Will doctors and hospitals be able to distinguish between people insured on the exchange

[apples and oranges]

and people on employer-based group plans?

[BumRushDaShow]

1. Shouldn't make a difference

They send the insurance company that you provide to them, the bill... the insurance company pays the portion they are responsible for, and you pay the difference. The doctor/hospital doesn't care who pays them as long as someone pays them.

[2naSalit]

2. Should it matter

if they can?

Shouldn't the point be whether the patient can be treated effectively and be able to cover the costs by having some form of insurance? Why should it matter how or where they gained access to it?

[etherealtruth]

4. I took the tone of the post as one concerned that there would be a bias against exchange ...

... policy holders. similar to the bias some practices have against Medicaid recipients. I may be presuming incorrectly, but my take was that the OP has concerns that exchange policy holders may have trouble finding practitioners taking the insurance.

[apples and oranges]

9. You're right

I have insurance, but I'm curious.

[kelliekat44]

16. They say they hate Mdicaid but many still take the government money. They are sure to get paid

by the government. If the numbers come in high enough they will be swarming to get the new business. And looking for ways to fraud the system. It is surprising, however, how many physicians out there really have disdain for people of low means. They dishonor their oath to first do no harm. But my dentist had a rant the other day about how HIS insurance deductible has doubled since the ACA. I asked him if his deductible had ever gone down? Then I asked him to explain how the ACA caused his deductible to double since it passed. All he could say was that it doubled. I told him that was a problem for his insurance company who is probably trying to bleed all they can from clients and blame it on the ACA. The I told him to try to get his insurance through the exchange in MD and see if he came out better. I also asked him why he was against the poor working class having health insurance? He said he would ultimately be paying more taxes...his accountant said so. I told him to stop using an accountant and do his own taxes on Turbo. He would save as much as the taxes he owed. He said I was probably right and then huffed out of the cubicle.

[etherealtruth]

20. Its a first step ...

The ACA is far from perfect ... (i desperately want to see single payer); I pray this is simply a step in the right direction.

My first career was as a nurse. i spent most of that time as a Hospice nurse ... you learn quickly that poor and under-served communities die from preventable diseases ... or die from diseases that would likely not have been fatal if diagnosed early.

Health care is a basic human right ... not health insurance. Again, I am hoping this is simply a step in the right direction.

[winter is coming]

3. Why would they care? n/t

[etherealtruth]

5. the same reason some practices care about and do not accept Medicaid

[winter is coming]

7. So we should assume that all of the plans on the exchange won't reimburse as well

as all employer-based plans?

[etherealtruth]

17. You do realize that the purpose of my post was simply to point out that the OP appeared ...

... well intentioned and concerned.

No clearly, you did not.

the initial responses to the OP appeared somewhat hostile .. I expressed my take on the OP and further explained why I thought the OPs question wasn't "stupid"

Funny how I read a post that was not quite clear ... and attributed positive "things' to it.

You read a post that wasn't quite clear and attributed negative things to it ... I am kinda glad I expect the best. Perhaps we expect what we put out there ...?

[winter is coming]

21. I never assumed the OP wasn't well-intentioned or concerned.

You're the one who assumed that asking why providers would care is negative. Apparently, your "expect the best" stats aren't as high as you imagine.

[etherealtruth]

24. Did you have a bad day?

I am so sorry that you have been so negatively impacted.

Perhaps my post was not clear ... I will clarify it further. my post was an explanation as to why someone might fear discrimination (based on historical discrimination ). I don't anticipate discrimination at all. I am very pleased with this as a first step toward an eventual single payer system.

hoping you experience some pleasantness in your life ... Everyone deserves at least a little

[2naSalit]

12. But it's Insurance

not medicare. Big difference and if there was a problem with some care facilities/service providers then they would likely be negating their agreement since their industry helped develop this program in the first place. This is the biggest hand-out to the medical industrial complex in the history of mankind... they better accept it as good.

Which is my misgiving about the whole thing, even though I'm likely one of those who won't qualify for it anyway (and not too sad about it).

[etherealtruth]

15. I am not arguing with you ...

... far from it.

I simply think the OP was well intentioned and concerned.

I wouldn't qualify for a penny ... but, I think it is a good first step. I hope single payer will eventually follow

[2naSalit]

18. I was just trying to

clarify my point. I didn't think the OP wasn't well intentioned, just uninformed perhaps. But if there was some way to deny care determined solely on that pretext, it would be flat out discrimination which isn't supposed to be tolerated.

I hope single payer comes about soon too... for all of our sake. I think it would help level the playing field when it comes to a portion of the corporate dominance in this country.

