Thursday, June 12, 2014

N.C. Journal Looks At Obamacare

The Northcoast Journal takes a look at Obamacare, although their angle seems to be blaming problems on the insurance companies, specifically Anthem Blue Cross. That's the company I signed up with. No doubt things are still screwed up on their end, but I'll take exception with at least a couple parts of the story:

"... when Anthem was preparing to roll out its Covered California plans it took a hard line negotiating with local doctors, offering reimbursement levels 65 percent lower than for its traditional plans."

My understanding, just from what I read in the news, is that's not quite right. I read that the insurance companies had to provide reimbursements comparable to MediCal/ MediCare in order to participate in the Affodable Care Program. 

MediCal/MediCare and CMSP have long been known to be among the lowest reimbursement rates in the country. I also read that as part of ACA those payments were at first reduced even further. Might that be the reason the insurance companies offered such low reimbursements in the first place? If that is the case, I'd hardly blame that on the insurance companies.

The article started off by suggesting the insurance companies falsely claimed a number of doctors and medical services were amongst their "in- network" providers. I'd heard about that early on but can't vouch for it as neither the official California Affordable Care Act web site or the Anthem Blue Cross web site list of in- network providers worked for me. No matter how many times I'd try it they came up blank. Last time I tried it a month or so ago the Anthem Blue Cross list still comes up blank.

I'd hardly call that fraud, just a mess. 
Addendum: Just came up with a possible reason for insurance companies listing in- network providers that turned out not to have been. 

Might it be that they listed providers that already accepted regular Anthem Blue Cross but didn't take into account those same providers might not accept Obamacare mandated reimbursements?

I wrote here earlier of calling Redwood Family Practice to confirm they accepted Anthem Blue Cross. They said they did. I called them again after hearing they might not accept those under ACA/Obamacare. They said they accepted and processed all ABC claims in the same manner, but whether they continued to accept the Obamacare policies depended on what the reimbursement rates ended up being.

It could have been because of confusion over accepting the rates.


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