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Health Insurance and the Affordable Health Care Act


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Greetings Y'all,

I am new to this forum and would like to inquire as to the experiences of other Escapee members who have ACA Texas Blue Cross / Blue Shield health insurance. My husband and I continue to run into providers who refuse to provide us medical care, once they realize that we brokered our health insurance via the ACA, even though they are listed as providers for our particular plan. We have also run into this when obtaining lab and radiology services. Any thoughts or advice? Thanks in advance. -Lola

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First, let me welcome you to the Escapee forums! We are happy to have you join us here.

 

Tell us a little more about what sort of plan you have chosen. I gather that you are domiciled in TX via the Escapee's mail service? And I'd guess it also means that you are not yet of Medicare age?

 

It is my understanding that any provider who accepts the contract of an insurance underwriter is then required to accept patients covered by that policy? Is there by any chance an insurance expert on the forums?

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I am not an insurance expert but I have been told by an insurance agent that more and more providers are refusing patients that have the subsidized health plans or any plan on the ACA marketplace. I know that some of them have extremely limited networks but it sounds like the providers in the networks are constantly changing continuing to limit access.

 

I have not used my plan other than for a routine physical and this is the first year I have had an ACA plan.

 

The agent I spoke with recommended getting a plan out of the ACA marketplace if you possibly can. Which most people cannot afford,

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Right...what the others said. There is no difference from the medical providers perspective. My BCBS of TX plan is no different than the other plans. I have no issue with providers at all. But my medical group is not taking on new patients....My labs are fully covered if they fall into the preventative arena. Occasionally I have had to pay some excess that the plan did not cover, but that is a-typical.

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This is the first year since the ACA was passed that my Medicare Advantage plan was not cancelled. Great, an end to the problems of finding new plans that cover your existing doctors. Wrong. This year my plan renewed, but with unannounced changes to the network providers. I had an appointment in December, with a follow up in January. Guess what, the January visit wasn't covered because the doctor was dropped from the network. After enough complaints about lack of notification, somebody eventually wrote it off and I didn't have to pay. It's still chaos.

 

You have to check each year to make sure your providers are still in the network.

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Thank you all for your prompt responses. The providers I am referencing are providers who openly acknowledge that they accept our particular plan and are taking new patients.The denial of service comes in once they realize our insurance was brokered by the

ACA. They outright state that they do not provide services to ACA participants.

 

It is true that incurred fees are covered exactly the same, regardless of who brokered the insurance. This leads me to

believe that this is more about discrimination and politics. I have since filed a complaint with BCBS of Texas and with a consumeradvocacy group. These providers should not be on the BCBS TX panel if they are going to knowingly misrepresent who they will

serve. There is an element of fraud under these circumstances as they are in a contract with BCBS to provide agreed upon services.

I was a health provider before early retirement in another state and if I ever pulled a stunt like that I would have been removed from that insurance panel in a heart beat. I also feel it is important to note that there are many excellent providers and medicalgroups here in Texas.

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This is the first year since the ACA was passed that my Medicare Advantage plan was not cancelled. Great, an end to the problems of finding new plans that cover your existing doctors. Wrong. This year my plan renewed, but with unannounced changes to the network providers. I had an appointment in December, with a follow up in January. Guess what, the January visit wasn't covered because the doctor was dropped from the network. After enough complaints about lack of notification, somebody eventually wrote it off and I didn't have to pay. It's still chaos.

 

You have to check each year to make sure your providers are still in the network.

I think your problem might be because you have a Medicare Advantage plan. They are doctor-specific and they're hard to travel with. Consider changing to a regular supplement PPO plan where you can go to any doctor in any state. We've never had problems in 16 years of full-timing with a PPO plan.

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I think your problem might be because you have a Medicare Advantage plan. They are doctor-specific and they're hard to travel with. Consider changing to a regular supplement PPO plan where you can go to any doctor in any state. We've never had problems in 16 years of full-timing with a PPO plan.

 

My Blue Cross supplemental PPO plan does not pay for me to go to "any doctor in any state". It clearly states that they will only pay for providers who accept Medicare.

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My Blue Cross supplemental PPO plan does not pay for me to go to "any doctor in any state". It clearly states that they will only pay for providers who accept Medicare.

That's correct. I assumed the poster who had the Advantage Plan would be going to a Medicare-approved doctor. However, the first step would be to find a Medicare-approved doctor in any state. HMOs are more difficult to do this. You normally have to go to a doctor on 'the list'. PPOs are much easier to find a Medicare-approved doctor in any state.

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Providers are required to post if they do or do not accept medicare assignment. Medicare instructs patents to inquire if provider accepts medicare assignment. 5 years with medicare and aarp supplement, I have had no problem with Doctors, labs, or x-rays. Some charges were not covered, but I did not have to pay as the provider "accepts medicare assignment". Sorry to hijack, this is not about your problem with ACA.

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A word of caution to all. When you go on an exchange and see the term Multi-State plan, do not assume that this means the plan will work in states other than the one where purchased. The job is not so simple. Multi State plan just refers to that fact that a similar policy is offered by the company in other states. To know for sure you need to look at the specific terms of the plan you are purchasing and the availability of a nationwide network of providers. If in doubt call and/or use an agent.

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If we are talking about the exchange we are only talking about non Medicare under 65 policies.

I found the multistate plan issue when I called Anthem Blue Cross in WI (before signing up). They do not have providers out of state and are known for not fully paying for emergency services out of state per my broker.

 

I did find out that since I am working out of state for a few months, I can get a policy due to moving in that state eventhough my legal state is not the state I am working in. I will be in Wyoming and the multistate plan there actually covers me better in my legal state of Wisconsin in terms of number of providers than my current WI HMO plan. The only plans offered in the county of my WI legal residence are HMO plans.

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Thank You Teri I did mean under 65.

 

Over 65 get Medicare which is obviously a great deal. They are not eligible for exchange.

 

I did not know that. Not everyone over 65 is eligible for Medicare. I have several friends who are not. I just assumed they bought insurance on the exchange.

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I did not know that. Not everyone over 65 is eligible for Medicare. I have several friends who are not. I just assumed they bought insurance on the exchange.

Not to derail the topic, but why are several of your friends not eligible for Medicare?

 

Thanks

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Not to derail the topic, but why are several of your friends not eligible for Medicare?

 

Thanks

 

You have to have paid into the system to be eligible for Medicare, I believe. Many municipal, county, and State employees did not participate in Social Security. I believe that starting in the 1980's newer employees had to pay into Medicare, but older employees did not.

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