The Marin Independent Journal is something of a joke as an investigative paper. People in Marin read it, not to get high-end analyses about news and policy, but, as is true for all small community newspapers, to find out what’s going on in their neighborhood. Sometimes, though, what’s going on in the neighborhood is a sufficiently important issue that it deserves to be broadcast widely. It is to the IJ‘s credit that it’s bringing to its readers’ attention yet another problem with Obamacare, and not one I’ve heard discussed elsewhere; namely, the fact that, when you go in for surgery, even if your doctor is on your insurance plan, the anesthesiologist, whom most people first meet only within a couple of hours of surgery, may not be.
The IJ’s report starts with the story of Marianne Michael, a local Marin woman preparing for back surgery. More savvy than many medical consumers, Michael knew that the anesthesiologist wasn’t actually part of her surgeon’s practice group, and that she would receive a separate bill. Before surgery, therefore, she decided to do a little investigation to find out if her insurance would pay her the anesthesiologist:
Much to her surprise, Michael discovered that Anesthesiology Consultants of Marin was not in her network. Michael has also attempted to determine whether other medical groups serving Marin General are covered by her insurance, without much success.
Michael said information on Anthem Blue Cross’s website indicated that the Marin Hospitalists Medical Group was also outside Blue Cross’ network of providers for Covered California customers.
The dawning of Obamacare has resulted in confusion over which medical groups supplying ancillary services to the hospitals — anesthesiologists, radiologists, pathologists and hospitalists — have contracted with Blue Shield and Anthem Blue Cross to serve their new Affordable Care Act customers. The insured with these plans must pay substantially more for any service provided by a doctor outside their insurer’s network of providers.
Once the confusion is lifted, it’s clear that Obamacare’s newest customers are screwed (emphasis added):
In fact, Blue Shield’s exclusive provider organization (EPO) customers in Marin must pay 100 percent of the cost for out-of-network services.
To recap: People in Marin, like most previously insured Americans, are accustomed to the fact that, if they’re insured and if they have surgery, their insurance pays for it all: surgery, hospital, and anesthesiologist (subject to whatever deductible they owe). In the new regime, though, they’ll be lucky if their policy pays for the surgeon and hospital. In addition to the deductible (usually higher under Obamacare than before), they’ll find themselves out-of-pocket, often to the tune of tens of thousands of dollars, for the anesthesiologist and other independent service providers affiliated with their surgery. Surprise!!!
Moreover, thanks to Obamacare, this disastrous, expensive, stealth change isn’t limited just to new “Covered California” (i.e., Obamacare network) customers. Instead, it applies to everyone, regardless of whether they purchased insurance in the remaining marketplace or through Obamacare:
It isn’t just people who purchased insurance through Covered California, the state’s health care insurance exchange, that stand to be affected by the coverage muddle. Under the Affordable Care Act, insurance companies were required to offer plans that mirror their Covered California plans. These plans have the same network of providers as the Covered California plans. Michael said she purchased her insurance directly from Anthem Blue Cross.
(One presumes that the sole exception to this is those lucky enough not to have been amongst the 160,000 people kicked off of California’s Kaiser network. If you’re a Kaiser member, Kaiser offers everything in-house.)
Bad as the above is, according to the IJ, it doesn’t stop there but, instead, gets even worse for Californians (the vast majority of whom enthusiastically supported both Obama and Obamacare). Thanks to an Anthem Blue Cross snafu, customers pursuing the list of networked doctors were misled to the tune of almost 1000 doctors who were erroneously identified as being part of the Anthem Blue Cross Obamacare-compliant network. In other words, vast numbers of those who signed up with Anthem Blue Cross because they were trying to keep their doctor (and didn’t Obama promise that they could?), ended up with a policy that probably costs more; that almost certainly has a higher deductible; that, through fraud or negligent misrepresentation, doesn’t allow them to keep their doctor; and that doesn’t cover significant parts of their costs.
Obama was boasting about the 8 million who signed up. He’s going to regret that boast, because it appears that America is soon going to have 8 million dissatisfied customers, not to mention the millions more who, even though they didn’t sign up, have been left with insurance contracts that, by law, must be just as bad as those offered under Obamacare.
One wonders how much longer Marinites and other Blue Californians can maintain the cognitive dissonance that tells them that Obama is the best president ever and that Obamacare has bent the cost curve down, bringing affordable, high quality health care to everyone. On a daily basis, the reality of their own lives is proving that all of this is a lie. Also, one wonders just how craven (stupid? corrupt? evil?) Congressional Republicans are when they say that Obamacare is here to stay, and that they are powerless to revert America’s health care back to a free market dynamic.
(And please don’t get me started on the House GOP’s promise to pass amnesty. Just let me say that, if I had a Republican representative in the House, I would be on the phone to his office every single day letting him know in the strongest possible terms that I would do everything within my power in his district to destroy his political career and to make sure that, should he ever set foot in his district again, he couldn’t get a job as dog catcher, street cleaner, or McDonald’s clerk, all of which forms of employment are way too honorable for him.)