KHH1

THE HEATHCARE reforms in the 2010 Patient Protection and Affordable Care Act remain a work in progress, with some of the law’s mandates causing new problems or exacerbating older flaws. One is inaccurate lists of the healthcare providers in insurers’ networks; another is surprise bills by out-of-network providers. California lawmakers have offered proposals to solve these problems, and the Legislature should pass them.
Insurers have been exploring ways to hold down rates by signing up smaller networks of doctors and hospitals, and the 2010 law accelerated that trend. Such “narrow networks” can be a good thing for consumers, provided that the doctors on the list can meet the demand for care and have offices throughout the service area.
Still, people want to know before they sign up for a narrow network plan whether they’ll be able to keep the doctors they like, or how far they’d have to travel to see someone willing to take new patients. And in too many cases, they’ve enrolled only to be turned away by doctors who were purportedly in their plan’s network, either because the list was inaccurate or the doctors didn’t understand their contract with the insurer.
SB 137 by state Sen. Ed Hernandez (D-West Covina) would require insurers to publish provider lists online and update them weekly, including information about office locations, specialties, languages spoken and willingness to accept new patients. To avoid penalties, the lists would have to be at least 97% accurate and be available to anyone who’s interested.
In an era of electronic payments and digital health records, it’s hard to believe that insurers can’t keep track of who’s in their networks, what services they provide and where their offices are. Insurers argue that doctors should bear some of the responsibility for the records’ accuracy, and they’re right; the bill’s supporters should explore ways to make sure providers know and abide by what their contracts require.
One reason it’s crucial to know who’s in a network is that the cost of seeing an out-of-network provider for nonemergency care can be ruinously high. Insurance plans cover a smaller percentage of out-of-network bills, if they cover them at all, and unlike in-network providers, out-of-network doctors don’t agree to discounted fees.
Even when patients arrange for care from in-network hospitals and doctors, however, they can still be hit with huge bills from out-of-network specialists and assistants they had no idea would be involved in their care. In the most egregious cases, an in-network surgeon will bring in an affiliated specialist or laboratory not in the patient’s network in order to multiply the fees.
AB 533 by Assemblyman Rob Bonta (D-Alameda) would protect patients who go to in-network hospitals from being billed at out-of-network rates for any service received there. The only exception would be for patients who agree at least a day in advance to receive and pay for out-of-network services. In effect, the bill would hold patients harmless while insurers and providers squabble over the fees for out-of-network services.
The measure has drawn the ire of physician groups, which argue that protecting patients against out-of-network charges would encourage insurers to leave gaps in their networks — a problem that legislators addressed in the last session by requiring regulators to check the adequacy of most plans’ networks every year. More legitimately, the groups want a better way to resolve fee disputes between insurers and physicians. That’s worthy goal, but it shouldn’t stop lawmakers from protecting the patients who are caught in the middle.
The opposition to both measures reflects the potentially difficult adjustments insurers and providers would be forced to make in their operations. Those adjustments, however, are overdue. With the Affordable Care Act requiring all adult Americans to buy coverage, insurers simply have to deliver accurate provider lists. And providers shouldn’t be able to undermine that insurance by seeking out-of-network rates from patients who stay within their networks for care.

son of witless

Obamacare is unfixable. It needs to follow it's daddy into Oblivion when he retires.

viking747

Right, It can not be fixed. Do you know Muslims are excempt from obamacare ?

no propaganda please Loc: moon orbiting the third rock from the sun

No kidding. I wouldn't be at all surprised.

son of witless

Didn't you ever have a used car that was a black hole. I had a 1970 Dodge Charger and a 1999 Kia Sportage. Both cars sucked the life out of me and my wallet. No matter how much money I stuck into them they were never going to be reliable.

At some point you got to admit defeat and get rid of what is k*****g you. Now come on. You had to have owned at least one car from hell in your life.

son of witless

I can't believe you never had a car that could not be fixed. Those of us who bought used cars all our lives have at least one horror story.