[etherealtruth]

22. Single payer is a good place to start

... also, the idea of "corporate person-hood" needs to abolished. As the saying goes ... I'll believe a corporation is a person when Texas executes one (a bit morose, but very true ... all of the benefits of person hood with none of the responsibilities)

[apples and oranges]

29. Thank you sincerely!

and thanks to everyone else. I get it now.

[etherealtruth]

31. No problem

[Motown_Johnny]

6. Reimbursement rates? No idea really but that is all I can think of

Assuming they are the same, then it can't possibly matter.

[brooklynite]

8. Simple answer: no

These people are buying insurance. Same insurance the company sells to employers. Why would they want to let the medical professionals know the circumstance of where they got their insurance? And why would the medical professionals care?

[PoliticAverse]

30. Perhaps they are reimbursing the professionals at different rates, which is why the insurers

are in some cases not offering the same number of doctors in the networks they
offer with business insurance as they are in the insurance they are offering on the exchanges.

See:
http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html?pagewanted=all&_r=0
http://articles.latimes.com/2013/sep/14/business/la-fi-insure-doctor-networks-20130915

[haele]

10. Same as they do now -

The exchange is just a group of plan from various insurance companies made available to the State or Federal exchanges, and the billing departments will handle it for the practice, clinic, or hospital. Some doctors have to "buy in" to types of plans, and they will let the patients know if plans on the exchange are in their package when the patients sign up for care.
It doesn't matter what company or type of plan it is; there's a wide range of coverage limitations even within plan groups.
My company and another company that works in the same office have the same PPO "plan" from Aetna, but a different group that has been negotiated by the company as to the levels of coverage their employees will get and how much the co-insurance, co-pays, and deductables are - and how much of a percentage of the premium the company will pay for and how much the employee is going to be on the hook for every month.
I can't see how the functionality of the exchanges in CA are set up any differently than the insurance I have through my employer is.

So no, to the doctor or the hospital, it shouldn't be any different than Medicare, TriCare, an Aetna PPO, a Kaiser HMO, or any other plan they might deal with now. Everything is already coded in, and all the coverage should be already identified.

Haele

[bluestate10]

11. No. My insurer is the same that large companies use. The insurer pays fees to doctors and

pharmacies.

[SickOfTheOnePct]

13. I doubt they'l know

I don't think they'll know, nor should they care, so long as it's an insurance plan that they accept.

[Hoyt]

14. It's possible. Some plans do pay providers less, others hassle them more.

Some have restrictive drug formularies, or use different hospitals or surgical centers from those docs prefer.

Fortunately, most providers have adapted to this. It's a good idea to see what docs and hospitals are in the network.

[winter is coming]

23. Some do, but I'd be surprised if exchange plans are so uniformly "stingy" that they'd be considered

a separate class from employer-based plans. I'm thinking there would be overlap between the two, and any negative feelings would be more along the lines of "ugh... that company never pays claims in a timely fashion".

[Hoyt]

26. Agree with that, but there will be some exhange plans that providers might not like.

Exchange plans will not be uniformily "desirable", and some might try to get a competive advantage in premiums by restricting networks, offering providers lower fees, etc. If they attract insureds, other plans might become more restrictive. I'm not criticizing, just saying. I don't need the latest and greatest drug, that is 3 times the cost of an older, proven med. But there are folks who will gripe about that.

[winter is coming]

28. In some cases, the "latest and greatest" may be preferred for a reason. I'm sure a lot of

people will scope out providers and formularies before making a decision.

[cbdo2007]

19. doesn't matter, commercial insurance is commercial insurance

From their perspective it's all the same.

[Nye Bevan]

25. Yes. In general the exchange plans have different networks.

Your insurance card will show which plan you have, so that the doctor's office can ensure that they are a participating provider in your network. Some doctors and hospitals may participate in Anthem non-exchange plans, for example, but not exchange plans.

[brush]

27. Everyone will have insurance cards . . .

just as always. They will have insurance through legitimate companies who choose to compete on the exchange for customers. This won't be a problem.

[kestrel91316]

32. Nope. They don't bother paying attention to that. They hire armies of staff to

deal with insurance companies for them.

Which would be the main reason why insurance companies need to be removed completely from the picture, but that's a battle for another day.

[gopiscrap]

33. Interesting question

I was wondering about that myself.

[lumberjack_jeff]

34. They only care that the insurance is one they accept. n/t

[cynatnite]

35. I think it's unlikely doctors will know unless they're told by the patients...

It's also possible that the patient questionnaire could have that question on it.

Either way, I don't see it making much difference. It's commercial insurance.