Video: WA “premium” exchange plan not so golden after all

posted at 3:21 pm on March 24, 2014 by Ed Morrissey

Barbara Boxer may argue that ObamaCare has been a huge success and Joe Biden may want to propose Barack Obama for sainthood, but the experience for most Americans has been far from heavenly. Even those who opted for the gold-level plans get unpleasant surprises when attempting to access medical services. In Washington, KOMO reported this weekend that one family paying high premiums for gold-level coverage will now also pay for half of all hospital costs after an emergency sent their daughter to a hospital that exists to treat children:

In early March, her 16-year old daughter had a medical emergency. Alex drove her to the nearest hospital, which was Seattle Children’s. Alex says doctors there felt her daughter’s situation was so dire she needed to be admitted to the hospital immediately. She was there for nine days.

Then came news that her stay, which involved specialized mental health care for adolescents, was going to cost $36,000 and her insurance would only pay for half because Seattle Children’s was considered on out-of-network facility.

She thought by going for the highest premium PPO gold level coverage offered the state exchange, a majority of the bill would have been covered.

“I’m paying a premium for that and I’m willing to pay that premium, but I expect to get services that are not so limited by the insurance companies,” she said.

She’s not alone. Seattle Children’s says its treated more than 125 patients who are not covered by policies offered by the exchange. In October, the hospital filed suit against the Office of the Insurance Commissioner, claiming the state office failed to ensure adequate network coverage in plans from its biggest providers like Premera Blue Cross.

“Because Seattle Children’s was not included in the major plans, children coming for care here were going to be denied care and in fact that’s what we are seeing,” said Dr. Sandy Melzer, senior vice president and chief strategy officer for Seattle Children’s.

Small wonder, then, that the uninsured aren’t exactly impressed with the rollout of ObamaCare:

The Kaiser Foundation has a cool interactive infographic tool to examine the polling they’ve done on the Affordable Care Act since it was passed, four years ago. You can click through the tool to see how approval and disapproval ratings have changed across different demographic categories and over the years. For the most part, opinion hasn’t changed much — it’s ticked up slightly over the last four or five months for most demographic groups, during the law’s troubled rollout, but not by a huge amount (a finding Gallup’s replicated). The one striking finding: Disapproval of the law among the uninsured population has risen substantially over the past few months …

Assuming the finding holds up, why might it be happening? For one, they’re more likely to be interacting with the law: Navigators are trying to reach them; some of them have probably been on the individual market at times, which only a limited percentage of Americans are, and are now seeing themselves priced out of coverage; others are perhaps just disappointed with what the law has to offer, or that its plans aren’t free, period. Some of them could be people who would have been eligible for Medicaid if their state had expanded it, and now see people making a little more money getting heavily subsidized insurance while they’re left out in the cold. It’ll be interesting to see if this trend holds up.

As the insured attempt to get medical care and find out just how little their coverage means, those trends won’t be limited to just that demographic.

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Who did this mother vote for in 08 and 12?

OmahaConservative on March 24, 2014 at 3:24 PM

…what?…say it isn’t so!

KOOLAID2 on March 24, 2014 at 3:27 PM

Liars and racists.

Just ask H.R.

Oxymoron on March 24, 2014 at 3:29 PM

plans aren’t free

Unfortunately, the low-info voter interprets “affordable” as “free”.

GarandFan on March 24, 2014 at 3:29 PM

Who did this mother vote for in 08 and 12?

OmahaConservative on March 24, 2014 at 3:24 PM

They live in Seattle. You know damn good and well who she voted for.

As Led Zeppelin once sang: “Nobody’s Fault but Mine.”

Agent of the Cross on March 24, 2014 at 3:30 PM

Before I shed any sympathy for these “victims”, I need to know who they voted for…

PatriotRider on March 24, 2014 at 3:30 PM

Who did this mother vote for in 08 and 12?

OmahaConservative on March 24, 2014 at 3:24 PM

I can already tell you–note she blamed the INSURANCE COMPANY, not the law.

Doc Holliday on March 24, 2014 at 3:31 PM

People, you can’t put a price on Marxist Utopia. The enlightened have a price though, and it’s everything you have.

emerson7 on March 24, 2014 at 3:31 PM

Harry Reid says you’re a liar…embrace the suck…

PatriotRider on March 24, 2014 at 3:31 PM

No sympathy for this family at all. Not. One. Bit.

