Even with Platinum coverage, you still get narrow networks
Guess what? Most Americans don't give a shit about choice of insurance plans, but they really, really care about choice of providers and hospitals.
I had the exact same problem as Mr. Rosenthal only in Florida with Blue Cross Blue Shield. Got screwed, as I also picked the Platinum plan and found out my hospital and doctors were not covered. The best research I did before hand indicated I would be covered and found after the fact I was not. Got furious with BCBS and they agreed to correct a few cost items with my doctors. They are playing dollar games with our health and I am completely frustrated. I am not upset with Obama-Care, only with the sligh and sneaky Insurance companies. Cannot drop my insurance and/or change until November of this year. What a fiasco. A singly payer system would correct all of this smoke and mirror games played by the Insurance industry.
Data to support this claim:
http://www.scribd.com/doc/201871033/Comparison-of-Bronze-Versus-Platinum-Obamacare-Plans
The bottom line is this. When you’re choosing a particular insurance offering, you typically can’t trade up to a better benefit by buying the gold or platinum variety of that plan. It’s usually the exact same benefit regardless of the metal you choose.
So what varies between these different metal plans? Typically, just the co-pay structure and deductibles. As you pay higher premiums for a gold or platinum plan, your deductibles and co-pays will decline. The insurer will typically cover 60 percent of expected medical expenses in a bronze plan, 80 percent in a gold plan and 90 percent in a platinum plan. So, by buying the costlier plans, all you’re doing is fronting a higher premium to buy down your anticipated out of pocket costs. You’re not getting a better network of doctors or a better formulary of drugs.
Across silver tier networks in our 20 analyzed rating areas, 58 percent of the lowest-price products utilize ultra-narrow networks and another 26 percent utilize narrow networks. Network breadth appears to be positively correlated with premium levels in many cases, but the use of narrower networks is common at all price points.
New York’s health insurance exchange (called “NY State of Health”) offers individuals and families numerous insurance plan options at various “metal” levels. What it doesn’t offer in most parts of the state are plans that provide coverage for non-emergency out-of-network care. In a sample Manhattan zip code, for example, there are 62 plans available at all metal levels. Not one of those plans pays for out-of-network care.
Why then did New York State not require out-of-network coverage? “We left it up to the insurers,” said (Department of Health’s Randi) Imbriaco, and the insurers, she continued, arguing that “a closed network helps keeps costs low,” chose not to provide out-of-network coverage in most of New York State, including New York City (some plans in the western part of New York State do offer such coverage).
Comment by Don McCanne of PNHP: According to the Bloomberg Businessweek report, Ben Rosenthal and reader John Alexander purchased the highest tier plans available - platinum plans - to ensure that they would have coverage for their current physicians and hospitals. No way. Insurers have pushed the perversity of narrow network plans all the way to the top.
Before Barack Obama was even nominated, the Democratic strategists had already decided that “Choice” would be a campaign slogan to market health care reform. Some of us protested that Celinda Lake and Herndon Alliance were pushing “choice of private health plans” when what the Democrats should have been advocating was “choice of physicians and hospitals.” It is clear which faction won this debate, as single payer supporters had the door slammed on them.
But look at the consequences. We were promised that we would have our choice of any plan we wanted with benefits as rich as desired, and with a selection of any health care providers we preferred. We could choose our doctors and our hospitals. But what happened?
So they did set up four levels of plans that we could choose from, plus a fifth catastrophic plan as an option for younger individuals. So we could buy a cheap bronze plan that would cover an average of 60 percent of our health care costs, 70 percent for silver, 80 percent for gold, all the way up to an expensive platinum plan that would cover 90 percent of costs. But there would be only negligible differences in the benefits since all plans had to cover the same ten categories of benefits, though some variation within each category is allowed as long as it had the same actuarial value.
But the shocker is the networks that the insurers established. As the AEI report indicates, for plans offered by the same insurer in the same market, the provider networks were just as limited for the high end platinum plans as they were for the cheapest bronze plans. If you want your medical bills paid, you do not have a choice of physicians and hospitals. You have to stay in network. Typically seventy percent of the providers are outside of the narrow network plans offered through the exchanges.
The Remapping Debate report reveals a further complication. Previously plans were available that provided reduced payments for care obtained out of network, with the patient paying a greater share of the costs. Now in areas such as New York City, none of these plans are available through the exchanges. You must stay in network or pay the full bill.
According to the McKinsey report, in some markets plans are available with broader networks, but these are less prevalent and declining in availability, and they are exorbitantly expensive. They will likely be subject to the death spiral since most markets do not have enough super wealthy individuals to maintain a vibrant market of broad network plans. The super wealthy then will simply pay their own bills.
So the Democrats traded off our choice of physicians and hospitals for a choice of deductibles and copayments, as the insurers took away the choices that we actually wanted. The narrow and ultra-narrow networks were a decision of the insurers, not us. We are getting what they want rather than what we want, simply because the Affordable care Act was designed to leave the insurers in charge.
As we’ve said before, all of this would go away if only we would enact a single payer national health program. As PNHP president Andy Coates says, physicians are placed in an “ethical bind” as they practice under “a corporate medical model that threatens to squeeze the humanity out of our interaction with our patients.”
