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Showing posts from March, 2014

CA Doctors Bailing on ObamaCare Patients?

Recently I saw some numbers for reimbursement rates on the spiffy new Obamacare 'stuff' from a large insurer in California. 

For CPT code 99213 (routine office visit)

Old Legacy Network pays doctor: $71.00
New Off Exchange Network pays doctor: $66.00
New Exchange Network pays doctor: $45.50

Article published today in the Visalia Times and Tulare Advance-Register.  

Doctor Networks Opt Out of New Plans



Insurance agents and doctors agree — call your doctor before the end of open enrollment (March 31) to confirm whether your doctor accepts your new plan. The alternative, they say, is boarding what can become a frustrating insurance merry-go-round.
 To add insult to injury, her doctor — whom she’d seen for years — informed her that his  office no longer accepted individual Blue Cross insurance plans, regardless of whether they were purchased from Covered California or not
 In many cases, private physicians who don’t practice in a federally qualified, hospital-owned or rural clinic ar…

It's ALL Obama Care, People!

There sure is a lot of confusion out there about individual & family coverage in California (and elsewhere).

Quite simply, it's all Obama Care.  There are two channels to purchase coverage but all of it complies with the ACA by law.  They are not separate markets, just separate channels within a market with some variations in terms of carriers and subsidies.

One, you can purchase your coverage from the exchange (Covered CA) if you want to get some money from Obama to subsidize your premiums/benefits and you are eligible for help.

Two, you can pay the full boat yourself and purchase outside of Covered CA in the private market.  Those plans must still comply with the ACA standards and must at least offer 'mirrors' of the exchange (Covered CA) plans (there can be extras in the private channel but they still have to meet metal and ACA standards).

It all comes down to only where the premium $$ are coming from.  Otherwise, all plans are part of a single market risk pool and all …