Here I am in a new city, embarking on trying to find an Obamacare doctor.

[Honeycombe8]

It's an HMO (Blue Cross sells only HMOs here).

I haven't checked before now because it's so stressful and upsetting, as the "we don't take that" responses pile up. I went through this last year. I spent hours and called over 20 doctors before I found one who would take my insurance (different city...before I moved). The provider list that BC provided (last year, anyway) was worthless. I think it was just any dr. who would take SOME Blue Cross policy, but not necessarily mine. And they sure didn't take mine. (I did finally find 2...one was 1 1/2 hrs away, and the other was close, but only to see a nurse; but I was moving by then, so too late.)

So now I embark on this again. I've called my first one. Response: She'll have to ask if they take my ins. & will call me back. She thinks they only take PPOs, and not sure about the Obamacare part.

I've already decided that I'm going to do w/o insurance altogether next year. I've been buying this stuff since 2014 and haven't been able to get a physical exam or anything. I did get a dog bite treated last year at an Urgent Care place (that was United Healthcare, tho...a better company; but they quit selling Obamacare in the state, so I had to go back to Blue Cross).

Wish me luck on the return call tomorrow from that dr. office. Even if they take me, it will only be the nurse. The dr. won't take it, she said. The cost of this insurance? Over $980/month. It's regarded pretty much like Medicaid, it seems, in my area. This process always gets me upset.

[OKNancy]

1. go to healthcare.gov

and there is a place on the different policies that list doctors in your area

[Honeycombe8]

4. No, there's not. It's a link to the ins. cos. "provider list," which is what I always use.

The Blue Cross list was always wrong for the city I came from. I think it was just a (very outdated) list of doctors that would take any Blue Cross policy of that grouping ("Advantage" or whatever).

Some of the drs were no longer in the city, one was a knee doctor and not a principal care doctor at all, and the rest didn't take Obamacare HMOs...until I found 2 (one was a nurse for a dr., and the other was 1 1/2 hrs away - I found that one on my own somehow,not using the provider list).

Maybe this nurse will take this policy in my new city. I'll see. Fingers crossed. If she says know, what I'll do is cry for a while, because I know what's going to happen next. I'll be making other calls like this one, all with the same response. Until I find the needle in the haystack. I'll be better off next year just paying out of pocket and hoping I don't have an accident or get cancer.

Then I'll be old enough for Medicare the following year.

[Eliot Rosewater]

2. This is not normal for HMO from a carrier like Anthem.

So your area must be really bad for some reason.

All the more reason we need (but wont get until our party controls the govt) single payer system where if you want to be a Dr. in the USA we will pay your medical school for you but you WILL take the single payer system or starve.

[Honeycombe8]

5. It was this way where I came from (Dallas).

I am now in Lake Charles, Louisiana.

Maybe this nurse will take the ins. I feel like I have leprosy or something, the way they act, when they find out I have Obamacare.

[sprinkleeninow]

38. The insurance scene is sucky.

I haven't kept up with the latest of Cigna merging with Anthem (BCBS). That announcement sent me into orbit.

Covered by hub's employer for now, but have no earthly idee what's it gonna be after he retires.

Even with a company you're sorta happy with, half the time their network list is not updated and you go in circles getting what you're looking for.

[Honeycombe8]

11. I totally agree. Medicare for all.

All I have to do is stay healthy until I can get Medicare. I think of all the people who aren't close enough to getting Medicare, and can't get or use Obamacare.

We really need to get single payer done, once and for all. And it doesn't need to be great or perfect. It just needs to get done. It can be improved later.

[Eliot Rosewater]

12. AGreed, but you have to take back two of the 3 first, WH and Senate or WH and house etc

we are very far from doing that, so what do we do in the MEANTIME

[Sissyk]

3. If you tell us where you are...

Some of us may be able to help you.

[Honeycombe8]

7. I am in Lake Charles, La.

Actually I'm in a growing area just north of the city limits, so the dr I called practices up there (it's a thriving community with nice houses).

But I would go to Lake Charles proper, too. I just started up here, near my house.

Maybe the nurse will take me. I just need a principal care office to refer me, should something bad happen. In the meantime, I thought I'd get a physical and mammogram before the end of the year. So I'm not sick or anything.

[Sissyk]

14. Try this link.

https://www.bcbsla.com/find-a-doctor/louisiana-medical

I saw 7 or 8 in your area. Good luck!

Btw: you tell the doctors office you have bcbs(hmo), not that you have Obamacare.

[Honeycombe8]

30. I've BEEN using the BCBS provider list for my area.

Just like I used it for Dallas. And the drug list.

I Just ask regular questions. I don't ask about Obamacare specifically (well, I have a couple of times), but it doesn't matter. They ALWAYS ask if that's employer insurance or individual or through the exchange. They are well aware of the differences. OR they ask for the card #...the numbers on the card identify that it was purchased through the exchange.

One who didn't ask me if it was employer insurance, said they would take some BCBS ins. (this was in Dallas) and "what is the policy #?" As soon as I said the policy number, she said, "Oh, we don't take THAT." With a not so nice tone.

So these providers are on the list because, I think, they do take SOME BCBS "advantage" policies or whatever group I'm in...they just don't take those thru the exchange.

It's not me. I'm not "asking wrong." They either take it or they don't.

BTW, TX passed a law requiring all the exchange policy insurance cards to have a code on them, identifying they are exchange policies. The providers in TX pushed for that.

One provider I DID find in Dallas (on my own), when I asked, I was shocked to hear her say, "Yes, we take that." I said "You do? I'm so surprised! I must have called about 20 doctors so far." She told me that she hears that a lot. She said they don't want to take it, really, but they are taking it because some of their pre-ACA patients have it, so they want to be accommodating.