Point, in the long run you get rid of the car, get a another one and get on with life. Obamacare should be scrapped because it is mostly a political law. Every special interest threw scraps into the pot and the stew cannot be saved.

You dump the pot out, scrub it, and start over. I don't care how much you think Obama cares about health care, his law needs to be scrapped. There were all kinds of stuff Obama and his dwarf Sir Harry Reid would not let into the law because Republicans offered them. They need to be put in a new law.

Obamacare can only be fixed piece meal and that will not work. Every special interest will fight for their goodie. It has to be destroyed and revamped.

no propaganda please Loc: moon orbiting the third rock from the sun

Years ago we had an MGB with a porous head ( a manufacturing flaw) but since we got it used , we were stuck with it until we gave it a funeral in the junk yard. first and last used car we ever bought.

son of witless

Wow there sure must be a lot of rich people on this site. It must be nice to afford new. I am not too familiar with British cars. I went to school with a guy in the 70s who had a Triumph and he complained about it's reliability.

Trooper745 Loc: Carolina

Good idea, son!

Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act. Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions.

Back in January, H&R Block figured that about half of the 6.8 million people who were getting ObamaCare subsidies would owe some of the money back. Another expert reckoned the average payback at $208. That was enough to set off alarms about the "unpleasant tax surprise" these millions would face. The tax experts were too optimistic, however. H&R Block now figures that two-thirds of ObamaCare enrollees who got subsidies had to pay at least some of it back. And the average payback was $729. So roughly 5.5 million ObamaCare enrollees had to return, on average, almost a quarter of their premium subsidies. Given that these subsidies are available only to families with modest incomes, that's got to hurt.

There may be just $1 in the piggy bank to cover every $10 in claims at an Obamacare program designed to spread risk among insurers, Standard & Poor’s said. The “risk corridor” program was designed to bolster plans that suffered losses on health-care insurance exchanges, in part by taking funds from those that turned a profit. It was one of three risk-sharing initiatives that help companies adjust to the Affordable Care Act. Yet companies mostly did poorly in state marketplaces, leaving the amount insurers expect to pay into the program at less than 10 percent of what others expect to get out, S&P found. And a bill passed last year doesn’t let the government use its own funds to make up the difference. “The only money they can use to pay the insurers who are on the downside is money coming in from insurers who are profitable,” S&P analyst Deep Banerjee said. Most insurers “ended up being on the loss side of the corridor. That’s why we are here.” The shortfall could mean higher premiums for customers and may threaten the viability of some smaller insurers…"

Excerpt from: Townhall.com, Guy Benson | May 04, 2015

dennisimoto Loc: Washington State (West)

You didn't write this all by yourself. How about attribution? You can look up "attribution," if you want.

KHH1

Polite people with social etiquette get better results from others in life....reminds me of this episode of Dr. Phil that was on in the lunchroom one day. This guy was talking about his wife complaining and talking down to waiters when they went out for dinner.....Dr. Phil's response, "Lady I bet you have eaten a lot of SNOT in your travels".....go figure.......

Trooper745 Loc: Carolina

Yes, .... the good old black waiter's response to someone who is white, ... spit in their food. Probably been done a lot since 'ole Jesse Jackson was a boy waiter.

Only the lowest of uneducated w****s would ever think of doing something like spitting in another human's food .... but here we have a (supposed) college educated black man who quickly advocates more of Jackson's filthy antics.

KHH1

right wingers really have comprehension issues....so now me quoting Dr. Phil is advocating something? FOX News...where we create our own t***hs....you people need counseling for real.....better you creating bulls**t out of thin air than me....wow.......... :roll: :roll:

KHH1

well imagine the spit score when integration first occurred.....everybody black in america would have a dry mouth trying to play catch up following your logic........

dwallace2015

The only cure for "Obamacare", (what I call Abysmal-care) is a total and unequivocal repeal. Put it back to what it was with some improvements, and let fair market practices have sway.