Bernie Sanders Health Plan Savings for Nearly Everybody

Air Langhi · Jan 21, 2016

Space Ghost said: ↑

Are you engaging in a serious topic?

Before you answer that, please consider the repercussions of downsizing our military strength to the likes of Canada and Mexico. There are many reasons why the US is the backbone to the world economy. Being able to defend and protect our assets are one of the major ones. Do you really want to Russia and China unchecked on that side of the world?
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The US could win wars using 1980s technology. What the heck is the point of the F35 F22 etc. Who exactly are we fighting. Aliens?

astros123 · Jan 22, 2016

glynch said: ↑

Well at least you do disclose your reason for possible bias.

Upton Sinclair's famousquote : "It is hard to make a man understand something when his living depends on him not understanding" from memory maybe off a word
Click to expand...

Im coming from a non-bias point of view honestly, I run a very successful business and will survive anyways no matter what. I would love to debate this topic with anyone this forum, because i deal with this day in and day out. I actually worked with 2 different congressmen in Texas in exposing the flaws with Obamacare and the industry as a whole.

The system is so bad in America it needs a totally restructuring and theres no way around it. MCOs and HMOs will slowly deteriorate and ruin healthcare for everyone in this Nation.

I actually worked with the NAAOP in rescinding proposed Medicare lower limb Prosthesis that they tried passing last year. That would have been the worst thing for amputees in decades if it had gone through.

astros123 · Jan 22, 2016

Anyone who has time read this article, this is just one circumstance I see EVERY day. I get patients who call in trying to set up appointments to later found out the person who signed them up for the HMO plan falsely represented the network providers. Then the patient is ****ed and has to scramble back to go through red tape for something that he needs RIGHT NOW.

http://www.houstonchronicle.com/bus...ance-plans-could-devastate-cancer-6603232.php

As the health insurance enrollment season opens Sunday, it's what missing from the list of options that frightens Martha Gardenier most.

The 59-year-old self-employed certified public accountant from The Woodlands area has a rare bone marrow disease that two years ago took a deadly turn, progressing to a form of leukemia so dire a doctor told her she should begin end-of-life care. But a Hail Mary plan put her in an experimental trial at Houston's medical crown jewel, the University of Texas M.D. Anderson Cancer Center. Against improbable odds, the treatment worked, dialing back her cancer from Grade 3 to Grade 1.

"Every day is a new miracle," she said, her honeyed drawl filled with awe.

Then came the Sept. 25 letter from her insurance carrier, Blue Cross Blue Shield of Texas, which said her Preferred Provider Organization (PPO) individual plan - one she picked specifically because, although expensive, it covered M.D. Anderson - was being dropped effective Dec. 31.

As many as 2,000 other patients at M.D. Anderson also may be cut off from coverage with the loss of such PPO plans either through the Affordable Care Act's federal exchange or, in the Gardeniers' case, bought privately in the individual market, said Dr. Lewis E. Foxhall, vice president of health policy at the cancer center.

In fact, in 2016 there no longer are any plans by any carrier for the Houston area on the federal exchange that cover M.D. Anderson, although the hospital may be able to accommodate some patients on a case-by-case basis.

"They look at it as a business decision," Foxhall said last week. "We look at it as a coverage issue, and coverage here can mean life or death."

Blue Cross Blue Shield announced on its website in July that it was dropping all PPOs in the state because the policies no longer made financial sense for the company. The Gardeniers had no idea until the letter arrived, the cancellation noted in boldface letters.

Coverage unclear

On Oct. 20 the Gardeniers got a follow-up letter saying Blue Cross Blue Shield had "selected" another plan for them and all they had to do was "continue to pay your monthly premium on time." The new plan is part of a Health Maintenance Organization, the coverage boundaries of which remain unclear.

Preliminarily, it appears M.D. Anderson now will be considered "out of network" on Gardenier's HMO plan, and the company will pay only 50 percent of covered costs instead of the previous 70 percent, an M.D. Anderson spokesman said. In the world of cancer treatment, such a difference can be financially crippling for patients.

One of Gardenier's medications, part of the cocktail of drugs she'll take for the rest of her life, is $10,000 a month. The second one costs $5,000 per month. It is not clear how medications would be covered under the HMO.