She also told me that the lists ARE terrible. She said she's gotten a call or two from out of state people, asking if they take their insurance, because she (the dr office I'm talking to) is on THEIR list in a totally different state.

[Demsrule86]

6. Well my daughter had Obamacare and every doctor here in Ohio took it...

Thank the GOP for trying to sabotage Obamacare and some Democrats who for some reason think now is the perfect time to go for single payer which will never pass until we have a super majority. They should be working on a pubic option for weak markets and fixing Obamacare which is what we have and may ever have.

[Honeycombe8]

8. I wonder why that is? Is it possible that the drs. in Dallas refused to take it...

for political reasons? I know that most of the drs there are Republicans and were dead set against the ACA (that's what I heard).

The first year I had it there, there wasn't even an oncologist signed on to it. In Dallas, a large city with several large medical complexes & big cancer treatment places. Not ONE?

I saw a married couple on the news that lived in Plano, TX (suburb north of Dallas). They were suing Blue Cross for fraud or something. The husband was very sick, but when they changed policies to Blue Cross, they went through what I had gone through: they couldn't find ONE doctor within a decent range who would take the insurance. In hte meantime, her husband was very ill. She said that even if they found a primary care provider, there was little chance they would be able to get the specialists needed to treat her husband.

So I thought at the time, "That's what happened to ME!" It's hard to believe, I know. But it's true! And for me, what happens to complicate it is...I get upset, start feeling unwanted like a pariah, I cry for a while, and then I start calling again and go through the whole process again. It takes a long time to call and "chat" with these offices. They put you on hold, or have to call you back, etc.

Maybe it'll be better here in the new city. I hope.

[Demsrule86]

17. It could be political.

Here are insurers...Texas does nothing for the Plan.



Eight insurers remaining in Texas exchange for 2018

Open enrollment for 2018 coverage will being November 1, 2017, and will continue until December 15, 2017. This is a much shorter open enrollment than past years, and it’s the first time that open enrollment will end before the start of the new year.

As of early August, eight insurers planned to continue to offer coverage in the exchange in Texas, although most counties will only have one or two insurers offering plans.

The insurers that plan to participate in the Texas exchange have filed the following proposed average rate increases for 2018, all of which assume that cost-sharing reductions will continue to be funded by the federal government (if the Trump Administration cuts off the funding, the result will be higher premiums — which will be offset by higher premium subsidies for most enrollees — and/or the possibility that insurers might withdraw their participation or limit it to a smaller coverage area):

AmBetter (Celtic): 21.3 percent. (187,155 members) Plans are available in 32 counties in the Texas exchange in 2017, but Centene/Celtic has indicated that they plan to expand their coverage area in Texas in 2018. A mid-July open records request did not yield any information in terms of which counties Centene/Celtic will cover in 2018. This page will be updated if and when that information becomes available.
Blue Cross Blue Shield of Texas: 23.6 percent; slightly lower for Blue Advantage, slightly higher for Blue Advantage Plus. (389,766 members) Plans are available in the exchange statewide in 2017, and BCBS of Texas has indicated that they plan to continue to offer statewide coverage in 2018.
CHRISTUS Health: 35.3 percent (25,000 members) Christus Health expressed opposition to the GOP Senate health care bill (the BCRA) in late June.
Community Health Choice: 26.4 percent Community Health Choice is planning to stay in the exchange, but possibly with an enrollment cap to prevent an influx of new enrollees. In their rate filing, Community Health Choice notes that one of the factors driving higher premiums is the “uncertainty regarding the laws, regulations, and environment that will exist at the time the proposed rates take effect.” The filing explains that “this uncertainty has a potentially significant impact on rates, persistence, and morbidity in the statewide market.”
FirstCare (SHA): 19.6 percent (19,250 members)
IdealCare (Sendero): 25.72 percent (projected 2018 membership is 456,000) Sendero plans are available in 8 counties in Central Texas, and the rate filing notes that Sendero’s plans had the most competitive premiums in that area. They anticipate that their prices will remain highly competitive in 2018.
Molina: 42.8 percent (251,266 members, but projected membership in 2018 is 205,444). Molina offers plans in nine Texas counties in 2017, and will continue to offer coverage in those same counties in 2018.
Oscar: 15 percent: After reducing their on-exchange 2017 coverage area to just a single San Antonio-area county (Bexar) in 2017, Oscar is expanding to two additional San Antonio-area counties (Comal and Guadalupe, according to their plan filing) for 2018. They are also expanding into the Austin area, with both on and off-exchange plans. Oscar offers off-exchange coverage in the Dallas area, and will continue to do so in 2018.

[Honeycombe8]

18. Wow, that's a lot of info. And a lot of carriers. But only BC is a big one, right?

I remember Oscar...a brand new ins. co. that had few plans and was very pricey with tiny provider list. And who knows if they'd be around in the future?

I haven't heard of those others. They weren't offering anything in the Dallas area, I guess.

Molina is horribly expensive. I thought they'd withdrawn from Dallas, but not sure. Not many bought their policies.

Baylor offered a policy in the Dallas area; only the Baylor Hospital, Baylor drs., and you had to get prescriptions filled at Baylor.

By "Obamacare," I mean individual policies purchased on the exchange (subsidies).

Where I am now (La.), only 2 cos. offer policies on the exchange: Blue Cross, I think the other is Vantage? Vantage is a no-go. Just a few policies, very expensive, tiny provider & drug lists. So BC pretty much has this state sewn up, I think.