OmahaConservative on March 24, 2014 at 3:35 PM

By the way

“Affordable, affordable, affordable…”

Schadenfreude on March 24, 2014 at 3:36 PM

“I’m paying a premium for that and I’m willing to pay that premium,”

Hope you’re happy knowing that your “premium” is paying for some taker to get a nice government medical subsidy…sucker…

PatriotRider on March 24, 2014 at 3:36 PM

Here’s the money quote

others are perhaps just disappointed with what the law has to offer, or that its plans aren’t free

Maybe not this couple but for a large part of the uninsured they want it all, and they want it to be “free”.

bsinc1962 on March 24, 2014 at 3:36 PM

Notice where she is placing blame. In the fourth paragraph she lays it squarely on the insurance company.
“I’m paying a premium for that and I’m willing to pay that premium, but I expect to get services that are not so limited by the insurance companies,” she said

Ufdaubet on March 24, 2014 at 3:36 PM

Keep voting Democrat you moron…

PatriotRider on March 24, 2014 at 3:37 PM

Scam insurance.

forest on March 24, 2014 at 3:40 PM

This woman is an idiot. Why did she not know what providers were in her network? I have looked at the plans available in my area and I can tell you that the “silver” plan that they push because it has cost sharing has an extremely narrow network. There is a good hospital 1 mile from my house but it is not in that network. The closest emergency room that Is in network is 15 miles away. We haven’t seen the actual death panels yet but the narrow networks are a part of death panels. If you don’t get to the hospital in time then you Are dead.

BeachBum on March 24, 2014 at 3:40 PM

She thought by going for the highest premium PPO gold level coverage offered the state exchange, a majority of the bill would have been covered.

IOW, she believed the media hype about how great Obamacare would be, and didn’t bother to read the actual terms of her Obamacare policy to learn what providers and services were covered.

She’s clearly an Obama voter.

AZCoyote on March 24, 2014 at 3:41 PM

“Then came news that her stay, which involved specialized mental health care for adolescents”

I hear that’s quite common in Democrat families…

PatriotRider on March 24, 2014 at 3:41 PM

So, she has the insurance company pay for the medical care, then she stops paying the insurance company and pockets the savings until she makes up the difference for what the insurance company should have paid in the first place. Sure, she takes a hit on the tax/penalty at the end of this year, but she comes out ahead. Then, she signs up again, if she’s dumb enough not to pursue other health plans that pool resources.

And by the way, she most likely voted for Obama and the rest of the democrats who run Washington. And then there were others who voted for her as well.

HiJack on March 24, 2014 at 3:42 PM

Socialism is hard.

mankai on March 24, 2014 at 3:42 PM

Hahahahahahahahahahahahahahahahahahahahaahahahahahahahahahahahahahahahahahahahahahahahahahahahahahah…a shame, but her out-of-control 16 yoa daughter is suffering the slings and arrows of a Lib upbringing.

vnvet on March 24, 2014 at 3:43 PM

Harry Reid says you’re a liar…embrace the suck…

PatriotRider on March 24, 2014 at 3:31 PM


Hey, Aqualung…

forest on March 24, 2014 at 3:43 PM

By the end of this year Mexican health insurance will be better than ours…

PatriotRider on March 24, 2014 at 3:44 PM

Notice that she went for the gold plan, and then all of a sudden her daughter needed serious medical attention. Yeah, right.

HiJack on March 24, 2014 at 3:45 PM

Notice that she went for the gold plan, and then all of a sudden her daughter needed serious medical attention. Yeah, right.

HiJack on March 24, 2014 at 3:45 PM

That’s a good observation.

WhatSlushfund on March 24, 2014 at 3:47 PM

We have a low-information president, who has appointed a low-information cabinet, including the low-information secretary of health and human services who is applying a low-information health care law (one of many such laws) behind the big power of a low-morality Internal Revenue Service. The result of all of this low information in power is a low-liberty nation.