"This is my life we're talking about," she said, her dismay and disgust colliding as she wonders why saving it has become an actuarial calculation.

Last week, a preview of the 61 health care plans for 2016 through the federally mandated exchange showed no PPOs plans being offered in the Houston area. For 2015, there were 19. Only HMOs or the rarer Exclusive Provider Organization, which allows members only to use doctors and hospitals within its network with no out-of-network benefits, are now listed.

Additionally, it appears no PPOs will be offered by major insurers in the individual market in the Houston area, insurance brokers said.

Plan typically sought

The loss of individual-market plan PPOs will affect tens of thousands of people in the region who, like the Gardeniers, buy their insurance privately rather than through an employer. Before the Affordable Care Act, it was the way most people who did not have employer insurance got coverage.

These individual plans remain the only option for many people not on a group plan, such as the self-employed, or for those who are ineligible for subsidies to lower premium costs on the federal exchange.

A PPO plan, although more expensive for customers, is typically sought by people looking for a wider range of physicians and hospitals. This can be especially important for those with complex medical needs.

While still being offered in many employer plans for 2016, the sudden disappearance in Houston of PPOs both on and off the exchange has stunned consumers and insurance brokers alike.

"It's pretty stark and shocking," said Jason W Bohmann, a Houston insurance broker whose clients include the Gardeniers. "It rips me up. I want to provide choices to my clients."

A cruel irony at play?

Gardenier was covered in the early part of her treatment at M.D. Anderson by Aetna. But in December 2014 she learned during a routine call to its customer service that the insurer was dropping the cancer center for the coming year. She panicked.

Then her broker steered the couple to a Blue Cross Blue Shield PPO plan in the individual market.

She never considered the federal exchange for coverage.

"We'll just do it ourselves," she and her husband thought, even as the premiums and out-of-pocket costs began draining their retirement savings.

"Are you sure?" she asked Blue Cross Blue Shield. "We want to get it in writing that you cover M.D. Anderson."

She signed up quickly, paying $886 per month for her plan and $658 per month more for her husband's. She thought she could relax and concentrate on getting better.

Dr. Dan McCoy, divisional senior vice president and chief medical officer at Blue Cross Blue Shield of Texas, told the Houston Chronicle editorial board in October it was a difficult decision to drop PPOs and that it was not made lightly. He previously has said the company paid out $400 million more in claims than it collected in premiums.

The company posted a message on its website last summer.

"Since the Affordable Care Act began, the market has changed. We found the individual PPO plan was no longer sustainable at the cost it was being offered," the statement read in part.

One of the most puzzling issues this enrollment season is why there is such an absence of PPO coverage in Houston.

Such plans are being offered by other carriers in Texas cities, both on the exchange and in the individual market.

Michael Ledgerwood, president of the Houston Association of Health Underwriters, wonders if there is a cruel irony at play for patients in a city with a global reputation for cutting-edge medical care.

"Being in Houston is good and bad. We have all of these wonderful medical facilities. People come from all over the world to be treated in Houston. But that kind of care comes with a very high price," Ledgerwood said.

'Distressing' to watch

"It's very distressing to see this happening," said Foxhall at M.D. Anderson. He, too, wonders if the kind of expensive care offered here may be spooking insurers.

In the first year of the exchange, several companies offered plans that covered M.D. Anderson. Last year it was only Blue Cross Blue Shield PPO. Now that is gone, too.

"We're in the process of trying to reach out to those patients that lost coverage to see what we can do to help," he said.

Bohmann, the Gardeniers' insurance broker, may have come up with a strategy to save their coverage. Since they both are CPAs and work together out of their home, they might qualify to get a PPO policy as part of a group plan. The premium would be $2,411 a month.

Blue Cross Blue Shield would not address the Gardeniers' case directly. But in a late-week email to the Chronicle, the company said it "has programs in place to help members if they are impacted by the PPO discontinuance in the individual market. If a member is seeing a health care provider who will no longer be an in-network provider for their plan in 2016, we offer other quality network provider choices for our members and will work with them to provide transition assistance address."

Trying to 'fool people'

That infuriates Gardenier, who said insurance companies think cancer care is interchangeable. She once believed that herself - before she was written off by one doctor as beyond saving.

