You Also Can't Keep Your Doctor

[lostinblue 1,989]

You Also Can't Keep Your Doctor I had great cancer doctors and health insurance.My plan was cancelled. Now I worry how long I'll live.

By

Edie Littlefield Sundby

Nov. 3, 2013 6:37 p.m. ET

Everyone now is clamoring about Affordable Care Act winners and losers. I am one of the losers.

My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.

My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits.

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Bloomberg News

Countless hours searching for non-exchange plans have uncovered nothing that compares well with my existing coverage. But the greatest source of frustration is Covered California, the state's Affordable Care Act health-insurance exchange and, by some reports, one of the best such exchanges in the country. After four weeks of researching plans on the website, talking directly to government exchange counselors, insurance companies and medical providers, my insurance broker and I are as confused as ever. Time is running out and we still don't have a clue how to best proceed.

Two things have been essential in my fight to survive stage-4 cancer. The first are doctors and health teams in California and Texas: at the medical center of the University of California, San Diego, and its Moores Cancer Center; Stanford University's Cancer Institute; and the M.D. Anderson Cancer Center in Houston.

The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy.

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.

You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).

So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.

Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.

What happened to the president's promise, "You can keep your health plan"? Or to the promise that "You can keep your doctor"? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.

For a cancer patient, medical coverage is a matter of life and death. Take away people's ability to control their medical-coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point.

Ms. Sundby lives in California.http://online.wsj.com/news/articles/SB10001424052702304527504579171710423780446

[Mr. Big Dog 10,747]

This has been the case for as long as I have lived in this country. Insurance companies make changes to their networks of physicians, hospitals and pharmacies all the time. So even if one gets to keep one's health insurance plan, that is no guarantee that one can continue to see one's doctor. That's nothing new.

[ready4ONE 5,400]

This has been the case for as long as I have lived in this country. Insurance companies make changes to their networks of physicians, hospitals and pharmacies all the time. So even if one gets to keep one's health insurance plan, that is no guarantee that one can continue to see one's doctor. That's nothing new.

Obama grrrrr! Messing up the greatest health care system in the world! Grrr! The sky is falling! And Obama wants my guns... putin save us!

[Dakine10 5,452]

For every story like this, there are 100 stories about people who died because they couldn't get health coverage or treatment once they had a diagnosis of cancer. Too bad this lady will have to find a new doctor. That's a hell of a lot better off than the person who gets to keep there doctor but not their insurance.

Obamacare sucks for some people? Yeah it does. So does the current system!

[Peikko 1,575]

You'd have thought this was all evidence that the Republicans got it wrong, Americans do want a working, affordable health care system and yet what is being argued seems to be that affordable health care has ruined a great system. Republicans do not make much sense on this issue.

[BatmanUSA 105]

This has been the case for as long as I have lived in this country. Insurance companies make changes to their networks of physicians, hospitals and pharmacies all the time. So even if one gets to keep one's health insurance plan, that is no guarantee that one can continue to see one's doctor. That's nothing new. lied to the American people.

####### kind of answer is that.???

The man obviously and definitely lost his great health insurance plan as a direct result of Obamacare..

OBAMA AND THE DEMOCRATS LIED..!!! THAT'S NOTHING NEW.

So please tell us, oh Big Dog defender of all things Obama... tell us what can this man do ? where are Peloisi and Feinstein.? surely they will do all they can to help this man.

Man, you tow the democratic line a true hard core blind believer..

Even when the truth is in front of some people's eyes as plain as daylight, they remain deaf, dumb and blind.

Obama clearly said, "if you like your health plan you can keep it, if you like your doctor you can keep him"..

Sadly, Obama supporters will continue his lies and never think for themselves. Democrats will never admit that Obama blatantly and purposely lied to the American people.. Oh, he was misquoted, it was taken out of context... .

Really, a 12 thousand dollar deductible? even a 5 thousand dollar deductible? and for 500 bucks a month people will receive one yearly well visit... Wow... I can't believe only 6 people signed up the first day.. The system must have crashed because of all the high volume from all those people trying to get affordable healthcare...

oh FYI, most doctors office expect payment at time of service, but hospitals still have to treat everyone before asking for payment, so where do you think poor people will go? oh nevermind, democrats don't think, they simply spout Omaba lies....