So when Matt Drudge – fully complying with the inane and unworkable law as it applies to his 2014 taxes – calls them out on it, they publicly and bumptiously step in their own pile of ordure. These liberals, who claim that they alone can run the auto industry, the banking industry, and all of health care – haven’t the foggiest notion how one of the most basic tenets of tax law works. This particular part of a disastrous health care law is exhibit A for what happens when those who have never signed the front of a business check in their lives have power over those who have. And power over everybody else, too.

Pardon the worn out cliché, but the inmates really are running the asylum. Yet when you expose their ignorance and incompetence, they just ramp up the outrage. Frankly, Drudge wasn’t even trying to expose their ignorance. He was simply making a point, and the policy mavens came out of the woodwork and volunteered headlong into their own excreta.

Schadenfreude on March 24, 2014 at 3:48 PM

Single-payer! That’s solve everything.

Unicorns and stuff too.

/

mankai on March 24, 2014 at 3:48 PM

I have to ask, don’t hospitals check to see if they are on the patient’s insurance plan? I know what hospitals are covered by mine. Although I can go out of network and pay more. But I don’t think it’s 50%.

Cindy Munford on March 24, 2014 at 3:49 PM

Hah, 4 years later, no bounce.

Schadenfreude on March 24, 2014 at 3:51 PM

Alex…you can be sure that Obama is really mad about this…

PatriotRider on March 24, 2014 at 3:51 PM

Why is it that so many people in this country are taken unawares by how awful this “affordable-affordable-affordable-affordable-affordable” law is? In this age of the internet, one gets news via a great many channels, not just the alphabet networks. Plus, if these people take any interest at all in politics, they’re going to hear that conservatives thought this law was terrible from the get-go. But they act like this is all totally unexpected.

Amerikans are D-U-M dumb.

MisterElephant on March 24, 2014 at 3:51 PM

The Dem’s are right about one thing, the GOP needs to coalesce around one central theme about where healthcare should go from here. Clearly the big government solution of Obamacare has been a failure and the GOP needs to get ahead of the next big Dem push to solve the problem – single payer!

Tater Salad on March 24, 2014 at 3:51 PM

“I’m paying a premium for that and I’m willing to pay that premium, but I expect to get services that are not so limited by the insurance companies,” she said.

She believed the media hype and thought by paying the Top of the Line Gold Plan Premium she wouldn’t have to pay anything else, and everything would be covered with zero out of pocket costs to her. Sucker!

Johnnyreb on March 24, 2014 at 3:53 PM

Senate Majority Leader Harry Reid (D-Nev.) told The Hill in December that ObamaCare will be a “net positive” for Democrats by Election Day. House Minority Leader Nancy Pelosi (D-Calif.) last week called it a “winner.” Rep. Debbie Wasserman Schultz (Fla.), the chairwoman of the Democratic National Committee, has made similar claims

So where is this mental hospital?

mankai on March 24, 2014 at 3:56 PM

Liars and racists.

Just ask H.R.

Oxymoron on March 24, 2014 at 3:29 PM

You can use his full name, you know: The Alleged Pederast Dingy Harry “The Crypt Keeper” Reid.

Occams Stubble on March 24, 2014 at 3:56 PM

Cindy Munford on March 24, 2014 at 3:49 PM

The WA exchange has false information about the in-plan doctors and hospitals. And it keeps changing.

In fact there’s only one insurance company that offers plans for the Seattle area that are really inclusive. The rest have quite narrow networks. And it’s VERY difficult to navigate the system and find this out.

kcewa on March 24, 2014 at 3:57 PM

Schadenfreude on March 24, 2014 at 3:48 PM

I was following this discussion yesterday. Yet another example of how stupid people are.

MisterElephant on March 24, 2014 at 3:57 PM

Who did this mother vote for in 08 and 12?

OmahaConservative on March 24, 2014 at 3:24 PM

I can already tell you–note she blamed the INSURANCE COMPANY, not the law.

Doc Holliday on March 24, 2014 at 3:31 PM

Like the jokers she votes for, she didn’t read the providers list. Maybe Obama can write you a check out of his stash. My tears have dried for those who voted for it, but our own are being swallowed up in the suck wave.