I'm hoping to move back to Texas next year.

[karynnj]

20. The public option did not pass even when we HAD a supermajority

It is more likely to get a public option than single payer -- but neither are likely now. Tell me 12 Republican Senators who would NOT filibuster it.

The one thing they might have a remote chance of doing is reinsurance -- which is important in keeping insurors in the plan. The ACA did it with the ruisk corridors, but Rubio sneakilly defunded that. It is interesting that Alaska has a waiver to do a reinsurance program on state level -- which they need because their costs exploded. It might be more likely as it might get insurance company support -- but it absolutely is needed to save the ACA.

[BigmanPigman]

9. I have endured what you are experiencing for almost 4 years.

It is frustrating, exhausting, depressing and takes a ton of time. I dread going through it again. I have subsidies with the ACA in CA and Healthnet dropped me then Blue Shield only had two plans to offer and they were twice the price. I have stayed with certain doctors and changed others. If you haven't been through it you have no idea how difficult it is. GOOD LUCK!

Right now I am calling Congress so they do not repeal the ACA during the next two weeks when their calendar expires or I will be screwed due to my pre-existing illnesses and huge $ meds bills.

[Honeycombe8]

10. So you know what this is like?

I am normally what I would call an upbeat, fairly strong emotionally person, but this process is very difficult for me. I end up in tears, feeling worthless, after so many rejections.

I am afraid that I'll have even more trouble because of the GOP wanting to repeal it, and drs being afraid they won't get paid. I understand that.

Oh, well. I'll get a call back tomorrow. Maybe it will be a good response.

Thanks for posting that you have gone thru this before. It's so helpful to know that others have.

[BigmanPigman]

15. It really sucks when their phone lines are busy and you are on hold for literally hours.

I even was calling them at 8:00 PM trying to get through before the deadlines. Some of them even remembered my voice it was that bad. Maybe it is because I get high pitched and start hyper-ventilating. I have had the best luck when I get one person and they stay on the phone with me while their manager or colleague tries to help at the same time. I have 4 manilla folders filled with all of my health insur documentation and notes. It is sooooo confusing. And when you are not feeling well it makes the whole ordeal even worse if that's possible. If the ACA is repealed or changed it will either kill me or I will slit my own throat out of shear anger and helplessness.

Believe me...you are NOT alone with these experiences. I have complete empathy for you and your situation.

[Honeycombe8]

19. +1. nt

[Demsrule86]

13. Also you don't ask for a "Obamacare Doctor" you use the name of the plan...

and you can check online who takes what.

[Honeycombe8]

21. What's online isn't correct.

It'll say, maybe, Blue Cross HMO. But that doesn't mean they'll take "Obamacare" BC HMO. You can have your own HMO outside the exchange, you can have an HMO from your employer, both of which they'll take.

Or it'll say PPO, but the dr will take some HMOs, as well.

It's almost impossible for all this info to be kept up to date. You have to call around.

I ask if they'll take individual policies, BC HMO, through the exchange. They need to know that, because that's different from other policies. In TX, there's a code on the card to let providers know that's what you have. I think La. may be the same way...not sure. Like a Scarlet Letter A.

I use the ins co provider list, then have called or emailed Blue Cross in the past. They weren't helpful. They don't know. They just look at the same list you're looking at.

Providers through the exchange are paid less than for other policies, and they are paid in a different way. So that's part of the problem, and I can understand why providers have a problem with that.

[Demsrule86]

23. There are doctors listed that take plans on the website.

[Honeycombe8]

25. No.

First, once you enroll, you can't use healthcare.gov any more. That's for the purpose enrolling. When you go back in, you have access only to your application, messages from the govt, your profile, etc. Not the plans that had been available when you joined, or anything like that.

There is/was a feature where you could plug in a dr name to see if it is included in what plans, but that info would be....what the ins. cos. provide, of course. The govt does not enroll providers or keep lists of the providers. There is also a link for each ins. co. to its website or its provider list, and its drug list.

I have the provider and drug lists direct from the ins. co. There is nothing on healthcare.gov that the ins. co. wouldn't have or didn't provide.

The provider lists, so far for me, are woefully out of date and in some cases, flat out wrong. So wrong as to be fraudulent, IMO. Some were not outdated. Those drs were not primary care doctors at all, or had never participated in any ACA individual plans. One dr I tried to call had actually moved from the city the prior year.

It may be different for your state. I have enrolled in both TX and La., and they were different. I could not plug in a dr name in TX, but could in La. But that's not meaningful, anyway, since it wouldn't be correct, anyway, since the provider lists I've had have not been correct so far. And since I'm new to La., I wouldn't have a name to plug in...I'd need the whole provider list, anyway. Which I have.

But I appreciate the attempt to help.

[Demsrule86]

42. They list the doctors because we wanted our primary physician to continue to be a certain doctor and

we checked with the plan and the doctor to be safe...it was not difficult.

[jberryhill]

52. If your provider's list is wrong, they are engaged in false advertising

If the doctors are not taking a plan which BC says they are, I would definitely chew BC's ass for the runaround they are sending you on.

[pnwmom]

74. If you live in LA now, you could try calling the State Consumer Protection agency. Health insurers

sell products in the state, so a complaint to the agency would be in order, if they're luring people in by naming doctors who are not in their plans.

They don't deal with actual insurance claims or complaints against licensed professionals, but that's not what you're talking about here. You're not disputing a claim or complaining about a doctor. You're complaining about a business that is misrepresenting its services.

https://www.ag.state.la.us/ConsumerDisputes

[sprinkleeninow]

39. Kinda know what you're saying.

In one dental insurance plan we had there were three sub levels or categories of coverage. Dentist office says yeah we take that. Then find out not the sub category one we had!

