massive demonstrations which usually turn into molotov cocktail festivals and street riots- per Europe.

Besides that, the Conservatives in this nation have done a terrible job of keeping citizenship as a major topic of discussion. Gradually, the Far Left is succeeding at adding and legitimizing millions of illegal immigrants, giving them healthcare, food and shelter subsidies- which increase with every child they give birth to. And all those millions of immigrants are very soon going to be finding their ways to the voting booths. And when they do, the only thing they're going to hear is that Liberal Candidate A wants to give them more benefits and Conservative Candidate B wants to take them away. Guess who wins those districts?

 

[TLDR20]

It won't matter if you have insurance or not, all of the mid range and higher doctors are bailing out on the exchanges. The payments to the provider are too low to cover the cost of doing business. It won't be very long and we'll only have third world medicine here. .

Why would a Dr. opt out of an exchange? Do you mean these mid-higher doctors are going to stop accepting health insurance from people? If they don't want to take insurance then I wonder how they are operating now? A hell of a lot of practicioners currently accept medicare, which is gov't subsidized and I don't see any doctors fleeing from that. I would like to see a study that says x doctors are going to be no longer accepting insurance. I haven't seen one yet.

 

[Dame]

Why would a Dr. opt out of an exchange? Do you mean these mid-higher doctors are going to stop accepting health insurance from people? If they don't want to take insurance then I wonder how they are operating now? A hell of a lot of practicioners currently accept medicare, which is gov't subsidized and I don't see any doctors fleeing from that. I would like to see a study that says x doctors are going to be no longer accepting insurance. I haven't seen one yet.

A 2012 survey of more than 13,500 doctors from around the country found that 26% have already cut services for Medicaid patients due to costs, and within the next two years more than 50% plan to cut some patient access to their services. About 7% plan to switch to cash-only practices, like Ciampi's, or "concierge practices" in which patients pay doctors an annual retainer.

http://finance.yahoo.com/news/obama...lYwNzcgRwb3MDMgRjb2xvA2dxMQR2dGlkA1ZJUDIyN18x

 

[Chopstick]

The practice where I formerly worked stopped taking new Medicare patients. If they currently had Medicare they would continue to treat the patient. However, unless the patient had a Medicare HMO such as Security Blue, no more straight Medicare patients accepted.

 

[DA SWO]

Why would a Dr. opt out of an exchange? Do you mean these mid-higher doctors are going to stop accepting health insurance from people? If they don't want to take insurance then I wonder how they are operating now? A hell of a lot of practicioners currently accept medicare, which is gov't subsidized and I don't see any doctors fleeing from that. I would like to see a study that says x doctors are going to be no longer accepting insurance. I haven't seen one yet.

Because the Government slow rolls MediCare/MedicAid/TRICARE payments.
ACA contains costs by limiting what a Dr can charge (i.e. limiting the inbound cash flow).
ACA does not limit Malpractice Insurance Rates, Rent, Utility Rates, Employee Wages, etc (ie. the outbound cash flow).
ACA can drive small self employed providers out of business, so they opt out to avoid bankruptcy.

 

[TLDR20]

A 2012 survey of more than 13,500 doctors from around the country found that 26% have already cut services for Medicaid patients due to costs, and within the next two years more than 50% plan to cut some patient access to their services. About 7% plan to switch to cash-only practices, like Ciampi's, or "concierge practices" in which patients pay doctors an annual retainer.

http://finance.yahoo.com/news/obama...lYwNzcgRwb3MDMgRjb2xvA2dxMQR2dGlkA1ZJUDIyN18x

Well seeing that is from 2012 and it is now two years later, I wonder where the follow up is. How many of those 7% actually followed up.

 

[TLDR20]

Because the Government slow rolls MediCare/MedicAid/TRICARE payments.
ACA contains costs by limiting what a Dr can charge (i.e. limiting the inbound cash flow).
ACA does not limit Malpractice Insurance Rates, Rent, Utility Rates, Employee Wages, etc (ie. the outbound cash flow).
ACA can drive small self employed providers out of business, so they opt out to avoid bankruptcy.

You think there are enough people without insurance to support/provide patients for a physicians office? HOw many people do you know who can straight afford an MRI? Or a Radiologist to read an MRI. Both of those things cost 1000's of dollars. Let these doctors leave, then let them go bankrupt when their patients cannot pay them, or they don't have patients, because people have to have insurance.

 

[Chopstick]

Patients can file their own claim with their insurance carrier and be reimbursed directly for what the insurance carrier pays for that service. We had patients with particular companies that our practice didnt participate with, that did it all the time.