[Dakine10 5,452]

####### kind of answer is that.???

The man obviously and definitely lost his great health insurance plan as a direct result of Obamacare..

OBAMA AND THE DEMOCRATS LIED..!!! THAT'S NOTHING NEW.

So please tell us, oh Big Dog defender of all things Obama... tell us what can this man do ? where are Peloisi and Feinstein.? surely they will do all they can to help this man.

Man, you tow the democratic line a true hard core blind believer..

Even when the truth is in front of some people's eyes as plain as daylight, they remain deaf, dumb and blind.

Obama clearly said, "if you like your health plan you can keep it, if you like your doctor you can keep him"..

Sadly, Obama supporters will continue his lies and never think for themselves. Democrats will never admit that Obama blatantly and purposely lied to the American people.. Oh, he was misquoted, it was taken out of context... .

Really, a 12 thousand dollar deductible? even a 5 thousand dollar deductible? and for 500 bucks a month people will receive one yearly well visit... Wow... I can't believe only 6 people signed up the first day.. The system must have crashed because of all the high volume from all those people trying to get affordable healthcare...

oh FYI, most doctors office expect payment at time of service, but hospitals still have to treat everyone before asking for payment, so where do you think poor people will go? oh nevermind, democrats don't think, they simply spout Omaba lies....

Just to clarify, the author is a woman. Not that it's central to the point, but since you keep saying "he", it makes me wonder how closely you read the article. The other point that you may have missed is that UHC chose to discontinue their PPO plan in that area. As Mr Big Dog pointed out, that happens all the time. It happens every year. It happened without Obamacare and it will happen with Obamacare.

My wife's UHC PPO option was cancelled 10 years ago. They instead offered a HMO and a CDP plan. Both plans have limited networks compared to the PPO, and the CDP plan had a crazy high deductable too. Do you think they knew Obamacare was coming 2 years before he got elected?

[lostinblue 1,989]

There can be no question that the aforementioned cancer patient lost coverage because of ObamaCare. The ACA is what changed the market dynamics and forced the cancellation of many policies in several states.

Moreover, even if one wishes to argue from the premise that coverage was "substandard" because it did not measure up to the diktat of ObamaCare, that does not explain the sobering reality that the options available through Covered California did not address her particular needs--which are obviously significant. She can't keep her doctors, she can't keep the oncologist,she can't keep the hospitalization arrangements.

Because of the impact of the ACA on the insurance markets in California, this person has lost access to the care which has kept them alive thus far -- she can get "coverage" on the exchange, she just can't get access to care.

If this person should die, her death will be directly attributable to the ACA. How many more lives will the Democrats sacrifice to this demonic and dysfunctional legislative monstrosity?

[Dakine10 5,452]

There can be no question that the aforementioned cancer patient lost coverage because of ObamaCare. The ACA is what changed the market dynamics and forced the cancellation of many policies in several states.

Moreover, even if one wishes to argue from the premise that coverage was "substandard" because it did not measure up to the diktat of ObamaCare, that does not explain the sobering reality that the options available through Covered California did not address her particular needs--which are obviously significant. She can't keep her doctors, she can't keep the oncologist,she can't keep the hospitalization arrangements.

Because of the impact of the ACA on the insurance markets in California, this person has lost access to the care which has kept them alive thus far -- she can get "coverage" on the exchange, she just can't get access to care.

If this person should die, her death will be directly attributable to the ACA. How many more lives will the Democrats sacrifice to this demonic and dysfunctional legislative monstrosity?

Why can there be no question? The UHC PPO plan met the minimum standards set by Obamacare so obviously it was not cancelled for that reason. UHC is a huge insurer so they are not opting out of the market because they can't compete. UHC is free to offer whatever type of plan benefits them in a given area. Insurers have been phasing out the PPO model for years in favor of higher dedectable CDHP's. And when they come up with a more profitable model, they will change again.