[Demsrule86]

43. My daughter has her firs job in a middle sized company here in Ohio...they don't even offer

dental...so any such coverage would be great.

[sprinkleeninow]

67. Employers change (downgrade) plans sometimes annually.

Any of our coverage costs are shared by the employer. We pay our share bi-weekly out of paycheck. Not complaining, but plans get more costly for diminished coverage. Without fail.

We're still grateful for what we have. You know, when an employee gives so much more than the 110% and no actual compensation, I feel the benefit of employer health coverage serves as a trade-off.

Believe me, we've been paying our 'dues' for 45+ years.

[haele]

16. Our insurance company changed vision care plan providers - not as bad, but still

Not to make it seem small what you're going through - but even with "employee-provided" non-ACA medical care, they look for ways to deny you service and screw with your ability to get decent health care.
Medical care and medical insurance "rules" make it difficult to find and keep good doctors or medical service providers. Any change, and you have to start over on your own...

We've been trying to find a place to get exams, glasses and contacts other than Walmart or Sams Club that work with our provider - which has been a problem as the list is apparently five years out of date and optometrists and ophthalmologists have dropped that provider. Our old doctor, part of a hospital affiliated medical group with several eye specialists, is not on our new plan, so we either pay twice annually to get both a proper checkup and a prescription update when the vision starts going out, or pay once annually just to get the new prescription, and hope there's nothing else going on.

Which is not good, since I'm apparently developing cataracts and spouse has inherited eye issues along with his diabetes. It's not like it's just a matter of going to a storefront type shop with bunch of techs who run vision tests and fill out order forms and the one doctor who's onsite just so they can call themselves an optometry clinic and sell glasses.

Haele

[Honeycombe8]

22. Oh, my. Cataracts. You need to have that taken care of, for sure. And diabetes...

that's nothing to fool around with.

It's all a racket. But it's between the ins. cos. and the providers. They have issues with each other.

Remember all that GOP talk about the ACA being bad because it steps in between the close relationship between the patient and the provider, so that the dr and patient can make decisions between the two of them? I thought at the time: What relationship? It was the INS. CO. that was in control.

[csziggy]

48. Not long before my husband retired his employer switched from VSP to Davis

The doctors we had been seeing for years did not take Davis and the one we found was profit driven - did not want to give us a copy of our prescriptions so we could shop around and wanted us to buy our glasses from the optometrist in his office. Also, I had a medical concern about my eyes and the only ophthalmologist in the plan was in a small town 45 miles away - when we live in the largest town in the area with lots of ophthalmologists right here in town!

When my husband retired I checked for individual vision plans - they were the same price as we had been paying through his employer. So we've been enrolled in VSP ever since. With both of us having glasses, it makes sense for us to have coverage. VSP covers the practice where we had been going for years - which has ophthalmologists on staff - they have better coverage for glasses and they offer deals for some extras that we like.

Check your preferred vision coverage company and see if you would have to pay any more if you go with an individual plan instead of through your employer. You may be able to get the coverage you prefer and need at no extra cost.

[CountAllVotes]

61. Try zennioptical.com

I lose everything and require 3 different RX's to be able to see.
So, I need all of these different glasses.

I buy them at Zenni Optical online. You can try them on if you upload a picture of your face and try them on.

I bought 3 pairs recently for $30.00 w/anti-reflective coating for free as an incentive.

I get more compliments on my Zenni Optical glasses than any other glasses I have! I'd highly recommend them.

[csziggy]

62. I worry about buying frames online

I have a hard time finding frames that fit my nose that has no bridge and still stay above my fat cheeks. I usually have to try several frames at the opticians before I find ones that will work. I don't care at all what they look like - I need them to be functional. Plus, they have to be capable of handling a thick lens - the lens for my right eye is about three times as thick as the one for my left. I've learned through hard experience that I HAVE to try on the frames before buying them!

I don't lose my glasses, but I need them scattered around so I don't waste time fetching them. I have two pair for driving (one tinted the other not), two pair for needlework (one with high magnification, one with lower), two pair of reading glasses (that each live where I like to read), and three pair of bifocals (one lives at the computer, one in my purse, and one in the kitchen).

With VSP I get a new pair of glasses each year - when it was through my husband's employer it was one new pair of frames every other year and in between new lenses - so I rotate among my various glasses to refresh the prescriptions periodically. I've been lucky that the only major change is I'm getting more far sighted so haven't had to make drastic alterations in the lenses.

[tammywammy]

63. Your frames should list the size on one of the arms

It's a xx-xx-xx. The bridge size is a number like 17, 18, 19, etc. Find a pair that fits well and you can search on Zenni by bridge size.

[csziggy]

65. Thanks - I'll check that out

I may have to get my husband to read the numbers - he's very near sighted.

[tammywammy]

66. I've never purchased from Zenni

I'm very nearsighted, I wear a -13.0 in contacts. I would just look at frames I have that I do like and get something similar. With thick lenses even with the upgrade to high index lenses I always wear an acetate/plastic frame. My lenses still stick out quite a bit, but it looks better than a wire frame or rimless.

A couple years ago when I looked at Zenni they only did lenses up to -10.

[csziggy]

70. I have to get frames with the nose pads

Otherwise the lenses are too close to my eyes and the frames rest on my cheeks. I've never been able to wear the acetate/plastic frames because of my nose and cheeks.

All my frames are metal with the nose pads and have been for the sixty years I have worn glasses. The right lens sticks out but now with the new plastic lenses, it's not as bad as it used to be.

