Covered California woes

[SHRED]

My wife and I will be eligible April 1st for a subsidized health insurance plan within the California exchange Covered California.

As we search for our current doctors within the plans offered we are finding out just how limited the networks are. They are a mess. They are narrow. If you need any kind of ongoing specialized treatment good luck.
A very limited number of doctors are accepting patients from these plans.

For instance if you want to go to UCSD Medical you will need the Anthem EPO plan but that is all the plan covers. If your primary and other doctors are outside UCSD you're out of luck. Blue Shield PPO would cover our other doctors and treatments but it does not cover health care from UCSD.

And also...when they say "maximum out-of-pocket" it sounds good however we are finding out that it is defined as health care costs incurred within the insurance company's negotiated rate. In other words a doctor charges $10,000 for a treatment, the insurance company is willing to pay $5,000 then you are stuck with the other $5,000 and it will not go towards your "maximum out-of-pocket".

The ACA is both a blessing and a curse.

[yeoman6987]

1. I am surprised

I thought California was the best. That is kind of disappointing. Sorry to hear of your troubles.

[CountAllVotes]

2. Jesus, that's rough

Who would have ever thought?

I'm sorry to read about your situation and I also now wonder about others here in Calif. and what changes they are seeing in their insurance with the new laws.

Your situation is most unfortunate.

I wish you the best of luck trying to find other options out there if there are any to be had.

& recommend.

[SHRED]

3. Thanks...it is frustrating for sure

[flamingdem]

4. I found the same problem in Los Angeles

It's scary to think I might need someone outside of the narrow network offered by Anthem. Blue Shield PPO was a joke for this area. They tried to sell me on the Blue Card idea, that I could see other doctors out of state but I was told by an agent that this is baloney.

So we get to pay less, but if anything goes wrong we can still be bankrupt seeking help from the appropriate dr. !!

[SHRED]

8. Good point about bankruptcy

I was under the false assumption that the ACA would eliminate bankruptcy due to health care costs...I was dead wrong.

It will lessen it but in no way will it end it. Wider network coverage and greater doctor choices would but the ACA (at least here in California) does not provide that.

[Adsos Letter]

5. Doesn't Kaiser have a large network?

Or am I confusing apples with oranges here?

[SHRED]

6. Kaiser is its own entity

You have to go their doctors and facilities.

[CountAllVotes]

7. and Kaiser ...

Not one of my favorite places to end up having to go. I had them for insurance for many years (ugh) and I was in fact born in a Kaiser hospital. Maybe it was better at that time, I do not know.

What I do know is that my father ended up at Kaiser towards the end of his life and the care he received was poor at best. I dislike Kaiser immensely needless to say.

What put the icing on the cake for me with Kaiser was when my brother (a Kaiser devotee) went there with pain in his side and was told it was a kidney stone and to not drink any more Coca Cola.

It was a few years after this that he fell very ill and was DX'd with metastasized cancer of the liver. He was dead in 9 mos. and was in his early 40s at the time.

So yeah, I'd go so far as to say that I HATE Kaiser Hospital!

[PasadenaTrudy]

9. I agree

I was with Kaiser for a while and they didn't take my fatigue seriously. I left and found a doc who did. I finally received meds for fibromyalgia and found out I carry a blood marker for lupus. Would Kaiser have thought to test for this? Nope.

My sis died in a Kaiser hospital too, of pancreatic cancer. I know that's a hard one to detect, but I wonder if they could have caught it early when she was losing weight, etc. We'll never know. She was 62

[Le Taz Hot]

10. I signed up for the Blue Shield Gold plan.

We are NOT anywhere near high income but, because of our age, even with the subsidy, it was going to be $606.00 a month. People over 50 are being gouged. After further research and finding out they outsourced their customer service to India, I cancelled. That $600.00 a month would have been just too devastating to our very-limited budget leaving NOTHING for unforeseen expenses which are bound to happen.

It's tempting to go another year without health insurance but we've been without for 4 years now and we're both over 50 so we'd really be pushing our luck. We'll probably have to settle for the bronze plan and hope neither one of us gets sick.

And one more thing. Since we have been uninsured and were very low income for awhile, I've been able to get our medication either free (from the manufacturer) or at greatly-reduced prices through Walgreen's prescription savings care. We'll loose those advantages when we get insurance and that insurance will only pay a small percentage of the cost, leaving us with the lion's share.

[SHRED]

11. We are over 50 also

The ACA does not allow preexisting condition into the equation anymore but you are correct about the age discrimination.

[lostincalifornia]

12. It is because it is an epo not a PPO

PPO should reimburse you at least a portion. It will be more expensive though, perhaps significantly

Socialized medicine is the answer , but do you see it happening soon?