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I work with someone who has health insurance from the California exchange. His assigned doctor is about a 2 hour drive away. Maybe he has picked the cheapest

by gscott 11y ago

I work with someone who has health insurance from the California exchange. His assigned doctor is about a 2 hour drive away. Maybe he has picked the cheapest plan but such a situation shouldn't really happen if this was well run.

methodover 11y ago
_Assigned_ doctor? Did he get put in an HMO? If he got a PPO plan, there shouldn't be a doctor assignment, right? It could be that the only doctor he was able to find that could take his PPO plan is 2 hours away.
- gscott 11y ago
  He had to choose a doctor, so I believe it is an HMO. He picked the closest one in Newport Beach but he lives in San Diego.
marincounty 11y ago
There's problems. We need health care for people though. Obama original plan was fine. The republicans started in with the death squads, and the scare tatics. We ended up with a system that Insurance companies exploited. I am waiting for someone to fix it, or offer a better solution. I have heard of nothing. Nothing feasible. See--if I get sick I go to a doctor's office, or hospital. It might be the only industry that isn't required to offer a bill in advance? Doctors, and insurance companies can charge whatever they like, or at least that's been my experience. I gave given this a lot of thought. I don't have an answer. My only plan would be to make medical bills bankruptable--for any amount, and at any time. There would be no ten year waiting. It's not feasible because it would clog up federal courts, unless we stream line the process. Made a medical related bankruptcy so easy you could send it in on a post card. I don't want to lose my shack because I get sick. Even now, people are losing their homes in municipal court because they got sick, and didn't have the ability to pay the outrageous bill. Hospital lawyers try to keep it quiet, but they sue. A friend's wife is recovering from stage three cancer. I don't know the type, or wanted to ask. They were in Switzerland, and she got very sick. When they got hone they were expecting a huge bill--the insurance company would balk at. It was completely covered by the Swiss government. What a country? We need a reform. We don't need a Blowhard in office who will make things worse?
magicalist 11y ago
FWIW as of 2015 California requires there be "primary care network providers with sufficient capacity to accept covered persons within 30 minutes or 15 miles of each covered person's residence or workplace", specialists within 60 minutes or 30 miles, and that there be sufficient capacity for doctors within those limits to accept new patients[1]. Getting that enforced isn't easy, but that situation not only shouldn't happen but should also be grounds for regulatory action against the insurer. [1] http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf http://www.insurance.ca.gov/0400-news/0100-press-releases/20...
- DrScump 11y ago
  Getting that enforced isn't easy How is that even possible? How does the state mandate that some random provider step in and subsidize higher payments to providers in order to encourage them to take on more new patients?
  - YokoZar 11y ago
    By preventing them from selling their insurance on the state-run exchange if they don't meet the standards.
    - DrScump 11y ago
      OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.
      - magicalist 11y ago
        > OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some area to meet its obligations it will then have to (though undoubtedly that will be eventually passed on to its customers). Meanwhile it's an agonizingly slow process to get justice for the people that need it, but insurance companies forced to refund money for not meeting their network coverage requirements is in the news right now, specifically because "more than 25% of physicians listed by Anthem and Blue Shield weren't taking patients in the Covered California health exchange or were no longer at the location listed by the companies, according to the state's investigation." http://www.latimes.com/business/healthcare/la-fi-obamacare-network-probe-20151103-story.html http://www.latimes.com/business/healthcare/la-fi-obamacare-n...

by gscott 11y ago

methodover 11y ago

_Assigned_ doctor? Did he get put in an HMO? If he got a PPO plan, there shouldn't be a doctor assignment, right? It could be that the only doctor he was able to find that could take his PPO plan is 2 hours away.

gscott 11y ago
He had to choose a doctor, so I believe it is an HMO. He picked the closest one in Newport Beach but he lives in San Diego.

marincounty 11y ago

There's problems. We need health care for people though. Obama original plan was fine. The republicans started in with the death squads, and the scare tatics. We ended up with a system that Insurance companies exploited. I am waiting for someone to fix it, or offer a better solution. I have heard of nothing. Nothing feasible. See--if I get sick I go to a doctor's office, or hospital. It might be the only industry that isn't required to offer a bill in advance? Doctors, and insurance companies can charge whatever they like, or at least that's been my experience. I gave given this a lot of thought. I don't have an answer. My only plan would be to make medical bills bankruptable--for any amount, and at any time. There would be no ten year waiting. It's not feasible because it would clog up federal courts, unless we stream line the process. Made a medical related bankruptcy so easy you could send it in on a post card. I don't want to lose my shack because I get sick. Even now, people are losing their homes in municipal court because they got sick, and didn't have the ability to pay the outrageous bill. Hospital lawyers try to keep it quiet, but they sue. A friend's wife is recovering from stage three cancer. I don't know the type, or wanted to ask. They were in Switzerland, and she got very sick. When they got hone they were expecting a huge bill--the insurance company would balk at. It was completely covered by the Swiss government. What a country? We need a reform. We don't need a Blowhard in office who will make things worse?

magicalist 11y ago

FWIW as of 2015 California requires there be "primary care network providers with sufficient capacity to accept covered persons within 30 minutes or 15 miles of each covered person's residence or workplace", specialists within 60 minutes or 30 miles, and that there be sufficient capacity for doctors within those limits to accept new patients[1]. Getting that enforced isn't easy, but that situation not only shouldn't happen but should also be grounds for regulatory action against the insurer. [1] http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf http://www.insurance.ca.gov/0400-news/0100-press-releases/20...

DrScump 11y ago
Getting that enforced isn't easy How is that even possible? How does the state mandate that some random provider step in and subsidize higher payments to providers in order to encourage them to take on more new patients?
- YokoZar 11y ago
  By preventing them from selling their insurance on the state-run exchange if they don't meet the standards.
  - DrScump 11y ago
    OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.
    - magicalist 11y ago
      > OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some area to meet its obligations it will then have to (though undoubtedly that will be eventually passed on to its customers). Meanwhile it's an agonizingly slow process to get justice for the people that need it, but insurance companies forced to refund money for not meeting their network coverage requirements is in the news right now, specifically because "more than 25% of physicians listed by Anthem and Blue Shield weren't taking patients in the Covered California health exchange or were no longer at the location listed by the companies, according to the state's investigation." http://www.latimes.com/business/healthcare/la-fi-obamacare-network-probe-20151103-story.html http://www.latimes.com/business/healthcare/la-fi-obamacare-n...