[CountAllVotes]

85. +1

Way to go.
Measure what you have on now and match them up with what you can find on Zenni that you like.
For me it was $11 for a new pair I now need, $11!

[sprinkleeninow]

69. We have VSP vision and so far thru the last number of years, an ophthalmologist

exam is covered pretty well, except for refraction (your vision 'prescription'!). That used to be covered, but no more.

My husband gets way better deals for frames and lenses from the optical company than thru our insurance!

[KelleyKramer]

24. I have Obamacare with Blue Cross and never had a problem, it's great!

As far as I can tell the plan uses just about every doctor in my area

I also had 'regular' Blue Cross for years, but with Obamacare my monthly premiums went down over 75%. Plus it has much better coverage with very low co-pays, a maximum of $150 for emergency room or hospital stay, and it covers prescription drugs! In over 30 years this is the first plan I have had that covers drugs, with a $5 (or less!) co-pay.

And why are you telling them it's Obamacare? As far as your doctor is concerned it is Blue Cross.. it's none of their business how you pay for your Blue Cross insurance

[Honeycombe8]

28. Where do you live? You know your premiums went up, not down.

You just don't have to pay 100% of your premiums because someone else pays the rest.

I don't tell them it's Obamacare. I ask the regular questions. THEY ask details, and so I tell them it's an individual policy thru the exchange. They would know from the card # that I got it thru the exchange. The numbering is different.

They will ask if that's employer insurance or .... So I tell them. They tell me they don't take the "Obamacare" or "that kind" of insurance.

I think it's not because of how I pay for it. It's because of how THEY are paid. They get paid slowly, apparently,and sometimes not at all.

Thru the exchange, an insured can fail to pay their part of the premium for several months before the ins co is allowed to cancel it. So if the insured had treatment in that time, the ins. co. will refuse to pay it because the insured hadn't paid his part of the premium. So the provider doesn't get paid.

For other plans, the ins. co. will cancel quickly if the insured doesn't pay the premium.

I think also that the contract prices for the providers may be lower than normal. I'm not sure about that, though. That may be one reason why nurses, and not doctors, see the Obamacare people. Because they don't get paid enough for the doctor to spend his time. I'm not sure about this, either, though.

I'm just calling around asking if providers will take my insurance, like I've done for decades. Nothing is different, except that it's an individual plan thru the exchange.

Part of the problem, too, is that it's an HMO, I'm sure. BC sells only HMOs here. I also had an HMO in TX.

[bettyellen]

32. Her payment went down, strange you want to make that sound bad.

Why didn't you choose Humana or Vantage? Too bad Humana is leaving the market. Maybe you need help exploring the options- maybe check what plans doctors in the area actually do take and work backward from there?
For 90/ mo you must have silver,right? No subsidy?

[Honeycombe8]

41. ACA payments went up. Pretty sure she meant what she has to pay went down...

but the premium went up. It's just that she gets a subsidy, so she doesn't have to pay the whole premium, like me. If her circumstances changed by end of year, the govt could make her, or me, pay all or part of the subsidy back, because that is our premium.

I had only one other choice of ins. cos. I think it was Vantage. Whatever it was, it was more expensive with a small provider list. If there was another one selling in La., it wasn't in my list.

Pretty sure I've got the options down pat. I've been doing this since the end of 2013. I spent well over 100 hours at that time on the exchange and analyzing plans and learning how it worked and trying to find doctors, so I don't have to spend nearly as much time, now.

It wouldn't make sense to work backwards, if there is only one acceptable ins. co. and it sells only HMOs. Yes, I said above that I get a subsidy. I buy on the exchange. My premium is over $980, but I pay less, since the govt pays part.

I don't recall if it's a silver or not. It's my first year for a low deductible, because my subsidy was large enough this year. I've only ever had those high deductibles before.

I'm not criticizing the ACA in general, and that wasn't my point. I was just posting the upsetting situation that is happening again. I can do what I've done in other years and just don't get a dr and don't go to the dr. But I wanted a physical exam, since I'm dropping the ins. next year. So I thought I'd try to get a dr. before the end of the year.

[bettyellen]

57. There were at least four companies with a few types and levels of plans each offered in LA

So there were at least ten plans available- yet you make it sound like no choice at all. Only a Blue Cross HMO. That is not true.

You're also talking about "the premium" as if it's the amount you're actually paying- and disputing others are paying less because it suits your narrative too. In short, I'm not going to rely on your account here as it's obviously skewed to present this is the most negative light possible. It's possible there really is a dearth of doctors in your area- but if you spent as many years and this year hours aware of this situation you could have spent a few of them on research.

[WinkyDink]

37. So get off the ACA if you're that concerned about payments to medical professionals.

[KelleyKramer]

40. No, that is not how it works

You don't contact any individual doctors to ask if they take a certain Blue Cross plan

The doctors sign up for any of the various BC plans before you even buy the insurance

You get your doctor by signing up with your insurer, in this case Blue Cross

Blue Cross will give you a list of doctors who have signed a contract them to give you treatment

[sprinkleeninow]

72. No, you know what. I had an issue finding an allergist several

years ago. Went on our ins. website, found list of allergists, called each one to double check. Two no longer with our insurance company!

I sqawked at ins. company and they go, oh, the online list is evidently not updated!

It's a big-time pain in the caboose!

