Chronic Pain Support Group
Physicians and professionalsdefine pain as chronic if it lasts longer than three to six months and is persistent. It's distinct from acute pain that is a direct result of injury or trauma. This support group is dedicated to those suffering from chronic pain. Discuss treatments that have worked for you, find advice for your specific experience, and find support. You're not...
For 2016 ObamaCare insurance providers have decided to basically remove the Houston area (Houston and surrounding counties) from any decent, or affordable, health insurance in the Individual Market Place (IMP). Last summer BCBS of Texas fired the first public warning shot saying that they were going to lose $400M in the Houston area with their IMP Plans. They added that they would have to make changes, but provided no details.
Well, now that the 2016 enrollment period has opened for the IMP Plans, we now have the answer. BCBS of TX, along with all other providers (about 5 or 6), have eliminated all PPO Plans and now only offer small, highly restricted, and expensive, HMO Plans.
I will use me as an example of what is happening. First, I am only in the IMP because my former employer saw ObamaCare as a get out of responsibility exit ramp, and terminated their long promised pre-65 retirement health insurance plan (that was similar to their regular employee plan). Since I was lucky enough to be able to retire early, I have counted on this long promised insurance. Well, they ended their Plan a year ago, so I had to find insurance in the IMP. For 2015, I found a good, but expensive ($836/month), Sliver PPO Plan from BCBS of TX. With this Plan I was able to keep all my doctors and it has worked fine.
For 2016, the apple cart has been turned upside down. As mentioned all insurance companies dropped their PPO Plans, and now only offer HMO Plans, all with NO OUT of NETWORK coverage, zip, nada. That sounds bad, but it is even worse than it may first appear (see hospitals).
After reviewing what little was available, I had to make a decision on which doctors I no longer wanted. No Plan offered all my doctors, and after reviewing all the networks, I either had to throw my PCP under the bus and keep some of my specialists, or keep my PCP and lose all my specialists. I decided to dump my PCP and hope that I can find a new HMO PCP that will refer me back to my specialists that I have been seeing for years. What a deal!
In addition to removing the great majority of doctors from all the networks, they also eliminated a huge number of hospitals, and other medical facilities of all types, and I am now limited to two walk-in pharmacies (CVS & Walmart/Sams).
It gets worse: As many of you probably know, Houston is home to the world famous Texas Medical Center (TMC). The TMC is the world largest medical center with 21 hospitals (including the most famous; The MD Anderson Cancer Center), and has over 100,000 employees. The TMC is as large as the downtown business centers in many large cities. It is unbelievable just to drive through.
I will let you guess which hospitals have been removed from all Plans. You're right, the entire TMC has been eliminated, along with their satellite hospitals in the suburbs. Therefore, even though I live about 25 miles from the TMC, I will not have the coverage to be able to set foot in any of them (remember, no out of network coverage). So, it is very likely that many of you folks that live all over the world will have a better chance to access these hospitals than I will in 2016.
That is my story, but do not forget that this covers anyone applying for insurance through the IMP or directly with the insurance companies. My Gold Humana HMO Plan (there are no Platinum Plans offered by anyone) will cost me $1,039 per month with a $2,500 deductible. Even if a person has a subsidized plan, the final costs for any of the Plans will still be too high for most.
My wife is a member of a Facebook support group for her major medical problem called CIDP. One of the members in Tennessee, I believe, said that her insurance was going through the roof and was so expensive that she did not know what she was going to do. She added the Obama is the anti-Christ for what he has done to the majority of the country. I would add Harry Reid and Nancy Pelosi.
One more thing about me; I turn 65 in September, so I get to start the whole process all over again with Medicare this coming summer. Will I keep my new PCP, or change back to the one I have had for 10 years???? All my doctors take Medicare, except one; at least for now.
Well, now that the 2016 enrollment period has opened for the IMP Plans, we now have the answer. BCBS of TX, along with all other providers (about 5 or 6), have eliminated all PPO Plans and now only offer small, highly restricted, and expensive, HMO Plans.
I will use me as an example of what is happening. First, I am only in the IMP because my former employer saw ObamaCare as a get out of responsibility exit ramp, and terminated their long promised pre-65 retirement health insurance plan (that was similar to their regular employee plan). Since I was lucky enough to be able to retire early, I have counted on this long promised insurance. Well, they ended their Plan a year ago, so I had to find insurance in the IMP. For 2015, I found a good, but expensive ($836/month), Sliver PPO Plan from BCBS of TX. With this Plan I was able to keep all my doctors and it has worked fine.
For 2016, the apple cart has been turned upside down. As mentioned all insurance companies dropped their PPO Plans, and now only offer HMO Plans, all with NO OUT of NETWORK coverage, zip, nada. That sounds bad, but it is even worse than it may first appear (see hospitals).
