General Discussion

flamingdem

(40,850 posts)

188. Anthem EPO looks like it works with UCLA doctors / hospital but when

Mon Nov 25, 2013, 08:59 PM

Nov 2013

I called a clinic there they said they will not be taking ACA. I'll try again with the specifics that you fortunately found, it really is helpful because at least I know that Anthem is offering access, but after speaking with Anthem and calling a clinic I am not optimistic that it's wide access. But maybe they don't know, even those who work the phones for Anthem.

On UCLA hospital site:

* Health Net was looking good until I realized that they don't accept Silver at UCLA. What a crazy patchwork, plus they exclude doctors on campus, that's really not good

Covered California (California's new marketplace for purchasing insurance coverage)
Effective Jan 1, 2014

There are two Covered California plans that provide full coverage for care from UCLA Health and our physicians. Learn more »

Anthem Blue Cross EPO (Pathway-Tiered)
Individual plans: Bronze EPO, Silver EPO, Gold EPO and Platinum EPO
Health Net PPO*
Individual plans: Bronze PPO and Catastrophic PPO Plan
Small group plans: Bronze PPO, Silver PPO, Gold PPO and Platinum PPO
*Note: At this time, Health Net PPO only includes UCLA Medical Group physicians in the general West Los Angeles and Santa Monica areas, including Malibu, Marina del Rey, and Manhattan Beach.

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Insurers to pay doctors 30-40% less under exchange plans. [View all] eridani Nov 2013 OP

Why do all these "experts" always ignore economics 101? tridim Nov 2013 #1

The market will always say that sick people should be executed for not having money eridani Nov 2013 #12

That's not the HC market, that's the investors. tridim Nov 2013 #56

Markets have no legitimate role in providing public goods eridani Nov 2013 #138

Doctors in the US are paid way too much as it is. JaneyVee Nov 2013 #2

some but not all. hobbit709 Nov 2013 #4

What's your solution for that? Make it easier and cheaper to BECOME a doctor? cherokeeprogressive Nov 2013 #5

Exactly, what's the average length in school and student loan debt Puzzledtraveller Nov 2013 #7

I agree. Making it easier, cheaper to become a doctor would be a great step. JaneyVee Nov 2013 #9

That would have been the major tenet of my ACA. cherokeeprogressive Nov 2013 #13

I like your solution. We should also subsidize engineering degrees and other JaneyVee Nov 2013 #17

Doctor yeoman6987 Nov 2013 #105

Having recently experienced health care in France for a broken leg and the upon my return to the Thinkingabout Nov 2013 #126

Because the French don't have the for-profit middleman mainer Nov 2013 #168

I think you are right and I did not experience long waiting lines or months for health care. Thinkingabout Nov 2013 #170

I wasn't referring to training. n/t cherokeeprogressive Nov 2013 #181

The AMA won't allow that. lumberjack_jeff Nov 2013 #189

long and hard and expensive gasman09 Nov 2013 #15

Don't you get paid an hourly wage as well? JaneyVee Nov 2013 #18

Salary plus production bonus gasman09 Nov 2013 #20

You are kidding right? Chuuku Davis Nov 2013 #117

welcome to DU gopiscrap Nov 2013 #21

and your average annual income for the last five years? hfojvt Nov 2013 #32

Envy is not becoming gasman09 Nov 2013 #47

who said anything about envy? hfojvt Nov 2013 #50

You pay 1 day of your wages to visit a doctor, true. How much of that does the doctor keep? uppityperson Nov 2013 #53

insurance pays half of that hfojvt Nov 2013 #67

I wrote ins pays 1/2, write off the rest. If you pay cash, typically there is a 10% discount, and uppityperson Nov 2013 #71

still a lot treestar Nov 2013 #120

My PCP clears around 50K a year for 4 days a week. That is "still a lot"? uppityperson Nov 2013 #123

It should be respectably middle class but not huge treestar Nov 2013 #125

Just because a clinic's hours may be 9-5 does not mean that is the hours worked. uppityperson Nov 2013 #128

"9-5 type hours, not terribly difficult?" mainer Nov 2013 #147

9 to 5 types hours covers a lot of professionals treestar Nov 2013 #151

No, the AMA has been trying to increase # of medical schools mainer Nov 2013 #154