[Demsrule86]

44. Here is the thing...I get that you don't like Obamacare but consider it is the only game in town

do you really want to go back to pre-existing conditions? We are not getting single payer this year or next or anytime soon...years away if we get it at all. And if you sit out, you will pay a fine and risk your life if you get a life threatening illness or have an accident. My cousin died six months before the ACA was implemented in a boating accident.. the hospital delayed life saving surgery because they wanted his Mom to sign that she would be responsible;had to wait for her to arrive. He had pre-existing (he was a premie twin which is all it took) and could not get insurance at any price. Now the GOP is trying to kill the ACA but you can still work with it...if I could I would help you...you can go to brokers who will help you also...just beware if they have a plan they promote as sometimes there are economic reasons.

[lunasun]

26. By asking if they take "obamacare" they may think you are asking about Medicaid

Hard to believe there are not a lot of Drs who would even take Medicaid in Dallas but what do I know. Just sayin that cuz it's a big city and I would think plenty would fill that niche but again I know it's Texas
https://www.yelp.com/search?find_desc=best+doctors+on+medicaid&find_loc=Dallas,+TX&start=50

[Honeycombe8]

27. No, they don't. And that's not what I ask, anyway. They know very well what it is.

The providers are well versed in the ACA program. They know it's the individual plans thru the exchange.

But I ask the normal questions that anyone asks. THEY ask if it's through employer or what. So I tell them it's an indiv plan thru the exchange. "Oh, we don't take THAT." or just "no."

I don't know what drs take Medicaid. I don't ask about that, of course. Why would I ask about that? But this one I talked to today sort of equated my plan with Medicaid, in a way. She said, "Well, I know we don't take Medicaid...."

Bear in mind, this is an ins. policy that costs almost $1,000 a month. I get a subsidy, but it still costs over $980/month. That's pretty far from Medicaid.

[Demsrule86]

45. There are lists of doctors who accept particular plan on the website.

You counter every suggestion...it is my opinion that you just don't like the ACA and think that you can get single payer if we lose it...you won't. We will get nothing.

[PoindexterOglethorpe]

29. For what it is worth, it has long been a problem finding a doctor who will take your insurance.

In the early and mid 1970's, in the Washington DC area, it could be incredibly difficult to find a doctor who was open to new patients and would take your insurance.

I would hope that a Single Payer would change that. Although, under the best of circumstances and assuming all providers have the best of will, it won't happen overnight.

Oh, and I don't know if things have changed in the past 30 years or so, but my brothers-in-law, doctors, did not accept Medicare or Medicaid. And back then it didn't seem to hurt their practice.

[The empressof all]

31. It's the insurance company that is the problem

Now of course in your state the choices for insurance under the ACA may be limited but that is due to the carriers willing to sell policies in your area. In my particular county we had lots of choices last year and I have never had an issue with seeing doctors or specialists. Don't get me started though on the monthly cost for premium plus co pays and deductibles The ACA is not perfect but without it those of us with pre-existing conditions would not have anything.

I'm sorry your state and county haven't done a better job in getting adequate carriers on board...It is a disgrace that where you live in this country so deeply impacts your ability to get adequate medical treatment.
.

[Honeycombe8]

34. Two states. Two counties/parishes. One large, one small.

Yes, the ACA works for some people, and not for others. We are all important, right? No one is more worthy of health care than another, right?

The only time I had trouble with a provider list or finding a dr was when my employer tried an HMO one year. HMOs are not popular with providers. There were doctors that would take it, but not many, and they were not the most desirable doctors. I remember going to one in a dingy office in a strip mall.

I'm not here to criticize the ACA, though. I was just posting about this one issue I've had with the ACA since 2014.

I'm getting a call back tomorrow, hopefully. So I'll see.

I have two ins. cos. to choose from, the second one was super unacceptable, so it was only BC. And BC sells only HMOs in the state.

[Demsrule86]

46. Contact the Dems and the GOP and tell them to fix the ACA instead of playing footsie with

single payer (Dems) or trying to kill it (GOP).

[sprinkleeninow]

75. Hear tell that's what's in the wind now.

Tweakin' the ACA to make it more better.

That might be more doable considering the repugnicants' pushback on every blessed thing that is beneficent and necessary.

I dunno. Whatever our Dem congress people see fit, I'm in.

Oh, anddd, BUCK FRUMPF!

💖🇺🇸🗽💪

[davsand]

33. Doesn't the insurance company have a list?

Call the insurance company and ask them who accepts your plan.


Laura

[Honeycombe8]

35. I wrote about this above. Yes, I use the list every year. The ins. co. uses the same list.

I've called in years past. They just use the same incorrect list. You have to call each provider on the list. This would not be a problem, if I got a "yes" answer.

[ecstatic]

36. Are you logging in as a member to BCBS so you can get the providers that specifically

accept your insurance? A general list would probably lead to a lot of wasted time.

I assume all the BCBS state sites are the same or very similar. To get specific providers for my plan on BCBS of GA's website, I log in, then there's a menu on the right hand side, near the middle of the page that says Useful Tools. Click Find A Doctor. On that page, on the top, it should say: "I want to search my plan/network: My Plan." From there you can narrow down your options, but in your case keep it as general as possible. Optionally, you can check the box that says Accepting New Patients. I'm on an employer/group plan now, but it worked the same way 7 years ago when I was on an individual plan.

[Honeycombe8]

50. Yes. It's my online account that has everything re MY policy..and I pay there.

My policy docs, the provider list, the drug list, etc. Yep.

[Weekend Warrior]

47. You don't need to make calls first.

Create a personal portal at BCBS and they will tell you the doctors who accept that plan in that area. I have used it and found the information to be accurate.

I can't imagine cold calling offices. That doesn't make sense considering the easy to use resources they have made available.

[Honeycombe8]

49. I have to call. The list is wrong. It's always wrong. "They" just look at the same list I have.

The last time they assigned a dr. to me, that dr. had moved out the city over a year before. It took me over an hour to track that down.