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who are exempted from buying any ins because of not being able pay a medical bill, for example. 
as pointing out what needs fixing. 
Problems have to be identified before a solution can be found. Kinda like listening a while to the weird sound your car is making, thinking about it, talking it over with friends and neighbors, before getting up the nerve to crawl under the car. A lot's riding on your ability to fix it in a timely manner. And you sure as hell want to make sure the car is jacked up correctly so you don't get crushed.
Some people are still discovering how it all works, some are already in brainstorming mode, trying to figure out how to go about getting from where we are to where we need to be.
The most important thing iright now is that these conversations occur. Progress will not happen unless people can discuss things openly.
I don't know if they're still here or not(and hopefully not),but those people who want to dismantle ACA are a minuscule minority.
No one in their right mind would want to unleash the wave of deaths and misery that would result with such an action.
Seriously horrifying to even contemplate abruptly removing what system we do have now.
Someone suggested doing away with deductibles, that we pay our premiums, "why do we have to pay deductibles?".
Indeed! Or at least get the deductibles down much lower so that people can use their coverage, instead of their insurance sitting on a shelf looking all shiny and new.
I don't know the answer to that one, but exploring the ramifications of that proposal will help get us to our goals.
There are suggestions popping up, and I think there will be more as people explore situations and tinker out loud.
One thing I've learned from my years here is that collectively, DU at it's best acts as a think tank of sorts. Or at least when conversation isn't stifled or sidetracked with busywork threads.
DU's think tank' ability is one reason why we get a lot of right wing visitors. But even at DUs worst, information and ideas result, even with threads that appear like someone is yanking our chain.
I used to absolutely hate the anti-choice threads where DUers would have to school the polite troll, until i started realizing how much valuable info they generate. Just one "let's solve this problem thread" doesn't seem to generate as many good ideas, it's the accumulation of threads, trainwreck ones and all that further the education of us all.
Short version: each one teach one.
These are plans that are competing to be low cost, not high quality. That's the way the system's set up. The metal-system used (Pt, Au, Zn, brass, bronze, Sn, whatever) speaks to add-ons and deductibles.
I have a more expensive plan than most in the range offered here. I get to see specialists without a referral and the network is large. In the range of plans offered, mine's probably "bronze". Maybe Al or Ag or whatever "intermediate" (aka "mediocre"
would be.
Obamacare had two big points. (1) Increased coverage. (2) Bending the "arc" of prices down.
Subsidies and increased taxes will accomplish (1). For (2), people seem to forget that often you get what you pay for. Also that something is better than nothing.
I don't see physicians as victims of a soul-crushing corporate system. I see them as equal players in a game that has four players: the physicians, Pharma, the for-profit health insurance market, and hospital networks. As with all games, the players are sometimes partners and sometimes opponents, but they all have one goal -- skim as much money from the system as possible.
Yes, all of these players, at some level, are there to help people and improve health outcomes -- in the same way that American Eagle wants to sell you trendy clothes or that Chipotle wants to sell you addictive, overly large burritos. However, the principal goal of all of these enterprises is to make money.
Look closer. The decision is partly driven by insurers, to be sure. However, the system is equally driven by hospitals and physician networks. Nowhere is that more evident than Nebraska: Alegent (a network of Catholic hospitals) and Creighton (the hospital associated with the Jesuit university of the same name) merged to form Alegent-Creighton Health. They have their own physician network, their own clinic, and their own pharmacies to which they try to steer you. This caused the Nebraska Medical Center (the University hospital in Omaha), Bryan-LGH (the hospitals in Lincoln), and Methodist to form their own counter alliance. So, now, money that could have been spend on improving patient outcomes is being spent on advertising campaigns. Hospitals invest millions in upgraded birthing suites to impress would-be parents into having their offspring in one network's hospital or the other, and then getting them hooked on taking their precious bundle to that network's pediatricians.
Insurers like physician network deals because they get a rate guarantee across specialties, and they get to offer customers something that doesn't have the annoying features of an HMO ("look Ma, no referrals"
, but (in practice) offers them all of the benefits of an HMO.
I'd add one more thing. If you think single-payer in America would be see-any-doctor-you-want, get-any-procedure-you-need, and get-any-drug-you-want, I personally doubt it. Not even Medicare works that well. First, if government single payer comes, the likelihood is that it will look like the world's largest HMO. Being that this is America, a lot of doctors will simply opt out if they see this as a pay cut. They'll go private-pay only, or they'll leave and go care for ex-pats in Belize and Nicaragua. Many Hospitals will offer the cheapest, least amount of service they can get away with (to be fair, some do that now).
I'm not knocking you or your desire to see an equitable system (and I think it's a great post); I simply think greed is vastly underestimated as a factor in your last paragraph.
For better or worse, I think we'll end up with something like half-assed single payer Eventually, Republicans will "fix what is wrong with Obamacare". That will principally mean letting insurers sell across state lines and a bunch of tort protection. As with wireless companies, this will reduce the number of insurance players and increase the sizes of the companies. As with wireless companies, eventually we'll all choose from one of 4-6 networks based on cost and coverage. By coverage, I don't just mean conditions that are covered - I mean coverage area -- places where they do (and do not) have doctors. As with wireless companies, that won't mean much to urban dwellers, but will mean a lot to the rural and exurban.
Can you fill us in? 