If it would lower health care costs treestar Nov 2013 #159

And it's NOT just "9 - 5." mainer Nov 2013 #155

They can. treestar Nov 2013 #160

discount gasman09 Nov 2013 #58

"envy is not becoming" hfojvt Nov 2013 #69

Not "e" gasman09 Nov 2013 #75

sounds to me then hfojvt Nov 2013 #87

My PCP told me how much he makes a year. Not to the dollar but in the range. Try it, you might be uppityperson Nov 2013 #95

lots of hate for healthcare providers!!!! gasman09 Nov 2013 #113

Doctors should be able to make good money because their expenses are pretty high OwnedByCats Nov 2013 #118

The answer is "d", if anyone's interested davekriss Nov 2013 #112

Thank you for what you do. redstatebluegirl Nov 2013 #81

actually my own daddy sent me to school hfojvt Nov 2013 #89

My husband loves teaching and research. redstatebluegirl Nov 2013 #90

I got my BA in 1985 hfojvt Nov 2013 #94

How much lower would it have to be before you'd quit? treestar Nov 2013 #124

You are a lawyer complaining about how much doctors make? uppityperson Nov 2013 #129

Not all lawyers make bank. n/t Adsos Letter Nov 2013 #135

Same applies to doctors. uppityperson Nov 2013 #136

Oh, agreed. Pediatricians come immediately to mind. Adsos Letter Nov 2013 #140

Did you read my post? treestar Nov 2013 #149

Not a conservative gasman09 Nov 2013 #171

why does it matter what he makes. Travis_0004 Nov 2013 #61

whee hfojvt Nov 2013 #74

Honestly, blame part of the on the very reimbursements this thread is discussing joeglow3 Nov 2013 #66

the dentist I know hfojvt Nov 2013 #76

I'm not yet a Medicare patient, but rusty fender Nov 2013 #116

You aren't looking at this correctly Act_of_Reparation Nov 2013 #70

wait "if you live OUT of state" hfojvt Nov 2013 #80

In-state isn't cheap either... Act_of_Reparation Nov 2013 #109

Insurance companies are killing us all (while making record profits). Laelth Nov 2013 #127

but the world does not work that way hfojvt Nov 2013 #184

welcome to DU! renate Nov 2013 #104

For my oldest daughter? Adsos Letter Nov 2013 #57

That's a lifetime investment. Puzzledtraveller Nov 2013 #68

New rules BlueStreak Nov 2013 #114

You do know medical schools limit enrollment for the reason they could make outrageous pay. duffyduff Nov 2013 #173

Indentured servitude? pangaia Nov 2013 #177

So, he makes too much? Are you proposing some kind of law limiting doctor pay? n/t cherokeeprogressive Nov 2013 #180

Not at all. pangaia Nov 2013 #182

Certainly not primary care physicians mainer Nov 2013 #16

And especially not Pediatricians. Adsos Letter Nov 2013 #60

oh really? and you base your statement on what? magical thyme Nov 2013 #24

why so defensive? hfojvt Nov 2013 #38

my questions are legitimate, not defensive... magical thyme Nov 2013 #46

vacations are one thing hfojvt Nov 2013 #52

Your point about the jeep is they called it a "toy"? uppityperson Nov 2013 #55

so go to medical school, become a doctor and you too can own those things...nt magical thyme Nov 2013 #134

You admit you do not know what doctor's income is, yet assume. A jeep means they are filthy rich, or uppityperson Nov 2013 #51

3 loans is one thing hfojvt Nov 2013 #64

So you want him to pay the same amount, get a loan for the same amount, but an older house? uppityperson Nov 2013 #72

specialists and often dentists often are, but not usually GPs. nt Deep13 Nov 2013 #77

Is $160,000 a year too much? mainer Nov 2013 #84

Which is more than Sgent Nov 2013 #98

How do you figure that? elias7 Nov 2013 #115

Yes! Doctors should be paid at the same rate as you are! Beausoir Nov 2013 #142

The gravy train for doctors in this country is about over. duffyduff Nov 2013 #172

My beef with ACA has always been that it was insurance instead of health care. hobbit709 Nov 2013 #3