 

[TLDR20]

Patients can file their own claim with their insurance carrier and be reimbursed directly for what the insurance carrier pays for that service. We had patients with particular companies that our practice didnt participate with, that did it all the time.

Not to be a dick but didn't your practice go under?

 

[racing_kitty]

HOw many people do you know who can straight afford an MRI? Or a Radiologist to read an MRI. Both of those things cost 1000's of dollars.

The office that did my aunt's MRI a few weeks ago charged those patients using their insurance policy to obtain an MRI $900+, as opposed to $450 for those patients who were filing no insurance claim whatsoever and paid cash up front. When she gets back home, I'll get their contact information so you can call and verify it for yourself.

 

[TLDR20]

The office that did my aunt's MRI a few weeks ago charged those patients using their insurance policy to obtain an MRI $900+, as opposed to $450 for those patients who were filing no insurance claim whatsoever and paid cash up front. When she gets back home, I'll get their contact information so you can call and verify it for yourself.

If you say it was 450 it was 450. How much for the radiologist to read it?

 

[racing_kitty]

.Wellstar imaging center at building 700. On church street. 770 420 1750

Radiologist's reading was included in the cash price, $200 extra for insurance claim price.

There's the contact info. Ask all the fine print questions you can think of.

 

[Chopstick]

Not to be a dick but didn't your practice go under?

No. One of the Doctors chose to leave and the other 2 left are not business men and have no idea what they are doing. Instead of looking ahead when they knew the one partner was going to retire either start looking for another partner in advance or hire a nurse practitioner or physician assistant to pick up the office side of things(less money than hiring a full physician partner) they did nothing and got caught with their pants down so to speak. They also are not what you would call hard workers and are rather toxic. No way they are going to get a doctor in there at this point.

On the issue of fee for service vs accepting and participating with insurances, it would actually be quite lucrative for doctors to dump insurance. The hassle of medical billing and the games one must play to get correct reimbursement out of Medicare and certain carriers requires a staff just strictly devoted to the billing. I am not sure if you have ever worked in a medical practice or billing department of a hospital but it is by no means a simple process. For instance, your MRI has a variety of components that would be billed under different HCPCS codes along with various ICD-9 codes which must match said HCPCS code along with modifier codes to describe particular parts of each HCPCS. There is the actual MRI component. Contrast with or without component. Or With and without component. Professional component and then there is the entire reading fee components. Back in the day, a doctor could employ a medical assistant to run the office and then run off the billing at the end of the day or the week and submit. Now that process has grown to so many steps and hoops to jump through that doctor now employs at least 2-3 billing specialists whose sole tasks are...billing. Take a look at the Medicare/Medicaid fee schedules sometime. It is enough to make you tear your hair out. The other downside of Medicare is the hospital side of things. Reimbursements are not only lower than with other carriers, there are rules, such as if an inpatient is readmitted to the hospital within 30 days of prior admission the hospital cannot bill ANYTHING for the second admission. Need a PET scan as an inpatient? The hospital gets zero reimbursement. You have to discharge the patient and schedule the procedure as an outpatient. And hospitals are doing just that. Forcing doctors to discharge a patient and delay the PET scan until they are outpatient.

http://www.cms.gov/apps/physician-f...h-results.aspx?Y=0&T=0&HT=0&CT=3&H1=99214&M=1

And as RK points out, some practices are moving to fee for service rather than participating with insurance carriers and giving savings to that type of patient, as then this cumbersome billing process is bypassed. Doctors have overhead, school loans, rent, employee salaries and benefits, malpractice insurance ect ect. If they are not getting fair reimbursement from Medicare, Medicaid and other carriers they wont be able to remain in practice. They have to seek out other ways to remain in business. Dr. Ciampi is pretty famous for doing it. But there are actually alot of doctors limiting or eliminating accepting Medicare, Medicaid and other certain low paying carriers. They may not advertise it, but it is happening.

http://www.huffingtonpost.com/2013/05/29/dr-michael-ciampi_n_3354120.html

http://www.businessinsider.com/priv...ing-insurance-michael-ciampi-obamacare-2013-5

http://money.cnn.com/2014/03/19/news/economy/obamacare-doctors/index.html

http://money.cnn.com/2013/10/14/news/economy/obamacare-doctors/index.html

http://nypost.com/2013/10/29/docs-resisting-obamacare/

 

[Brill]

Imagine you are a fresh out if the military guy with no service connected disability who needs insurance. Say you get into your wife's plan. 400 dollars a month. The GI bill pays 1700 dollars a month, or just pays BAH, which is only 875 here. Now half of your monthly income is going to insurance. Well why not just go to the VA? Well there are not Va hospitals everywhere and the VA insurance isn't that great. Under the ACA there are subsidies for a guy like above. Getting the rates way down, to under 60 dollars a month. That is affordable insurance.

