In my previous blog I wrote about some of the fallout that was occurring in the Insurance field as a result of the mandatory requirement for individual health insurance. I was focusing on the carriers constricting their panels of providers and also culling risk oriented individuals from their policies.
As an example here are two Facebook commentaries from the same author not solicited by myself but found at random.
“Like many, my health plan is being phased out at year-end and eventually Anthem will send me info on a recommended replacement. I have asked three Anthem agents about how to accept if I want it. One said it would convert automatically if I do nothing. One said I will receive a number to call and verbally accept. One said it is just a recommendation and I will have to formally apply. I need one of those emoticons for: bangs head against wall:”
Given how much incorrect info Anthem is putting out, I think I am going to look into Connecticare, also. I just don't feel like I will really know what I am committing to buy from Anthem right now. There are different plan details on the Exchange and Anthem sites right now for the same plan and the agents can't explain it.”
Thank you HR
These are excerpts from and article in Medscape; a cardiologist in RI received this letter
“United Healthcare (UHC) is amending your Agreement . . . to discontinue your participation in the Medicare Advantage network effective on February 1, 2014," The October 2, 2013 letter went on to say his termination is "without cause," his contract permits the company to take this action, and his affected patients would be contacted about the change separately. “An interventionalist in Connecticut, received a similar letter from UHC more than a week ago, along with the 16 other cardiovascular specialists in his practice. About 3000 of their patients are affected, including >500 of his own patients, "people that I've cared for for over 20 years. I'd say that represents 10% to 15% of my practice," he said.
"These are relationships that have been established, and all of a sudden they are terminated in this absolutely irrational way by United Healthcare," he said.
A spokesperson for the Yale Medical Group (New Haven, CT), with >1000 physicians who are Yale University School of Medicine faculty has said that UHC has dropped it from its Medicare Advantage plans.
The cuts' impact could be especially hard on patients in remote areas.
In an October 22 letter published in the Providence Journal, the director of health services on Block Island, 13 miles off the coast of Rhode Island, reports that all of the tiny island's physicians received one of UHC's termination letters.
The island of about 10 square miles with a year-round population of about 1000 is a popular summer destination for tourists. To avoid out-of-network rates, the according to the letter to the editor, "patients in need of care who have Medicare Advantage would need to travel to the mainland by ferry or plane, no easy task in bad weather."
UHC has sent such a letter to thousands of physicians in the US, specifying that the cuts apply only to their Medicare Advantage contract, not to any other UHC plans they may take. The company sells such plans nationally through AARP, which calls them AARP MedicareComplete.
The intriguing part is that many of these physicians have received high efficiency ratings from the company and have not been dropped from their other plans; only Medicare and exchange plans.
A UHC spokesperson wrote "Our decisions are based on providing a network of physicians whom we can collaborate with to help enhance health plan quality, improve healthcare outcomes, and curb the growth in healthcare costs. Factors include geography and ensuring ready access to care, the relative performance of providers on a range of industry quality metrics, and a provider's ability to deliver high-quality care for the most members in the most cost-efficient manner."
I have copied this document to illustrate one of the greatest changes that will happen. Like England and other European countries we are going to develop a two tier system; an expensive because it will be tax supported government controlled healthcare system in which convenience, and I believe quality will be compromised, serviced by Insurance companies that are profit oriented. The other system will be a private independent system including not only physicians but also hospitals catering to those who can afford to pay for their care.
Tuesday night's NBC 7:30 pm world news segment had a report about those self insured individuals not having their policies renewed. In many cases they are told that the policy which was low cost did not meet the new specifications required by the ACA. If and when they can get new policies the premium is often several 100% higher than the old one. But then again a 60 year old woman may need maternity or abortion coverage.
There are other repercussions that I have not discussed, such as programs to cut the Medical School training to three years and the postgraduate residencies to at the most two years to counteract the deficiency in primary care physicians, which is being met by increased use of Nurse Practioners, as well as Physicians Assistants, all with different degrees of expertise. I could add to the list the growing tendency for chain pharmacies to have in store care centers.
Nowadays it takes many physicians up to five years after Medical School to refine the skills of their trade.
One bright spot away from this subject that I will get back to from time to time; tonight is the final local candidates forum. With the election next week; politics will be on the front burner.
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