Can You Keep Your HMO Doctor?

[GreenSky]

Looks like in the Los Angeles area (including surrounding counties) this may not be true. I had thought that the reduced payment only affected PPO doctors but I learned yesterday this is not the case.

One of the largest medical groups here, HealthCare Partners has about 2,000 primary care doctors between their staff model and IPAs. Moving to next year, they will only have a contract with LA Care an insurance carrier with about 1.5% of the enrollments into CoveredCA.

I have no idea how many people this will affect but clearly many of them will have to change their primary care doctor along with their specialist. But maybe they can just pay more to see the oncologist keeping them alive. That was promoted as a good idea by one of the designers of this wonderful program.

Rick

 

[houcoogster]

I also read where Cedars-Sinai and MD Anderson will not be in network for most exchange policies. They're just too expensive.

http://www.ft.com/intl/cms/s/0/994951f8-5e71-11e3-8621-00144feabdc0.html

 

[GreenSky]

I also read where Cedars-Sinai and MD Anderson will not be in network for most exchange policies. They're just too expensive.

Cedars will only have a contract with one carrier (Health Net) for Obamacare compliant plans. For plans bought through the exchange it's only the Bronze level. Outside the exchange it's all levels.

So apparently is really is correct. If you pay more, you get a better doctor and hospital. Certainly this isn't class warfare.

Rick

 

[houcoogster]

Rick, Clarify for me here....are you saying if they buy a Bronze plan On the exchange they can use Cedars?

Silver, Gold and Platinum On exchange...no dice?

 

[GreenSky]

Rick, Clarify for me here....are you saying if they buy a Bronze plan On the exchange they can use Cedars?

Silver, Gold and Platinum On exchange...no dice?

Exactly correct. I can't quite figure out why they did that. Also, rather than paying a 4% commission Health Net pays $30 dollars (not monthly, just once) for the Bronze level on or off exchange.

So they hospital is ok with the Bronze level but agents have little incentive other than "charity" to help a client sign up.

Just another of the amazing things we've learned about this wonderful law.

Rick

 

[somarco]

For plans bought through the exchange it's only the Bronze level. Outside the exchange it's all levels.

Very odd . . . until you know the rest of the story (as Paul Harvey said). That (plus the comp) is one way to fight adverse selection.

For the most part the carriers are not real bright but they do know if there is a type of business they don't want all they have to do is tighten the screws on agent comp. Since most carriers get 80 - 90% of their business from agents it makes sense to reward the "good" business.

 

[houcoogster]

Oh well not to worry folks.....if someone comes down with Cancer I'm sure (well not really) this would be viewed as a "Life Changing Event" and be given a SEP.

 

[Dave020]

Very odd . . . until you know the rest of the story (as Paul Harvey said). That (plus the comp) is one way to fight adverse selection.

For the most part the carriers are not real bright but they do know if there is a type of business they don't want all they have to do is tighten the screws on agent comp. Since most carriers get 80 - 90% of their business from agents it makes sense to reward the "good" business.

Except Health Net is doing the exact opposite, intentionally. They feel Bronze level is attractive to the younger healthier prospects and that those who are sick or have chronic conditions will favor the higher tier plans. It seems backwards until you understand that...........

Health Net is in it to lose it next year. They are banking on the Risk Corridor funds from reinsurance to make them more $ or mitigate their losses. That is their goal, lose as much as possible to be made whole by reinsurance money. Their bonus program starts at age 40 and above and pays no bonus at all on bronze tier.

I was told their ideal client for 2014 is 50+ with at least two major health conditions.

BTW, Comp from Health Net is 5% on all tiers except Bronze which pays $30 one time only so long as the plan stays on the books at least 90 days. If it falls off before 90 days they take the $30 back.

 

[number9]

I think in most places you will have access to a doctor but it won't be by an appointment basis. They will be using the DMV ticket dispenser system.

 

[houcoogster]

I think in most places you will have access to a doctor but it won't be by an appointment basis. They will be using the DMV ticket dispenser system.

Have you seen the abysmal enrollment numbers? Shouldn't have any problem getting an appointment.