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Seattle Children's Hospital - see msg

Posted: Nov 5, 2013

Seattle Children’s Hospital ranks No. 11 on the U.S. News & World Report best pediatric hospital list. When Obamacare rolled out, the hospital found itself with just two out of seven insurance companies on Washington’s exchange.

Seattle Children’s is the only pediatric hospital in King County, and offers keys services, such as cancer care, which are not available anywhere else in the region. So if you sign up for Obamacare, good luck surviving. Fortunately, that represents only about six people at the moment.

I find this to be a horrible decision. It was discussed on the news earlier today that if you take your child to this hospital for treatment, you have to prove to the ACA that your child could not have been treated elsewhere or else you pay out of pocket!

;

You have to prove to the Affordable Care Act? - not making sense to me

[ In Reply To ..]
Maybe you can clarify?

Yes, Washington Has Their Own Exchange - *Seriously

[ In Reply To ..]
Actually they accept three of the seven on the Washington Exchange and will work with the others.

Group Health
Community Health Plan of Washington (Community HealthEssentials)
Molina Healthcare of Washington, Molina Exchange plans

If you choose an Exchange plan from another company, Childrenâ��s is considered â��out-of-networkâ�� for these Exchange plans, and your plan may not pay for your childâ��s care, but they will try to work with your insurance plan.

I think people confuse the ACA or Obamacare as being actual insurance. The ACA is not insurance. The government is not going to be your insurance company. You still have an insurance company of your choosing on the free market and choose the level of care you want. It's Romneycare, comes right out the Republican playbook of free market health care. The Republicans insisted on, crafted the ACA with their blueprint and then would not vote for it. It's all part of their just say "no" to anything Obama wants and make him a 1-term President. Oops. Too late. Epic fail on that 1-term President idea. Have to resort to trashing him personally, but I digress.

Also from the hospital's home page:

World Class Care Closer To Home--You can come to Seattle Children's without coming to Seattle. Our seven regional clinics offer access to the same talented doctors as on our main campus.

They also have locations in Alaska and Montana.

This is yet another issue between healthcare providers, - INSURANCE companies and

[ In Reply To ..]
their state insurance officials. Seattle Children's Hospital is suing Washington STATE'S insurance commissioners for failing to insure adequate network coverage. Neither ACA nor the federal government dictate to insurance companies who they do and do not include in their provider networks, whether it be hospitals, clinic, physicians or whatever.

In King County (Seattle), seven insurers are offering plans through the exchange. Only two — Group Health Cooperative and Community Health Plan of Washington — include Seattle Children’s in their provider network. The five that do not are Premera Blue Cross, LifeWise Health Plan of Washington, Bridgespan, Molina Healthcare and Coordinated Care.

In each separate case, it is the insurance companies who have, for whatever reason, decided not to include Seattle Children's in their provider networks. Please explain how ACA is responsible for this decision and not each individual company.

Your last paragraph is completely fictitious. Each company will determine their own separate policy provisions on how they will handle out-of-network services. Most of the time there is partial coverage of varying ratios of out-of-pocket expenses, i.e. 70-30, 60/40, 50/50 and so on. It is not a foregone conclusion that patients with out of network policies will have to pay 100% of those expenses. Also, there is nothing new about insurance companies requiring "proof" (read medical necessity or need) for certain levels of care, cancer treatments being a prime example.

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare?page=2

http://seattletimes.com/html/localnews/2021968776_acachildrenssuitxml.html

Seattle Childrens - A Washingtonian

[ In Reply To ..]
At least you, and the person who posted above you, reads the newspaper and is able to comprehend facts. People who are "out of network" are not denied health care. It usually means that they pay more out of pocket, but probably not 100%, and that is nothing new. I live in Washington, and just my opinion, but I don't see Children's turning anyone away because they have an out of network insurance provider. Also, the statement in regard to Children's Seattle being the only care provider is false. There is another pediatric hospital in Tacoma (near Seattle) that probably has many of the same staff members, and Children's operates a number of regional facilities in other states, as was previously mentioned. I live in a small city on the opposite side of WA from where Children's is located; we have an outreach clinic here. Children's treats patients who need care in all medical specialties, not just cancer, and are affiliated with the University of Washington. No one is going to be locked out of receiving medical care due to being out of network.

Don't worry, Obama will probably force them to - treat people. I know SM

[ In Reply To ..]
several docs who aren't taking Medicare or Medicaid patients, and they say if Obama forces them to they will look for another profession.

Good. Then they are in the profession for the wrong reason anyhow. - NM

[ In Reply To ..]
x

You can't mean that. You want the fed to determine - what doctors are worth? SM

[ In Reply To ..]
Then why should a doctor care how good he/she is or not?

What will happen is they will start accepting only cash, until that is outlawed. What happened to Free America?

Just because someone wants to be compensated for years of schooling doesn't mean they aren't compassionate. Many of them perform services for free.

What happens if all doctors choose not to treat Medicaid - Medicare?

[ In Reply To ..]
It's not like they are going to have to take up residence under a bridge.

That's not the point. They have staff to pay, malpractice insurance - rent, their families, etc, SM

[ In Reply To ..]
When they accept Medicare and Medicaid there is a fixed amount of money they get back. Medicare has it's own ICD codes and administrative rules, and they have to hire additional help to deal with that.

I think we need tort reform. - nm

[ In Reply To ..]
x

I just wonder how many students will go into medicine - if they think the fedgov (sm)

[ In Reply To ..]
can dictate how much money they can make.

probably all the ones who want to go into medicine - nm

[ In Reply To ..]

They are free Americans. No one can "force" them - to see patients. Except the corporations

[ In Reply To ..]
more and more of them are working for these days, of course. Their employers have a long list of instructions they have to follow if they want to keep their jobs.

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