When I called them and told them that that dr wasn't here, they assigned one I had already called and who told me they wouldn't take my ins.

Whenever I get the ins., I immediately set up my info online on their site. I access the provider list, the drug list, I download the policy documents, and I pay online.

So they're just looking at the same list I am. They also don't know the geographical area to know who is closer, time-wise. One provider was about 15 miles away...but it was on the opposite side of town, which would've required a trip through the heart of downtown, making that trip time consuming...and impossible if I were sick.

So I call. That's necessary. I've been doing this since the end of 2013. I've tried every way imaginable.

I used to do this for employer-provided insurance, but for those, I could use the list. Not for this. (The one I did find in Dallas...I think I started doing general internet searches, yelp, etc., and that's how I found one who would take it...1 1/2 hrs away.)

[jberryhill]

54. What does the provider say about the list being wrong?

If the list is wrong, this is false advertising. There are several routes you can go with that including your state insurance commissioner.

[Honeycombe8]

55. Yes, BCBS has been sued over it. Providers know about the problem, or are surprised...

it doesn't really matter what they think about it.

BCBS rep told me once that it's unreliable because the providers don't update their information with the BCBS, which BC relies on. But the list I was using at the time wasn't just not updated...it had a knee specialist listed as a primary care dr., and drs that flatly did not take, and never took, that ins.

I concluded on my own (just a guess), that the list is for all providers who take that "group" of ins., whether from employer insurance or off-exchange (Say, Blue Cross Blue)...but a provider may in fact take only ONE type of Blue Cross Blue (a PPO, or employer insurance or whatever). Just giving BC benefit of the doubt.

[jberryhill]

56. Don't give them the benefit of the doubt

You are already giving them the benefit of your premium. That's enough.

They are inflating the perceived value of their product by making false representations and by continuing to do so after receiving notice it is false. You are spending your time and effort chasing around as a consequence of the knowingly false statements they are making to you.

[Ms. Toad]

73. We currently have two different BC/BS policies

Based in two different states (but both covering the state we live in). Each portal has its separate list of providers that are specific to that policy. Your experience is inconsistent with the experience I've had - not only with BC/BS, but with every other insurer but one (an off-brand company that went out of business).

Every other policy (a dozen or so in the last 2 years), working with the 16 doctors the three of us in our family see regularly, the portal has never had more than one inaccurate listing. (The off-brand company that went out of business did have several.)

The list available to you in your portal (signed in, connected to your plan) is specific to your plan - not a generic insurer list. It is pointless to cold-call providers based on website assertions that they accept BC/BS, because individual plans are different - and doctors under contract with one are not necessarily under contract with the other.

So assuming you are actually working from the portal for your specific policy, and finding doctors from that list who are not accepting your insurance, get on the customer service line with BC/BS, document the calls you have made to providers on their list, and make them call until they find a doctor who accepts the insurance. That's what worked with the off-brand company. By the time we were done with them they had cleaned up their list considerably. Then they went out of business. Not necessarily connected.

[sprinkleeninow]

77. Ai Chihuahua! I know what you're saying.

This happened to me with two types of our ins. and it was not BCBS! I won't divulge the names.

Providers drop out, move away, retire, move around like playing musical chairs, etc.

I feel it's always smart to call the provider you hope to see and let 'them' confirm specifics.

It's a game. Better to CYA!

[Weekend Warrior]

64. Much different experience than I had.

BCBS was even excellent over the phone helping me to chose a Dr. Sorry you experience is so much different. I lover their portal and the help I get from their people.

[Honeycombe8]

84. I wish I lived where you live. They're nice, but they're unfamiliar with things.

Today I asked if the list has nurse practitioners in it. The BC rep didn't know. I could look that up but didn't have to. When I called the dr office back to let her know that I couldn't get a reference # from BC for the N.P., SHE told me that the ins. co. lists typically do list the N.Ps. So she knew more than BC. She also told me that the NP would be on the bill, not the dr. So he could not be in network for me.

I'll check into the cost for out of network.

[Honeycombe8]

51. I got the answer from dr. #1...no. BUT...

if I call BCBS back and get a reference # for using their nurse practitioner, that nurse will see me. So I call BCBS..she looks on "the list" (my provider list...the one I have), and sees that the nurse's name is not on the list. (I don't think nurse practitioners are on the list at all, since they work FOR doctors? The rep doesn't know.) So she tells me it's possible that being assigned to a nurse practitioner would be considered out of network, unless the dr office "says" I'm his patient.

Since I can't take that chance, I move on to dr. #2.

BTW...this is something I picked up on in years past. The GOP makes a big deal out of insureds gaming the system, but I've noticed that the providers have started gaming the system. Having their nurses take the place of the doctor is one way...they get paid doctor rates for nurse time.

Another thing that some in Dallas did was require a "meet and greet" or orientation meeting, costing about $100 or so. That way, they get more $ than the paltry fee for the free annual exam for new patients. If the insured has a deductible, that would be an out of pocket expense for the lower level policies, altho a copay may apply for the higher level ones. This is gaming the system to increase their fees.

[sprinkleeninow]

79. Aw man. Hafta jump in again.

I saw an urgent care practice last Dec. for upper/lower respiratory.

Evening trip. Asked at desk, $20 co-pay, right? Yes, that's correct. Was seen by a P.A.
Got EOB (explanation of benefits) in mail. Sez I owe $40 for co-pay, which is for a specialist.
I called our billing office and our insurance company. Each one pointed fingers at the other.

One evening, husband flew over to office after I related how this issue was stuck in mire. Got two contact names/numbers. I let him take over because I had it up to here. This crapola is bad for your pressure and mine's not high.

