New in Health Care Reform today...
Remember about a year ago when I wrote about how big changes were coming as far as your ability to actually see a Dr or get hospital care under the new system? Unfortunately I was right. I will try to summarize what I've just learned:
Currently, in choosing a health plan, you would first look at price right? Then look at co pays. Then you'd look at what Dr's were available. Most plans were pretty comparable to each other. Not anymore.
You will now first be looking for your Dr, because there are less chances of an overlap & choosing the wrong plan may send you clear out of town! If you want THIS Dr, you must choose THIS insurer only, the Drs may not be able to take more than once insurance due to what are called "exclusive contracts".
There were rumors over the summer that letters were going out to doctors and hospitals from carriers with intent to reduce reimbursement sizably for the new Exchange plans.Essentially, the DOCTORS were going to take the hit for the insurers increased expenses due to larger enrollment of people with illnesses. The doctors had two options...accept a much lower reimbursement for the patients care or choose not to participate in the networks.
In the individual & family market, the ultimately decided to sign exclusive contracts with hospitals and hospital groups. For example, the UC's signed a contract with Anthem. Blue Shield signed with Sutter. Scripps...Shield. Sharp...Anthem. We don't have information yet on Health Net's approach. The new PPO and EPO networks will probably have 50% of the current PPO doctor networks and 75% of the current PPO hospitals. Different areas will have PPO while others will have EPO within a given carrier.
So what does this mean to California health insurance shoppers and members?
Unless the choice of doctor (and even more importantly, hospital) doesn't matter to you (assuming there's an alternative in your area), come Jan 1st, 2014, you will likely choose a plan which contracts with your chosen hospital and doctor.
**The real question is how people without a subsidy will react to paying much more for health insurance and getting about 1/2 of the prior network to access. We're not looking forward to those calls.**