Cheese Wheel on March 24, 2014 at 3:59 PM

But these Obamacare posts are about whistling past the graveyard, by next Novemeber Democrats will be openly running on the ACA. Mark my words.

libfreeordie on December 20, 2013 at 10:14 AM

Schadenfreude on March 24, 2014 at 3:59 PM

It’s part of the plan. Make those people so angry for having to pay and jump thru hoops…..and then offer up single payer, taking away all those burdens and *poof* you’re the magic savior again.

None of this, None of it, is a unexpected “glitch”. It is all going exactly as planned.
Before 2016, the red meat (organic, free range red meat) of single payer will bring the flock back to usher in another progressive to administer the final death blow to America. This will most likely happen (if it does) because too many people will choose to remain gullible or the vote will be tipped by fraud.

Mimzey on March 24, 2014 at 4:02 PM

but the rapping idiots in the insure wa commercials make it seem like such a great deal, this must be wrong https://www.youtube.com/watch?v=qtt39C4lQOI

I’m also wondering if the green rapper got free admission to “lets move” as part of his compensation, nothing like using the obese to encourage 26 yr old baby birds to be healthy, its almost like this has nothing to do with wellness at all…..

dutch love on March 24, 2014 at 4:02 PM

Koch Brothers!

/

mankai on March 24, 2014 at 4:03 PM

She believed the media hype and thought by paying the Top of the Line Gold Plan Premium she wouldn’t have to pay anything else, and everything would be covered with zero out of pocket costs to her. Sucker!

Johnnyreb on March 24, 2014 at 3:53 PM

She reminds me of a “brilliant” young Harvard Law grad who had purchased a bare-bones, liability-only auto insurance policy for his car, and then was shocked! to learn from his claims adjuster that his insurance company wouldn’t be paying for the collision damage to his car.

“Insurance is a rip off! I paid for coverage! How can a Harvard Law grad be expected to understand the difference between liability coverage and collision coverage? They never covered this stuff in my racial grievance law classes. Insurance is haaaaaard!”

AZCoyote on March 24, 2014 at 4:06 PM

Once again proving the adage: Elections.Have.Consequences

Infidelius on March 24, 2014 at 4:09 PM

She thought….

No, she assumed. As others have said – she failed to read what was actually covered by her plan before using it.

I’m betting she’s a liberal. They tend toward blind belief in what they’re told, rather than showing some measure of skepticism – at least, as far as government is concerned. They also tend to not read the fine print in their contracts and then expect others to bail them out.

GWB on March 24, 2014 at 4:09 PM

kcewa on March 24, 2014 at 3:57 PM

Gosh, this is all just swell. Doesn’t it seem like she would have a case for someone to pay if she was given the wrong information. Of course her kid will be 40 by then. I saw a doctors panel on Special Report last week and they said that a lot of the insurances had whole areas of medical specialties missing and I’m talking about things as mundane as pediatrics.

Cindy Munford on March 24, 2014 at 4:09 PM

Mark my words.

It won’t be long before the Dems start responding to these stories by saying that Mr./Mrs. John Q. Public should probably have taken advantage of the unilaterall decision by Obama to allow them to keep their original insurance policy.

“Its their own fault……”

BobMbx on March 24, 2014 at 4:17 PM

From her LinkedIn page:

Association for Humanistic Psychology
Existential Therapy
Mindfulness-Based Interventions – UCSD Center for Mindfulness

Oh, yeah, she’s gotta be a Lefty.

mankai on March 24, 2014 at 4:20 PM

Alex Szablya

OmahaConservative on March 24, 2014 at 4:26 PM

From her LinkedIn page:

Association for Humanistic Psychology
Existential Therapy
Mindfulness-Based Interventions – UCSD Center for Mindfulness

Oh, yeah, she’s gotta be a Lefty.

mankai on March 24, 2014 at 4:20 PM

Well, now we know why her daughter needs mental health care, too.

HiJack on March 24, 2014 at 4:26 PM

Alex Szablya

OmahaConservative on March 24, 2014 at 4:26 PM

HA! She’s an out-of-network provider herself!

HiJack on March 24, 2014 at 4:30 PM

Looks like that whole out-of-pocket cap is bullcrap, also.