After reviewing what little was available, I had to make a decision on which doctors I no longer wanted. No Plan offered all my doctors, and after reviewing all the networks, I either had to throw my PCP under the bus and keep some of my specialists, or keep my PCP and lose all my specialists. I decided to dump my PCP and hope that I can find a new HMO PCP that will refer me back to my specialists that I have been seeing for years. What a deal!
In addition to removing the great majority of doctors from all the networks, they also eliminated a huge number of hospitals, and other medical facilities of all types, and I am now limited to two walk-in pharmacies (CVS & Walmart/Sams).
It gets worse: As many of you probably know, Houston is home to the world famous Texas Medical Center (TMC). The TMC is the world largest medical center with 21 hospitals (including the most famous; The MD Anderson Cancer Center), and has over 100,000 employees. The TMC is as large as the downtown business centers in many large cities. It is unbelievable just to drive through.
I will let you guess which hospitals have been removed from all Plans. You're right, the entire TMC has been eliminated, along with their satellite hospitals in the suburbs. Therefore, even though I live about 25 miles from the TMC, I will not have the coverage to be able to set foot in any of them (remember, no out of network coverage). So, it is very likely that many of you folks that live all over the world will have a better chance to access these hospitals than I will in 2016.
That is my story, but do not forget that this covers anyone applying for insurance through the IMP or directly with the insurance companies. My Gold Humana HMO Plan (there are no Platinum Plans offered by anyone) will cost me $1,039 per month with a $2,500 deductible. Even if a person has a subsidized plan, the final costs for any of the Plans will still be too high for most.
My wife is a member of a Facebook support group for her major medical problem called CIDP. One of the members in Tennessee, I believe, said that her insurance was going through the roof and was so expensive that she did not know what she was going to do. She added the Obama is the anti-Christ for what he has done to the majority of the country. I would add Harry Reid and Nancy Pelosi.
One more thing about me; I turn 65 in September, so I get to start the whole process all over again with Medicare this coming summer. Will I keep my new PCP, or change back to the one I have had for 10 years???? All my doctors take Medicare, except one; at least for now.
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Can you identify these rom-coms from just a screenshot from the middle of the films? This is a multiple choice quiz so even if you're not entirely sure you can always take a guess and at least have a 25% chance of getting it right anyway, so why not have a go?! https://www.buzzfeed.com/alysaurus688/rom-com-screenshot-trivia-quiz
Houston has been treated this way because (IMO) we do have the most famous hospitals in the world. People from all over the world come to the TMC for treatment. It is obvious that us folks that live near these super hospitals are going to go there first since they are so close.
The other public reason is that BCBS of TX said that they will be paying $2.5B in benefits in the Houston area, while collecting only $2.1B. The top State of Texas Insurance Officer, said publicly that they cannot force any company to sell a product that loses money. Maybe a red flag for the rest of ObamaCare that is already in a death spiral??
FYI - - From newspaper reports, there is no other place in Texas where all PPO Plans have been eliminated (or may even the all of the US?). The only reason I can think of is the cost and ease of going to world class hospitals for treatments.
I don't know what the hell PPACA is supposed to be it's not healthcare reform that's for sure.
I am sorry you are going through this and glad you soon get Medicare.
There is a lot of pressure from drs and hospitals for Texas to expand Medicaid, hopefully this will happen soon though Greg Abbott ( governor) is even more of an idiot than Rick Perry was...he's in Cuba for some odd reason. Cuba has a health system, he should take a look.
The problem so far as I can see is many of these politicians simply don't care about anything but money and power- for themselves.
Where are they sending you for hospital, Humble, Spring, Conroe, Cleveland??? If they've eliminated Herman, M.D. Anderson (my dad worked there for 25 years) TX Childrens, TX Womens, University of TX, Etc., what major Hospital is In-Network?
I'm curious, because I"m from Kingwood, 'bout 25 or so miles out of Houston, I've only been in NC for 17 yrs. now....so those are all the Hospitals I'm familiar with...but my main Hospital use was Northeast in Humble....my son spent alot of time in TX Children's over the first 10 yrs. of his life.....too much time....my ex-husband survived a massive brain/body trauma because of Herman's level 1 Trauma Center, he died 4 times, but they managed to keep the stubborn S.O.B. alive in the end.
Yes, I know Kingwood well, in fact, I will be going there tomorrow. If it has been 17 years since your last Houston visit, things have really changed!
I live about 1 west of "Old Town" Spring, which for you folks not familiar with the Houston area, is about 25 miles north of downtown Houston. Kingwood is about the same distance, but north-northeast, and was annexed by Houston a few years ago.
On Humana's Network (which I found to be the largest a few weeks ago), I did a 30 mile (60 miles in diamter) search from my home for "hospitals". That is a huge area, but small by Houston standards and includes areas far to the north (Willis, TX), near Dayton to the east, a few miles south of the Texas Medical Center (TMC), and as far west as Katy and Waller. Akso included is the all of downtown Houston. The total number of hospitals found was less than 20, and this includes mental health and out-patient hospitals.