And I 100% fully support that...even for you!

However I don't support the "unlawful" changes to the law to cater to specific groups for political purposes all the while saying the Republicans need to accept the law of the land while changing parts that one party doesn't like.

 

[compforce]

What statistic or study are you using to validate what you said above?

I'm personally caught up in it myself, even though I offer employer covered health care in my business. MY doctor opted out of the exchange plans with BCBS of GA. My ID number happens to start with an 'X' which was later used to identify exchange plans. Even though my account is specifically flagged as "Off Exchange" according to BCBS, when the provider calls, they tell them that I am out of network because the provider opted out of the exchange plans. We've been trying to work through this for about three weeks now over multiple conference calls with BCBS and the provider on the line at the same time with me.

That said, there are plenty of articles out there, note some are partisan, some are from healthcare and some are from other sources, I just took a random sampling:

http://www.newsmax.com/Newsfront/Obamacare-Medicare-doctors-drop/2013/07/29/id/517497/
http://www.nbcconnecticut.com/news/local/Some-Doctors-Say-No-to-Obamacare-Plans-244881541.html
http://health.usnews.com/health-new...2013/10/30/top-hospitals-opt-out-of-obamacare
http://www.cnbc.com/id/100935430
http://www.breitbart.com/InstaBlog/2013/11/01/The-Best-Hospitals-Are-Opting-Out-of-Obamacare
http://nypost.com/2013/10/29/docs-resisting-obamacare/
http://www.kaiserhealthnews.org/Sto...doctor-rates-marketplace-insurance-plans.aspx
http://washingtonexaminer.com/doctors-boycotting-californias-obamacare-exchange/article/2540272


If you only read one article, read this one, plenty of sources and statistics (edit - yes, it's an older opinion piece, but from a doctor and with quite a few citations):

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

http://online.wsj.com/news/articles/SB123993462778328019?mg=reno64-wsj&url=http://online.wsj.com/article/SB123993462778328019.html

 

[compforce]

Patients can file their own claim with their insurance carrier and be reimbursed directly for what the insurance carrier pays for that service. We had patients with particular companies that our practice didnt participate with, that did it all the time.

Unless it's Tricare Reserve Select who never paid a single claim (edit - claim I submitted), not even a standard office visit.

 

[JHD]

One of the key quotes from the USNews article Compforce supplied above was this

"There has been an incredible amount of focus on the premium cost and subsidy, and precious little focus on what you get for your money"

So, even if you do get a debilitating disease and need treatment at one of the top hospitals in the country, you may very well not be covered.

 

[0699]

Top up the VA????? You've got a future doing political comedy.

Hey, I'm ignorant. I use TRICARE which I'm pretty happy with. I truly don't know the answer to my question... :-/

I should clarify: "underinsured" was the wrong word to use. I had "sufficient" coverage through the VA's 5-year post service coverage, but it was next to worthless. 2-3 days to get a doctor appointment to get a staph infection looked at, and that was only AFTER I spent three hours navigating the phone system to get someone on the phone. I ended up going to my school's health office instead. Under my current, ACA-subsidized plan, I just have to walk down the street, pay about 25$ for an office visit and 5$ for antibiotics. And it only costs about 70$ a month, so it's perfect for me.

EDIT: Also, wherever I end up going for school may not have a convenient VA hospital nearby, so having private insurance, for me, just makes sense.

Maybe I'm asking my question wrong. Before you "looked into" the ACA plans, did you call any private insurance companies on your own to see what they offered? Would it have been possible to get a similar plan before the ACA?

 

[TLDR20]

Hey, I'm ignorant. I use TRICARE which I'm pretty happy with. I truly don't know the answer to my question... :-/



Maybe I'm asking my question wrong. Before you "looked into" the ACA plans, did you call any private insurance companies on your own to see what they offered? Would it have been possible to get a similar plan before the ACA?

I know that the second my enrollment is up on my current plan I am going to an ACA plan. Unfortunately that isn't until August. It will save us about 300 dollars a month to switch.

 

[0699]

I know that the second my enrollment is up on my current plan I am going to an ACA plan. Unfortunately that isn't until August. It will save us about 300 dollars a month to switch.

Wow. Is it because of government subsidies? How else could it be so much cheaper?