After six months of screwing around, find out it WAS the insurance co. that read the claim as seeing a specialist because they thot the P.A. not being on the M.D. roster of providers was a specialist.

If you're pretty well, THIS'LL make you SICK!

[Honeycombe8]

81. That's crossed my mind. That dealing w/ins. could make a person sick. Really.

It's so stressful (to me, anyway) that words can't express. I went into a deep depression several years ago over it. Until I just decided not to go to doctors. Which is what the ins. cos. want...they do this so that no claims are turned in. BC has not had to pay out one penny for me. Just rake in thousands of dollars of pure profit.

I went to urgent care last yr for a dog bite, but that was United Healthcare. I had to pay $75 on that.

My ins. only pays for Urgent Care when dr's office is closed, and it is a true emergency. They're more expensive than a dr., I guess.

[Lee-Lee]

53. I've had the same problem and worse trying to use the "VA Choice" program

I have other insurance also but the issue I have is service connected and therefore supposed to be treated by the VA. But they don't have the doctors I need available in a timely fashion in a reasonable distance.

When the VA Choice program was started it looked great. You could get a referral to the doctor near you that could see you fast or if you found your own they would call and see if they could get them on as a provider. It was supposed to be fast pay for them and quick access for patients.

I did get in to see a doctor, and she was great. My follow up was a month later and they said the VA Choice system had hiccups for them but they were working with it. My next appointment was 3 months later and they called a week before and said the VA had still not paid them for the first visit 4 months earlier and if I still wanted the appointment I needed to provide insurance outside the VA or pay cash. And of course her practice was out of network for my employer. I ended up paying the huge out of network costs and they did reimburse me a few months later when the VA finally paid. They are working with me still through the program but told me there is no way they will take any new patients on the program.

Sad that the VA has bungled it because it was essentially a step toward a single payer type system for veterans.

[Honeycombe8]

58. Yes, I've heard horror stories about Vets' med. care.

One guy needed surgery on his leg. He lived in Dallas...big city, with at least five large medical complexes with hospitals, not counting those in the burbs. He had to go hundreds of miles away out of town to get surgery thru the VA, so had to find someone to drive him there. It's horrible.

Your experience sounds similar to mine. I think it's probably not the fault of the providers. We can't expect them to work for free, or wait months to get paid, and then get paid next to nothing.

So I sympathize with your plight. I think a person has to go through it to really understand. So when someone speaks about such problems related to other programs, I can totally empathize, because I know exactly what they're talking about.

Hopefully the vet care is getting better, since I think someone new was named to get that in shape, as I recall? The vets have many with serious conditions....we can do better for them than what they had.

Is insurance involved in the VA Choice program? I think insurance profits are part of the problem.

[MichMary]

59. Six months ago

everyone on here LOVED Obamacare.

[sfwriter]

60. I went through this, confirm your card information.

I went through this and it turned out the cards were "misprinted." The numbers I read to the provider for the plan were incorrect. I wonder how many people don't get care because of these shitheel games.

[beaglelover]

68. Don't they have a website where you can plug in what network you're in and they give you the

list of doctors in that network? We have that with both our Aetna and UHC offerings here in CA.

[taught_me_patience]

71. You have a double whammy... ACA plan + HMO

The reason why doctors are not taking those plans are twofold:

1) BC ACA plans reimburse 20% less than non-ACA BC plans of a similar nature. It's very hard to find a doctor (or anybody) what will work for 20% less for the same amount of work.

2) BC HMO plans are utter crap. For each visit, the doc might be reimbursed $7-$10, depending on the contract, and the maintenance fee is crap too. HMOs also require a huge amount of paperwork too.

3) BC HMO ACA plans are truly terrible from a reimbursement standpoint.


My wife is a primary care provider, so I'm very familiar with the economics of insurances. She only takes PPO and was taking ACA PPO BC plans until this year, when she stopped because the reimbursement was just too low to justify. When a doctor owns their business, a 20% reduction in reimbursement can easily result in a 40-50% reduction in profit after expenses are accounted for.

*********
If you have to see a doc for a physical... one option would be to pay a cash price. I'd call around and offer $175 for a physical and see if any doctors would take it. Typical reimbursements here in CA for a one hour physical are 175-220.

[Honeycombe8]

82. Yes, exactly. I'm sympathetic to their point of view, actually.

They also get stiffed on some bills because of the ACA rules when an insured fails to pay a premium. The ins. co. can't cancel for 3 mos or something. If the insured gets medical care in the interim, ins. co. will likely not pay those bills.

Good idea about the cash. I have no idea what that would cost when ins. is not involved. One benefit of insurance is that they contract for a cheaper rate...so if you don't use the insurance, you have to pay full retail, maybe.

I'll check on that. Yeah, I just want an exam and a mammogram. I haven't had these done since 2013.

Thanks so much!

[guillaumeb]

76. The miracle of free market capitalism.

And your story is only one of many.

[cyclonefence]

78. Last week (I think) somebody posted about "concierge" doctors

who don't take insurance at all but charge a flat monthly or annual fee. Would this be something you'd want to look into? Your BC/BS premium is so high that I bet a concierge dr. might be cheaper for you, especially if you're thinking of not insuring at all next year. You'd need what used to be called Major Medical I suspect to cover hospitalizations and procedures, but that would be much cheaper than what you're paying now.

There are concierge physicians near Lake Charles that I found on Google.

[Stinky The Clown]

80. Sounds like you'll be going deep

[Honeycombe8]

83. LOL. Love that expression. I'm going to steal that! nt