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I'm talking aboiut Blue Shield's behavior right now, but I don't know that the other companies are behavin better. So you already know that Blue Shield customers in California had their rates jump at the New Year (since the good people of California bought the idea that having the [elected] Insurance Commissioner be able to regulate health insurance rates is--somehow tyrranical? Somehow is bad for consumers? anyway, they voted against it). For example, the part I pay after my subsidy has increased 220%. I'm still not paying much, but we have no apparatus to keep it from increasing at the same rate year after year, do we?
What else happened after the New Year--not quite after open enrollment has ended (that'll be February 12), but contemplating changing my insurance while I'm in the middle of preparations for surgery (February 15) is not a happy thought, and I imagine a lot of other patients have similar issue to changing abruptly--is this:
Blue Shield has announced that as of December 31, 2014, they've ended their contract with Palo Alto Medical Foundation (Sutter Hospitals). They magnanimously conceded that they'll cover us through June 30, but after that we all have to get new doctors. PAMF has been sending us letters about how they're trying to re-open negotiations and how they're trying to get us covered through the year, and Blue Shield is not cooperating.
Nobody's ever said what Blue Shield and PAMF are disagreeing about in the negotiations.
My belief is that it has nothing to do with anything PAMF is doing, or anything they're asking for, or anything they're saying. I have believed it is a simple attempt to deny coverage to a large number of patients while still collecting their subsidy money. Because in my part of California, there's not another large organized health provider which is not connected with a religious organization. The next available places are forty miles away over a narrow winding mountain road. The fact that a lot of people in my community drive that road to go to work every day makes this situation worse. But wait, I have another thought down the line.
Did I say that for the Affordable Care Act some wit invented the EPO--Exclusive Provider-- which means that if you go to a doctor, etc., that's not "in network," they don't pay reduced rates, they pay nothing? Which means if you don't find a doctor from the network, you're screwed, right? Remember what I said about PAMF being the only large organized health provider besides the Catholic Church in the Monterey Bay Area? There's a passle of tiny hospitals and physician's groups, but nothing like Kaiser down here. And we're short of medical providers of all kinds anyways because the only doctors who establish independent practice here are ones who will sacrifice making the normal doctor's living for a chance to go surfing in the morning. I'm serious: the fixed costs of doing medical business in this area are as high as they are in San Francisco, but Medicare (for example) pays the "rural" rates -- that is, the amount of money they would give to a doctor in the middle of the country.
My point, and I do have one: when we have to get new doctors in May and June, there will be none. Every doctor who actually is covered by Blue Shield at that time, if there are any left, will have no places for new patients.
I don't remember and I'm not in the mood to check to see whether I told you about the shenanigans I experienced at the beginning of this, where my old doctor was listed on the EPO website during signup time but it was revealed months later, after I (like many others) had accrued hundreds of dollars of costs, that in fact the Physician's Medical Group had not achieved a contract with Blue Shield, and eaqch doctor had to contract indivually and in the meantime... in the meantime, I had to pay for all the healthcare I had received at the outrageous uninsured rates that still pertain in this stupid stupid country.
So the thing I just realized is this: last year, Blue Shield used the new enrollees under Covered California as a lever to effectively break up the collective bargaining power of the Physicians Medical Group. This year, they're using us to attack PAMF.
I don't know what they're doing in the rest of California, and I don't know what they're doing in other ACA states, and I don't know what the other insurance companies are doing, but I know for sure it's not even a little bit benign.
The thing about being used as a weapon is that weapons get used up in the process. And that's what's happening in the marketplace.
So I'm getting all the healthcare I can before June, because after that I don't know if I can get any.
Edit: as the letter from PAMF points out, also:"Blue Shield sold health plan products during open-enrollment that featured the doctors and hospitals of Sutter Health; and then just days into the New Year abruptly announced plans to reassign members to non-Sutter doctors." That's what they did to Physicians Medical Group patients last year.
What else happened after the New Year--not quite after open enrollment has ended (that'll be February 12), but contemplating changing my insurance while I'm in the middle of preparations for surgery (February 15) is not a happy thought, and I imagine a lot of other patients have similar issue to changing abruptly--is this:
Blue Shield has announced that as of December 31, 2014, they've ended their contract with Palo Alto Medical Foundation (Sutter Hospitals). They magnanimously conceded that they'll cover us through June 30, but after that we all have to get new doctors. PAMF has been sending us letters about how they're trying to re-open negotiations and how they're trying to get us covered through the year, and Blue Shield is not cooperating.
Nobody's ever said what Blue Shield and PAMF are disagreeing about in the negotiations.
My belief is that it has nothing to do with anything PAMF is doing, or anything they're asking for, or anything they're saying. I have believed it is a simple attempt to deny coverage to a large number of patients while still collecting their subsidy money. Because in my part of California, there's not another large organized health provider which is not connected with a religious organization. The next available places are forty miles away over a narrow winding mountain road. The fact that a lot of people in my community drive that road to go to work every day makes this situation worse. But wait, I have another thought down the line.
Did I say that for the Affordable Care Act some wit invented the EPO--Exclusive Provider-- which means that if you go to a doctor, etc., that's not "in network," they don't pay reduced rates, they pay nothing? Which means if you don't find a doctor from the network, you're screwed, right? Remember what I said about PAMF being the only large organized health provider besides the Catholic Church in the Monterey Bay Area? There's a passle of tiny hospitals and physician's groups, but nothing like Kaiser down here. And we're short of medical providers of all kinds anyways because the only doctors who establish independent practice here are ones who will sacrifice making the normal doctor's living for a chance to go surfing in the morning. I'm serious: the fixed costs of doing medical business in this area are as high as they are in San Francisco, but Medicare (for example) pays the "rural" rates -- that is, the amount of money they would give to a doctor in the middle of the country.
My point, and I do have one: when we have to get new doctors in May and June, there will be none. Every doctor who actually is covered by Blue Shield at that time, if there are any left, will have no places for new patients.
I don't remember and I'm not in the mood to check to see whether I told you about the shenanigans I experienced at the beginning of this, where my old doctor was listed on the EPO website during signup time but it was revealed months later, after I (like many others) had accrued hundreds of dollars of costs, that in fact the Physician's Medical Group had not achieved a contract with Blue Shield, and eaqch doctor had to contract indivually and in the meantime... in the meantime, I had to pay for all the healthcare I had received at the outrageous uninsured rates that still pertain in this stupid stupid country.
So the thing I just realized is this: last year, Blue Shield used the new enrollees under Covered California as a lever to effectively break up the collective bargaining power of the Physicians Medical Group. This year, they're using us to attack PAMF.
I don't know what they're doing in the rest of California, and I don't know what they're doing in other ACA states, and I don't know what the other insurance companies are doing, but I know for sure it's not even a little bit benign.
The thing about being used as a weapon is that weapons get used up in the process. And that's what's happening in the marketplace.
So I'm getting all the healthcare I can before June, because after that I don't know if I can get any.
Edit: as the letter from PAMF points out, also:"Blue Shield sold health plan products during open-enrollment that featured the doctors and hospitals of Sutter Health; and then just days into the New Year abruptly announced plans to reassign members to non-Sutter doctors." That's what they did to Physicians Medical Group patients last year.