Author Topic: Politics aside, using obamacare  (Read 9483 times)

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Politics aside, using obamacare
« on: January 12, 2014, 02:51:56 PM »
Please! no politics! no left right stuff! or this thread will get locked like the previous one.
The ACA is reality, like it or not. So how will this work with HR?
The two problems I see are;
1. A narrowing of the in network providers, I have read many stories and articles about how the ACA does not allow patients to just travel around and go see whatever Doctor they want like some of the very best insurance policies would allow, this will be more like a Kaiser or cheaper policies that only pay for in network care and in fact indications are the ACA will have an even narrower in network selection. So unless you live in the same county as your HR Dr. of choice it looks to be a problem.
2. Doctors and hospitals opting out. Apparently some of the top hospitals in the country are opting out of accepting ACA plans.
We have all read about Doctors opting out of Medicare and some opting out of insurance altogether. Will many Doctors start to opt out of ACA plans and accept only cash or preexisting plans that don't get cancelled?

Perhaps my situation will become similar to ACA patients. I am a Veterans Administration patient, the VA does not pay for hip resurfacing. They will give you a total hip when you reach the point of being crippled and you certainly don't get to choose your surgeon.
Because I live on a small island with only a VA clinic and not a hospital I was referred to out patient "civilian hospital care" the Doctor will not recommend a new hip because I am "only" 50 and he told me that the ACA now requires a more conservative approach exhausting all the alternatives first, injections, therapy etc... but hey! the VA will provide me with a cane free of charge! So.... like many people I'm stuck in limbo between doing nothing and a total hip and HR will be on my own dime.
I will consider getting an ACA plan but I'm not sure it will cover me for HR or allow me to see the Dr. I want.
One question is, do grandfathered preexisting plans have to comply with the apparent stricter in network provisions of the ACA?
Will HR be reserved for rich people paying cash or executives, professors and politicians with preexisting Cadillac plans?


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Re: Politics aside, using obamacare
« Reply #1 on: January 13, 2014, 08:25:45 AM »
I'm real sorry that your options are so restricted under the VA plan.

I share your concerns about the future, and access to procedures such as HR. You were presumably in the military. I never was, but I work for the federal government. I think people who have seen how the government actually operates know enough to be afraid of what the future holds.

I view it as almost fortuitous that other hip has gone so quickly, so that I can have it done while Dr. Gross still accepts my insurance. As the government, directly or indirectly, controls a larger and larger percentage of re-imbursement rates, and those rates continue to stagnate, less and less doctors will accept them, leading to longer and longer wait times for all procedures. There's just an inevitability to it.

RHR April 2012.
LHR March 2014.

Both Biomet Magnum/Recap 54/48, by Dr. Thomas Gross.


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  • Hip Resurfacing with De Smet, 09 July 2013
Re: Politics aside, using obamacare
« Reply #2 on: January 25, 2014, 03:04:32 AM »
I, fortunately, was able to get my insurance company to agree to reimbursing me if I did my resurfacing overseas (De Smet - Belgium). It took months for them to agree, but the cost difference is insane. If you have to cover your own expenses, even with a plane ticket, it is much, much cheaper to go elsewhere...and I have nothing but great respect for my surgeon and my new lease on life!

Good Luck....and I won't make political comments....except to say I don't see how it will work. I also lived in Canada for over 10 years.....their health care is often times like the VA.


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Re: Politics aside, using obamacare
« Reply #3 on: January 26, 2014, 07:33:43 AM »
The NY Times had an article about travelling abroad for hip surgery:
This was about THR but I assume HR is similar.
BioMet Left Hip Resurfacing, Dr. Gross, 07/2013


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Re: Politics aside, using obamacare
« Reply #4 on: January 27, 2014, 03:05:40 PM »
The 'narrowing of in network' hospitals and doctors has occurred only if you are talking about insurance products available on state insurance exchanges or the federal exchange.  And the only ones who have to purchase health insurance on such exhanges are those who did not have insurance previously or those whose old health insurance was deemed not in compliance with the ACA.

The vast majority of people in this country are covered by their employer and are seeing no such changes.

As always, check with your insurer (and proposed surgeon) to determine your surgical options.  For example, Dr. Su takes Untited Healthcare and is in network.  If your employer uses United Healthcare you can have your surgery done by Dr. Su In Network.
Dr. Su
RBHR 4/9/12


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  • Right hip resurfacing, age 42, Dr. Kim, Conserve+
Re: Politics aside, using obamacare
« Reply #5 on: April 12, 2014, 09:31:42 AM »
If the ACA is similar to the OHIP (Ontario Health Insurance Plan) it shouldn't be a problem, I did my Hip resurfacing procedure 48 hours ago here in Ottawa, the two surgeons here Dr. Kim and Dr. Beaule are very good so people come from all over Canada to here. my roommate was from Prince Edward Island ( a different Province) 1000 miles to the east, and he didn't had to pay a single loonie for the surgery.
Right hip resurfacing, done at the Ottawa General by Dr. Kim. Implant:Conserve+  age:42


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My Costs FEP BC/BS
« Reply #6 on: April 13, 2014, 11:43:42 AM »
I started out with the VA; getting an ortho consult. I asked this VA Orthopedist MD for a resurfacing referral.  He said I would be a good candidate for resurfacingl  and got a referral to the regional VA ortho center in Raleigh, NC. 

Then the fun, bureaucracy, began!  Raleigh was too busy to even give me an initial consult appointment date  It is a good thing that the VA has multiple ways to try and correct the nonsense.

VA Fayettevile, my home clinic, could not give me a out of system voucher unless Raleigh's wait list was "too long".  And since I didn't have an appointment date that was an unreasonable wait...

After multiple calls to patient's advocates, Director's offices, and congressional liaisons about both locations my situation was recognized and resolved with vouchers to the local provider of my choice.

This surgeon and practice are locally well known and thought of with recommendations coming from several directions.  And though HRs are on his webpage, he disparaged, criticized HRs and recommended a THR for me and suggested first tryingr non surgical injections.  We tried a cortisone shot into the hip.  Symptoms returned in 3 days.  We discussed next trying a lubricant, hyaluronic acid, shot.  After all of this, the provider I chose was too busy and I fell through some crack and they never scheduled another follow up. 

Meanwhile, I enrolled in Federal Employees Plan, FEP BC/BS.  This was at least a one year committment, $180/month. 

Feb3, 2014, I went to Manhattan's HSS, Dr F Boettner, just to get another opinion on getting an HR.  I appreciated that Dr Boettner did not push, seel HRs.  In contrast to me previous experience locally about getting a THR.  To the contrary, Dr Boettner had me advocating why my quality of life and life style preferences required an HR.  We had a meeting of minds within 15 minutes and a surgery date (Feb 28) 5 minutes after that!

I can not say enough about my wonderful treatment at HSS.  From the receptionist, food push, floor sweeper; everyone was positive, helpful and proud of their part at HSS.  Additionally, I am HAPPY (so far so good!) with my outcomes, progress, and mobility.

FEP BC/BS - Out of pocket medical costs; hospital ($250), Physician vists consults copays x 6 ($180), not covered, anesthesia ($500), radiology ($500), surgery ($950) 



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