Guess the world owes that other woman an apology for pulling numbers out of thin air and saying that her exchange plan would be cheaper than her cancelled insurance for covering her cancer treatment.

The Schaef on March 24, 2014 at 4:30 PM

The woman apparently failed to read the terms of the policy, so she got stuck with half the bill when she got medical care for her daughte( out of network. You can pay for the most expensive product and still be getting a bad deal.

It is not unreasonable to expect a premium policy to cover emergency or urgent care at the closest facility, but experience has shown that it is essential to confirm whether or not reality meets expectations.

I think taking her to Children’s was the smart thing for her daughter’s welfare, but her ignorance of her insurance terms is not smart at all, and this will be a lesson learned at significant cost.

My hope is that from this whole ACA experience, the people of the USA will learn from this costly and ill-conceived experiment in limited socialized medicine. But my personal experience in observing the people of the USA, does not make me feel super optimistic, and single-payer is poised to pounce if ever given an opportune moment.

P.S. Maybe the insurance company said something like: “You have to buy the policy to find out what is in it.” That would explain a lot. But nobody would be that stupid, right?

s1im on March 24, 2014 at 4:32 PM

From her LinkedIn page:

Association for Humanistic Psychology
Existential Therapy
Mindfulness-Based Interventions – UCSD Center for Mindfulness
Oh, yeah, she’s gotta be a Lefty.

mankai on March 24, 2014 at 4:20 PM

For someone concerned with matters of the mind, she doesn’t know much.

MisterElephant on March 24, 2014 at 4:32 PM

Can’t muster a modicum of concern for her. Reap what you sow ignoramus.

Murphy9 on March 24, 2014 at 4:33 PM

Gosh, this is all just swell. Doesn’t it seem like she would have a case for someone to pay if she was given the wrong information. Of course her kid will be 40 by then.
Cindy Munford on March 24, 2014 at 4:09 PM

She might have a case. I feel sorry for her – her daughter was obviously quite sick or she wouldn’t have spent 9 days in the Hospital. The obligation to check in a case like this should be on the Hospital – the mother needs only to thinking of her daughter.

Seattle Children’s is reportedly suing the state: Seattle Children’s Hospital Sues State over ‘False Promise’ in Obamacare

kcewa on March 24, 2014 at 4:35 PM

She thought by going for the highest premium PPO gold level coverage offered the state exchange, a majority of the bill would have been covered.

I’ve been led to believe that Platinum is the highest level plan, not Gold.

Agree with others though, regardless of the level of her plan she should have known what her network was and not made assumptions. How can she not have read in the news or seen reports on TV about lousy networks in Obamacare?

slickwillie2001 on March 24, 2014 at 4:38 PM

It won’t be long before the Dems start responding to these stories by saying that Mr./Mrs. John Q. Public should probably have taken advantage of the unilaterall decision by Obama to allow them to keep their original insurance policy.

“Its their own fault……”

BobMbx on March 24, 2014 at 4:17 PM

If you read the comments in the Seattle Times about this story you’ll find they’re already blaming her. I find it sad how both the right and the left are both blaming this poor woman.

kcewa on March 24, 2014 at 4:39 PM

Koch Brothers!

/

mankai on March 24, 2014 at 4:03 PM

Booosh!
Cheney!
The Jooooos!

And of course…

Palin!!!

GrannyDee on March 24, 2014 at 4:40 PM

don’t hospitals check to see if they are on the patient’s insurance plan? I know what hospitals are covered by mine. Although I can go out of network and pay more. But I don’t think it’s 50%.

Cindy Munford on March 24, 2014 at 3:49 PM

If she went in through the emergency room and needed to be admitted, under EMTALA she can’t be transferred til she is stabilized.

For many of the uninsured or those on Medicaid, they don’t care, because they don’t have any assets and the hospital eats it.

For people with insurance, the copays are the killers. Out of networks can be as high as 50%. Some services wouldn’t be covered at all.

