I found this story today. Supposedly, many (most?) hospitals are refusing to accept many of the plans being offered under the healthcare exchanges. For example, a hospital might only accept 1 or 2 plans out of a dozen being offered in your area. Worse, there seems to be no way of finding out which hospitals accept which plans before you sign up. The upshot is, you might choose a plan, get sick, and then find out the hard way that your local hospital is out of network.
Well, my first thought upon reading the premise of the thread was, “Is this today’s conservative talking point?”
A simple Google search shows that yes, yes it is. If I were you, I’d wait a couple of days for the story to be backed up by non-partisan sources. We’ve certainly seen a lot of right-wing lies so far.
It’s nothing new. Very few, if any, hospitals, doctors or pharmacies take all insurance companies. You might remember a couple of years ago that Walgreens wouldn’t fill prescriptions from Express Scripts, one of the big pharmacy benefits providers. The two companies simply were not able to reach an acceptable negotiation.
The hospital where I work had a year where they didn’t take one of the major insurance companies - I think it was Blue Cross Blue Shield - and they happened to provide our employee health insurance the previous year. Our employer switched to a different company for employee coverage during that time.
We had something to this effect mentioned at a staff meeting. I think our hospital takes about 2/3 of the state’s available ACA plans. As always and well before this initiative, please check your insurance company’s coverage to see what is in-network for you.
So the story seem to be that, in this respect, obamacare has brought about no change in the dysfunctional way that US healthcare insurance works.
“In this respect” the dysfunction is primarily that of the providers, not the insurers. If hospitals wanted to charge a reasonable base rate for their services, then we could blame the insurers for wanting to beat them up further on what they’ll pay, and for the hospitals backlash refusal to work with them. Instead, I read hospitals refusing certain insurance as an attempt to undermine the utility of health insurance in general, leaving them free to charge and collect whatever ridiculous costs they want for lifesaving services. Health insurance practices have certainly been predatory, and many of those practices HAVE been addressed in ACA. But the other half of the problem is greedy providers.
I’m not sure why this surprises anyone. In general, if you want to have lower insurance rates insurers will have to offer providers less money for their services. Many, if not most, providers will not accept less money for their services. Therefore, the plans with the lowest premiums will generally have the smallest provider network. Plans with higher premiums will generally have larger networks. The headline is misleading. Providers are not opting out of Obamacare, they are opting out of the lower premium plans.
IANAD. I do understand business economics.
This isn’t news - and has nothing to do with Obamacare.
In 1991, Jean Baudillard wrote essays basically arguing (in the way that only clever French philosophers can) that the Gulf War did not take place. Very few people could stand to read his works, because, as I alluded to earlier, he was a French philosopher, and who wants to read what they write?
Anyway, the gist is that the Gulf War didn’t happen because the West was just dropping bombs all over the place, Saddam didn’t actually fight, and in the end the world didn’t really change at all if you compare the summer of 1990 to the summer of 1991. It was a total non-occurrence. (That’s my summary, so it may be off on the details, but at least it’s readable.)
I began reading the linked article in the OP with the thought, if you hear the phrases: As soon as someone says “Obamacare did this!” or “I got some Obamacare!” or “How much is Obamacare?” then you know the person who is saying it has no fucking clue what they’re talking about. You don’t go on a website and get Obamacare. You go on a website and buy insurance from the same companies that have been screwing over sick people for decades.
But by the end of the article, I thought to myself: “Mon dieu! C’est vrai!” Obamacare really doesn’t exist at all!"
The ACA invented post-modernist legislation, and invented it with such perfection that simply cannot be replicated: So full of words, and so lacking in meaning.
Cannot speak for all exchanges, but my state exchange allow you to check both hospital and physician before applying.
Not all hospitals accept my insurance.
And even if they do, if the hosptial is not in my group*, my insurance will not pay. ACA is not a factor.
*they do this just to piss me off
Yeah, my family’s insurance coverage is through my husband’s job. Same employer, same insurance company, virtually the same rates, virtually the same coverage as the past four years. The PPACA changed not much beyond removing the lifetime benefits cap and raising the age that our children could maintain insurance through us.
And for the past four years, one of the two major hospital systems in this region doesn’t accept our insurance. C’est la vie.
It does.
The issue here is that many of the major national carrier have declined to participate in the exchanges - or have participated on a very limited scale. (The major national carriers being Cigna, UHC, Aetna & the Blues.)
As a result of this, the exchanges have been dominated by small local carriers, with very small networks.
Truth is that the individual market was never all that hot to begin with. But apparently it’s gotten worse with the exchanges. There is considerable uncertainty as to what type of population will enroll on the exchanges, especially with the removal of pre-ex exclusions and limiting of age-rating, and a lot of big companies who have other fish to fry feel it’s better to wait and see.
[At any rate, people crowing about how the rates for exchange plans are lower than predicted need to be aware that this is one of the main drivers of those lower rates.]