I will have to walk back a statement made previously that all TMC hospitals have been excluded. There are four in the area including; Park Plaza, Memorial Hermann Childrens, Hermann, and Texas Orthopedic Hospital. That is 4 of 21, but I am not sure that Park Plaza is part of TMC since it is several blocks away from the others just mentioned. Also, as far as I can tell, there are no other inter-city hospitals included (inside the I-610 Beltway). Since a large portion Houston's poor people live within that area, any Plan that they could signup for have no hospitals at all within any reasonable distance.
Most people in Houston area do not go into the TMC unless they have a very serious condition, or live nearby. I would not, for example, unless for cancer treatment at the MD Anderson Cancer Center, which has been excluded from all Plans.
The hospitals that are in Plan(s) are older (much older) regional hospitals such as Kingwood, Tomball, Northwest Medical Center, etc. that existed 17 yers ago when OldCPer lived here.
In that 30 mile search zone, there is only one out-patient hospital, which luckily, is nearby and would be the only one that I would use.
Even though it may sound like there are a lot of hospitals listed, it is only a small fraction of the actual hospitals in the search zone. If someone was to ask me two months ago which hospitals that I would want to go to for non-emergency inpatient care, not a singe hospital that I would have mentioned at that time will be available to me 1/1/16. And not one of the newest hospitals that are less 10-15 minutes away from my house.
Of all the medical catagories that I looked for few weeks ago, lab services such as Quest and LabCorp were the only ones not severly limited. I guess they had to keep them otherwise I would be doing my own blood draws. I guess they will be the next to go.......
Exactly.
When you've got some greedy leech saying $4 million predicted losses are blamed on 5 million insured ( United Healthcare) also that it's hurting their $160 BILLION profit...do these people think all Americans are stupid?
Enough already.
I live in CT...home to most of the big insurance companies. We have a Democratic Governor who happily accepted the ACA and we had the highest percentage of enrollment when the plans first opened. And now? We have companies with plans from other states trying to get into CT and it's driving DOWN the costs of insurance...just as predicted by Obama if the states accepted the plan originally and did the increase in Medicaid. GOP states fought it and refused the Medicaid increases and did everything they could to stop it's implementation until the Supreme Court upheld it.
Maybe if your governor hadn't thrown a hissy fit, you'd be seeing the same results we are here. The plan works if you work it!
Some of us here are Democrats and I'm a bit fed up with the Obama bashing of late. Put the blame where it belongs...your state government.
This man has lied and lied and lied.
I voted for him and took his promises on face value. He hasn't followed through on a single one.
Obama worship is what I see, people who simply cannot see it for what it is.
My original post, and main point, is that all the insurance plans (odd that all did exactly the same thing??) that are available in the Individual Market Place in Houston, and connecting counties, intentionally removed all the top hospitals in Houston. Whether purchased by an individual like I have to, or through Medicaid or other means, all are in the same mess for next year and probably beyond. The main problem from the insurance companies' point of view, is that not enough healthy young people are signing-up, just older and sicker people and that these sicker people have easy access to famous, and expensive, hospitals. Therefore, a money losing situation that could only be fixed by severely constricting the Plans offered. The whole area could be offered expanded Medicaid and it would not change a thing, except that maybe more people would be on Plans that still cost too much (deductibles) and provide almost nothing.
For another example that was published is the Houston Chronicle newspaper two weeks ago. The article described a single woman who is a CPA and currently has a Silver BCBS of TX Plan, which from what I could tell, is identical to what I have today. She is currently being successfully treated at MD Anderson Hospital for a rare form of cancer. As of 1/1/16 she will lose this hospital and its leading cancer care. She is afraid that she will lose her life because of this. After being publicly embarrassed in the paper about this specific person, BCBS offered that since she "shares" an office space with another individual CPA, then maybe they can be reclassified as "group" and then be eligible for a PPO plan. No word since if they (BCBS) actually followed through with this idea.
Another point, the ACA specifically prohibits the sale medical insurance across state lines. This is a problem that the Republicans have been trying to get fixed for years with no luck. If it was allowed, then I guess we would all be buying insurance from the least expensive state; North Dakota (or other lightly populated state) would be insurance heaven.
Sorry, if I offended anyone, it was not my intent. The situation in Houston from all reports is very unusual.......at least for 2016.
I'm not surprised the Herman is on the list since its the only Level 1 Trauma Center and its the life flight base....it'd be really bad if it was not. I've been back home to visit many times, the last was in 2012, but have not desire to go back to live...prefer the mountains and the coast of NC. (sorry) My sister is an RN at Kingwood Hospital, has been for 20 or so years now.
The hospitals that are on the BCBS list are so far spread out, kind of all over the place.....I don't think people can appreciate how far those cities are apart unless you've been there and driven around to them. I'm disappointed they chopped it up so much.
I have BCBSNC here and its a great policy, it varies so much State to State....it's quite sad. It should be more fairly distributed across the board.