"My assumption was, I live in Houston. All cancer specialists and hematologists would be aware of all the latest research and would be about the same," she said. "That is the point insurance companies are trying to fool people with, that all treatment is equal."

But without the unique treatment she received at M.D. Anderson, Gardenier has no doubt she would have never met a cherished milestone.

"I got to hold my fifth grandbaby last summer," she said.
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Harrisment · Jan 22, 2016

astros123 said: ↑

Anyone who has time read this article, this is just one circumstance I see EVERY day. I get patients who call in trying to set up appointments to later found out the person who signed them up for the HMO plan falsely represented the network providers. Then the patient is ****ed and has to scramble back to go through red tape for something that he needs RIGHT NOW.

http://www.houstonchronicle.com/bus...ance-plans-could-devastate-cancer-6603232.php
Click to expand...

I work at MDA and remember reading about this when news hit that PPO's would no longer be available on the markets for patients of MDA and the other top hospitals in town. Since then, apparently Humana has changed their mind and decided to offer a PPO which will provide that coverage. The plan is apparently extremely expensive, but it's better than what our patients were facing previously, which was no coverage at all.

http://www.houstonchronicle.com/bus...-to-offer-access-to-Houston-s-top-6687778.php

(sorry about the formatting...probably best to just click the link if you want to read about it)