For the last 15 years I have been expected to produce more for less at my job. jbond56 Nov 2013 #6

+1 n/t Bonhomme Richard Nov 2013 #10

so have doctors... magical thyme Nov 2013 #25

And the number of patients they are being expected to see is actually increasing. Adsos Letter Nov 2013 #65

I know. That's why it's ludicrous for people to claim they're in collusion w/insurance companies magical thyme Nov 2013 #133

Take out the middleman. Pay the doctors, starve the insurance guys mainer Nov 2013 #8

Might be good, but even under Medicare, insurance companies do most of administrative work. Hoyt Nov 2013 #27

Claims processing for basic Medicare is also done by insurance companies FarCenter Nov 2013 #30

I know, insurance companies do most of admin work. Plus, drug coverage is through insurance Hoyt Nov 2013 #39

So pay the insurers and starve the doctors? mainer Nov 2013 #165

Apparently you missed the point. But, see how quickly you get an appendectomy without insurance Hoyt Nov 2013 #166

See how fast you get an appendectomy without a doctor mainer Nov 2013 #167

I did not say that, you need to read the posts again. Only this time Hoyt Nov 2013 #169

Anti-ACA threads are counterproductive and should be ignored. gulliver Nov 2013 #11

Because ignoring things always makes them better frustrated_lefty Nov 2013 #14

wow, THANK YOU philosslayer Nov 2013 #131

Two simple questions. How do they know it is an exchange policy? & Since they arent in force stevenleser Nov 2013 #19

They do know if it's an exchange policy by group # flamingdem Nov 2013 #22

LA PasadenaTrudy Nov 2013 #23

LA as in Los Angeles. It's by zip code and my hospital would be UCLA Harbor flamingdem Nov 2013 #40

What do you mean "aren't being accepted"? That is present tense. That is not possible. stevenleser Nov 2013 #26

Insurance companies contract with physicians. Apparently some -- maybe a lot -- are not accepting Hoyt Nov 2013 #28

Well, I've contacted two hospitals there to find out. stevenleser Nov 2013 #31

I would imagine it means the hospitals have reviewed the fed regs and policies Nuclear Unicorn Nov 2013 #29

I reached out to UCLA medical center and Cedar Sinai to see what they have to say. stevenleser Nov 2013 #34

Some NY Hospitals Opting Out of Health Exchange Plans FarCenter Nov 2013 #36

I can already tell you that Anthem Blue Cross and Blue Shield are not covered by them flamingdem Nov 2013 #41

I look forward to reading what they have to say. Perhaps an OP would be in order. Nuclear Unicorn Nov 2013 #43

Response #1 (UCLA Medical Center) stevenleser Nov 2013 #145

Thanks Steve, very interesting that Anthem does cover them flamingdem Nov 2013 #157

Response #2 Cedars Sinai. Looks like they have fully embraced ACA stevenleser Nov 2013 #185

Yes exactly Anthem and Blue Shield are excluded flamingdem Nov 2013 #187

Anthem EPO looks like it works with UCLA doctors / hospital but when flamingdem Nov 2013 #188

I found out more about the Anthem EPO after another round of calls flamingdem Nov 2013 #190

The contracting logically would have to be in place before the plans go effective. TheKentuckian Nov 2013 #35

How would they break them? flamingdem Nov 2013 #45

Already in progress. Increase nurse practitioners and make them a less valuable commodity TheKentuckian Nov 2013 #54

Insurers don't contract by group number/type, they contract by type of policy - HMO, PPO, etc. cbdo2007 Nov 2013 #49

That seems to be the case judging from my first response from UCLA. See above nt stevenleser Nov 2013 #146

Instead of "Medicare for all", ACA is more like "Means-tested Medicaid for all". FarCenter Nov 2013 #33

The AMA works hard to limit the number of doctors treestar Nov 2013 #37

Hey man! It costs money to be wealthy! JNelson6563 Nov 2013 #42

Agree flamingdem Nov 2013 #59

My wife (primary care physician) found out she needs to re-enroll taught_me_patience Nov 2013 #44

Medicare is lowering all of their mental health rates by 3%-25% in 2014.... cbdo2007 Nov 2013 #48