Caveat emptor.

talkingpoints on March 24, 2014 at 4:51 PM

What did her prior policy cover?Why didn’t the reporter ask her that?

docflash on March 24, 2014 at 4:59 PM

I don’t think you can assume someone voted for Obama because they live in seattle. I live in massachusettes and have always voted republican.

gerrym51 on March 24, 2014 at 5:07 PM

Check out her website, gerrym…

OmahaConservative on March 24, 2014 at 5:12 PM

Desperation

Schadenfreude on March 24, 2014 at 5:16 PM

Schadenfreude on March 24, 2014 at 5:16 PM

Freakin’ ridiculous…

OmahaConservative on March 24, 2014 at 5:23 PM

Glad those two votes are costing you, mom.

SUFFER, RUBE!!!

RedNewEnglander on March 24, 2014 at 5:31 PM

Check out her website, gerrym…

OmahaConservative on March 24, 2014 at 5:12 PM

Good Lord. No wonder she voted for The Won twice.

RedNewEnglander on March 24, 2014 at 5:32 PM

At some point, some frantic, desperate parent whose child is being bureaucrated to death is going to turn violent.

kurtzz3 on March 24, 2014 at 5:34 PM

don’t hospitals check to see if they are on the patient’s insurance plan? I know what hospitals are covered by mine. Although I can go out of network and pay more. But I don’t think it’s 50%.

Cindy Munford on March 24, 2014 at 3:49 PM

Some check to see if you’re in-network, others don’t care and just check to see if they accept your insurance company. I got burned by the front desk “verifying” that their hospital was in network with my insurance for an emergency with my ex; I wasn’t too happy when I got the bill.

That said, always a good idea to find out which ERs around you are in-network vs out of network, especially with the ever changing/shrinking list of network providers.

nextgen_repub on March 24, 2014 at 5:55 PM

Check out her website, gerrym…

OmahaConservative on March 24, 2014 at 5:12 PM

Wait…..just wait…….this is without a doubt the most glorious, supercalifragilisticexpealidocious piece of irony I HAVE EVER SEEN.

Our intrepid, but betrayed, mother complains that her hospital is “out of network”, and is disgusted by the amount she has to pay. Yet, on her own website, under the “Rates” tab, there is this gem:

Rates

I charge $125 per 50 minute session.

I am an out-of-network provider and will provide you with a bill that you can then submit to your insurance company.

BobMbx on March 24, 2014 at 5:57 PM

Get used to this. My wife, a school nurse, went to a conference at the Children’s Hospital of Colorado, the premier children’s hospital in the state (and on a par with premier children’s hospital in the rest of the country). A presenter from the hospital, talking about the effect of Obamacare, stated that without changes Obamacare will eventually drive premier hospitals like theirs out of business because of just what this article says: premier hospitals are all out-of-network and therefore unaffordable. Eventually patients will get used to that and stop going to premier hospital they can’t pay for out-of-pocket.

So, get used to lowest-common-denominator health care. It’s all the insurance companies are going to pay for.

So much for “If you like your hospital, you can keep your hospital”. But we knew that was a lie four years ago, didn’t we.

lovesthesun on March 24, 2014 at 6:29 PM

Too many confuse the term “healthcare coverage” meaning “insurance” with actual medical care. One does not guarantee the other as I’ve tried to tell countless people. And good luck trying to get medical care through the unAffordable less Care Act.

stukinIL4now on March 24, 2014 at 8:11 PM

Who did this mother vote for in 08 and 12?

OmahaConservative on March 24, 2014 at 3:24 PM

If she’s living 5 minutes from Children’s that puts here squarely in the Burke-Gilman/Laurelhurst/U-District area.
Jim McDermott / Obama country

jaydee_007 on March 24, 2014 at 8:34 PM

She wasn’t b!tching about the high costs associated with the Gold plan – which most of us would be doing… she was busy blaming the insurance company. Of course if this were single payer – the government would NEVER restrict access to certain hospitals or types of care. /

Hill60 on March 24, 2014 at 8:51 PM

I live in south central Washington. Trying for over a week to call the Washington Obama hot line to correct a glitch on my application. They put you on hold for several hours and usually your phone goes dead before they will answer. I finally quit and will pay the fine. Which is cheaper than taking time off work to make these useless calls. I voted GOP in both elections. I have not voted for a demo for decades. I’m eligible for Medicare in a year and I will wait for that. My company discontinued our plan as Od 4/01/14. Isn’t hope and change just grand.

garydt on March 24, 2014 at 9:55 PM