In a surprise policy reversal, Humana Insurance Co. will begin offering a broad*network
health plan in the Houston area, potentially covering thousands who just days ago felt shut
out of the city's top hospitals, the insurer confirmed on Wednesday.
The 11th*hour move by Humana to begin offering a high*deductible Preferred Provider
Plan comes as patients * some in the middle of lifesaving treatment * have scrambled in
recent weeks to find coverage before their existing plans disappear.
The Humana bronze plan is scheduled to become available Dec. 18 through the carrier's
subsidiary, ChoiceCare Network, and will cover inpatient and outpatient care as well as
prescription drugs, the company said. The plan can be bought through an insurance broker
or directly from the company but will not be offered on the Affordable Care Act's federal
exchange.
When the individual health insurance market opened on Nov. 1 in Houston, both through
the federal exchange and in the private market, customers and health care providers
realized there were no longer any PPO plans offered by major insurers, creating a void
where a year before there were 19 such plans. Those with group plans were not affected.
Additionally, the Health Maintenance
Plans, or HMOs, that were offered as
replacements had pushed Houston's
most prestigious medical institutions
out of network in many of insurers'
plans, leading to continuing worry that
access would be curtailed or even
eliminated for those who need it most.
IMAGE 1 OF 3
Renee Mathew, who has a high risk of cancer and paid for a high cost Preferred Provider Organization insurance
plan through Humana, was notified in October that the plan she was on would not be offered and she ... more
Photo: Michael Ciaglo, Staff
1/22/2016 New Humana plan to offer access to Houston's top hospitals * Houston Chronicle
http://www.houstonchronicle.com/bus...*to*offer*access*to*Houston*s*top*6687778.php 3/5
CHI St. Luke's Health
opens Springwoods Village
hospital
Single payer health care? We're nearly there
already
Alcohol marketed to youth
on social media
Few women have fallopian
tubes removed as
recommended
MEDICAL
Rumors have flourished over the past several days on social media that a large insurer was
about to re*enter the PPO market in Houston.
Humana on Wednesday did not offer an explanation for reversing its earlier decision.
In late October, the insurer said in an email to the Houston Chronicle that it would not be
offering any PPO plan on the federal exchange in Texas but would offer a plan in the
private market in some cities. The Houston area was noticeably absent.
PPO plans, typically more expensive to customers, offer a wider choice of doctors and
hospitals and are favored by people used to having full coverage or those with complex
medical needs. By contrast HMOs are cheaper but more restrictive in where patients can
go.
Among the hospitals that appear to be
in*network under the new plan are the
University of Texas M.D. Anderson
Cancer Center, Houston Methodist,
Texas Children's Hospital and
Memorial Hermann * the very
institutions mostly cut out of Blue
Cross Blue Shield's HMO plans,
according to area insurance brokers
and some of the hospitals.
Late Wednesday, officials at M.D.
Anderson would not officially verify it
was in network because officials there
said they were waiting for written
confirmation from the insurer.
"It's a relief," said a cautiously
optimistic Renee Mathew, a 52*yearold
Sugar Land woman who is about to
1/22/2016 New Humana plan to offer access to Houston's top hospitals * Houston Chronicle
http://www.houstonchronicle.com/bus...*to*offer*access*to*Houston*s*top*6687778.php 4/5
UTMB research could
pave way for universal
Ebola treatment
lose coverage for herself and her 21*
year*old son when her current Humana
PPO plan ends in three weeks
She is at high risk for breast cancer and
gets screenings every six months at
M.D .Anderson. Her next appointment is Dec. 31.
"What if this is the one where they find something?" she said.
Mathew does not qualify for a subsidy on the exchange and instead pays $1,100 per
month for herself and her son. When she heard Wednesday of the new possibility she felt
hopeful for the first time in more than a month.
"I want to look at the network and look at the numbers, but the deciding factor will be if it
covers my doctors," she said.
Jason Bohmann, a Houston insurance broker, cautioned the coverage probably will not
come cheaply.
Enrollees must meet a $6,450 deductible before coverage kicks in, he said. While he does
not yet know all of the details, he said a plan that appears to be identical offered by
Humana in Dallas cost a healthy couple in their 50s almost $700 each per month. That
would mean they could both have to pay close to $15,000 out of pocket every year in
deductibles and premiums alone.
"We have no options here now, so anything is good," he said of the race to find plans with
wider choice for his clients.
Blue Cross and Blue Shield executives said it had become too expensive to continue with
PPO plans and to cover patients in care at the expensive medical facilities. The company
has said it will help those who lost coverage find other doctors and hospitals.
Patients have countered they would be willing to pay more if just given the chance to keep
1/22/2016 New Humana plan to offer access to Houston's top hospitals * Houston Chronicle
http://www.houstonchronicle.com/bus...*to*offer*access*to*Houston*s*top*6687778.php 5/5
continuity of care.
Humana, too, has previously said it was dropping PPOs to "retain the overall affordability
and access of the individual health plans."
But an email obtained by the Chronicle sent from the company to a Houston insurance
broker said, "Humana has decided to launch our Bronze ChoiceCare PPO plan that has
been available in other counties across the state in the 26 counties surrounding Houston
and Austin that previously had no PPO offerings available to clients."
Hospitals included in the new plan were just starting to get word on Wednesday.
"This is great news for our patients who had no options if they wanted to continue getting
care from Houston Methodist," said Mick Cantu, executive vice president at the Methodist
Hospital System.
Still, many like Mathew find all of the uncertainty both dizzying and infuriating. She
places the blame squarely at the feet of any insurance company dictating where people can
go for care.
"Let's see where the top executives go when they get cancer," she said. "I love
Obamacare. I think it's done a lot of good helping people get coverage. But this is a
loophole that is being exploited."
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astros123 · Jan 22, 2016

Harrisment said: ↑

I work at MDA and remember reading about this when news hit that PPO's would no longer be available on the markets for patients of MDA and the other top hospitals in town. Since then, apparently Humana has changed their mind and decided to offer a PPO which will provide that coverage. The plan is apparently extremely expensive, but it's better than what our patients were facing previously, which was no coverage at all.

http://www.houstonchronicle.com/bus...-to-offer-access-to-Houston-s-top-6687778.php

(sorry about the formatting...probably best to just click the link if you want to read about it)

Click to expand...

Its a fkin joke in reality and it disgusts me. Theres a team of about 4 people in blue cross blue shield that work in credentialing to get doctors in there network and they make it SOOOO difficult. If you guys saw some of the contracts they make us sign to join their networks you guys would laugh

I think its hilarious that normal healthcare providers cant call medicare patients offering any sort of services, BUTTTTTTTT the insurance company's are provided a list of Medicare beneficiary phone numbers/addresses and are fully allowed to solicit their hmo plans.

The system is a fkin joke. It needs a complete overhaul. If you ever have time watch this documentary and please tell me this doesnt change your view on health care in the US.

http://www.imdb.com/title/tt0386032/

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