The funny thing is, if they had regulated insurance companies so they could not make any market changes, you would be having a shitfit about that. The fact of the matter is we have a for profit health care industry. The biggest mistake of Obamacare was not getting rid of that. As long as we have that, dollars will be the driving force behind what plans and services an insurer offers in any given area. Someone is always going to come up short.

[lostinblue 1,989]

When there is no profit in the health care field WHO will take care of you....only your drug addicted family.... No new drugs in the pipeline. No new medical devices. No doctors or nurses. Why spend 10 years in medical school and make 20/hr . Got cancer go see your local dealer in the hood and maybe he can fix you up with whatever you can afford to kill the pain. Profit is such a dirty word for you liberals.

[Mr. Big Dog 10,747]

Just to clarify, the author is a woman. Not that it's central to the point, but since you keep saying "he", it makes me wonder how closely you read the article. The other point that you may have missed is that UHC chose to discontinue their PPO plan in that area. As Mr Big Dog pointed out, that happens all the time. It happens every year. It happened without Obamacare and it will happen with Obamacare.

My wife's UHC PPO option was cancelled 10 years ago. They instead offered a HMO and a CDP plan. Both plans have limited networks compared to the PPO, and the CDP plan had a crazy high deductable too. Do you think they knew Obamacare was coming 2 years before he got elected?

Exatly. None of this is new and I don't see how this is a result of the ACA.

[Mr. Big Dog 10,747]

When there is no profit in the health care field WHO will take care of you....only your drug addicted family.... No new drugs in the pipeline. No new medical devices. No doctors or nurses. Why spend 10 years in medical school and make 20/hr . Got cancer go see your local dealer in the hood and maybe he can fix you up with whatever you can afford to kill the pain. Profit is such a dirty word for you liberals.

Wasn't the argument that the ACA provides a windfall for insurance companies? Is that not the case anymore?

[Dakine10 5,452]

When there is no profit in the health care field WHO will take care of you....only your drug addicted family.... No new drugs in the pipeline. No new medical devices. No doctors or nurses. Why spend 10 years in medical school and make 20/hr . Got cancer go see your local dealer in the hood and maybe he can fix you up with whatever you can afford to kill the pain. Profit is such a dirty word for you liberals.

What simpleton came up with that bullshit? Drug companies are happy as pigs in ####### to sell their pharmaceuticals in highly regulated markets like Canada and Europe, and anywhere else in the world. No ones forcing them to do it. Most of the Canadians doctors I've worked with get sick of it here in a matter of months. Most healthcare professionals make more $$$ in Canada and have a better standard of living.

Anyway believe it or not, health insurance companies are not a prerequisite to health care. They are a factor that contributes to our #1 rating for health care expenses in the world, but only a #38 ranking in quality of care. Just ahead of Slovenia.

[The Nature Boy 4,224]

For every story like this, there are 100 stories about people who died because they couldn't get health coverage or treatment once they had a diagnosis of cancer. Too bad this lady will have to find a new doctor. That's a hell of a lot better off than the person who gets to keep there doctor but not their insurance.

Obamacare sucks for some people? Yeah it does. So does the current system!

Obama care is the current system on steroids. More insurance, more people in health care that do not provide patient care.

Insurance is the problem.. If this was T3, it would be the day Skynet became aware,

How in the flying hell is a 200 dollar a month policy that pays 80%, with a 3K deductible going to make healthcare affordable to the working poor..?

What is an uneducated person going to do when they get a claim wrongly denied becuse of a code and get bills from 4 different places after one procedure

Obama care is going to suck for most, if they ever get signed up

[The Nature Boy 4,224]

What simpleton came up with that bullshit? Drug companies are happy as pigs in ####### to sell their pharmaceuticals in highly regulated markets like Canada and Europe, and anywhere else in the world. No ones forcing them to do it. Most of the Canadians doctors I've worked with get sick of it here in a matter of months. Most healthcare professionals make more $$$ in Canada and have a better standard of living.

Anyway believe it or not, health insurance companies are not a prerequisite to health care. They are a factor that contributes to our #1 rating for health care expenses in the world, but only a #38 ranking in quality of care. Just ahead of Slovenia.

And Canada does not allow drug companies to file fake revised patents. Viagra is already generic there. Here nope not until 2020. The courts let pfizer extend the patent.