Does anyone need more proof insurance companies are bloodsucking assholes? The thread title sums uppityperson Nov 2013 #62

Too many "if's" in this story coming from the right wing propaganda machine Lifelong Dem Nov 2013 #63

Wouldn't doctors on single payer complain about the same thing? pnwmom Nov 2013 #73

Yes NoOneMan Nov 2013 #79

Most good doctors I've called take Medicare but NOT ACA flamingdem Nov 2013 #82

I work for a large health insurance company.... cbdo2007 Nov 2013 #85

You're not informed. I called insurers, doctors and hospitals flamingdem Nov 2013 #86

LOL....I do this as my job everyday. cbdo2007 Nov 2013 #91

Silver Level Blueshield PPO - could do Anthem EPO but that's more narrow flamingdem Nov 2013 #92

Have you called Blueshield PPO to ask about their network? cbdo2007 Nov 2013 #97

So you're not going to do any work to prove your claim after all? flamingdem Nov 2013 #99

You said you called the doctors and hospitals and asked them if they "took ACA".... cbdo2007 Nov 2013 #106

Look again under Covered California nt flamingdem Nov 2013 #108

UK pays doctors a decent income mainer Nov 2013 #83

We have a shortage of family doctors because specialists make pnwmom Nov 2013 #88

Once one is older we need specialists flamingdem Nov 2013 #93

I'm going to ask our primary care doctor which insurances pnwmom Nov 2013 #107

True, it's an interesting bash coming from the left treestar Nov 2013 #121

This is great news! NoOneMan Nov 2013 #78

Message auto-removed Name removed Nov 2013 #96

Here, from the article... uppityperson Nov 2013 #100

It was my understanding... cyberswede Nov 2013 #102

I know uppityperson Nov 2013 #103

You & your fancy numbers & stuff! cyberswede Nov 2013 #111

Which is why I hid behind the door when that talent was offered. What can I say? freshwest Nov 2013 #144

To those who say that doctors are overpaid. BlueCheese Nov 2013 #101

IMO the AMA probably makes the difficulty, too treestar Nov 2013 #122

Health care has gotten a lot more complicated, the more is known, the more technology there is uppityperson Nov 2013 #130

Tell me about it. Adsos Letter Nov 2013 #139

But I was talking about GPs treestar Nov 2013 #150

Perhaps you're not aware of what "GPs" actually do mainer Nov 2013 #152

Every profession has people in the lowest ranks treestar Nov 2013 #161

The lowest rank of doctor is still 11 years of training mainer Nov 2013 #164

Yep GPs just are stupid know nothing Drs. gasman09 Nov 2013 #183

So, let's figure out how to get more folks into primary care... HereSince1628 Nov 2013 #110

So we basically want to ensure that NO ONE goes into medicine then. Good plan. nt Demo_Chris Nov 2013 #119

Doctors should be insulated against their patients poverty XRubicon Nov 2013 #132

Please explain how Medicare For All will PASS??? Your entire post is a moot point. RBInMaine Nov 2013 #137

State by state, obviously eridani Nov 2013 #141

OK, but we needed something nationally NOW, and MANY states will never pass Medicare For All. RBInMaine Nov 2013 #148

PLease inform me if I am wrong, but doctor/hospitals choose which insrurane plans Incitatus Nov 2013 #143

Medical treatment will be outsourced. nt valerief Nov 2013 #153

Average salaries for physicians... 99Forever Nov 2013 #156

Those days are about over. That can't be sustained. n/t duffyduff Nov 2013 #174

Welp Tien1985 Nov 2013 #158

Well, that sounds like an attempt by insurance companies to sabotage healthcare kestrel91316 Nov 2013 #162

My family doctor is worth 30-40% less fadedrose Nov 2013 #163

With improved medicare for all, there's still a shortage of doctors, and they'll still be paid less bhikkhu Nov 2013 #175

With Medicare for All being paid less only decreases gross income eridani Nov 2013 #179

How about the middle men, or the hospitals that charge 8 dollars for an aspirin. Where do the lostincalifornia Nov 2013 #176

The goal is ALWAYS to suck profits to the very top. woo me with science Nov 2013 #178

exactly. great post. solarhydrocan Nov 2013 #186