Quoted from CICERO

Lol...yeah...that's it.  Me and 70% of eligible voters.

Quoted from Box A Rox

That's OK with me Cissy.  I'll continue to decide how your government works and who is elected.

Quoted from CICERO

Yes, I'm quite confident you will participate in the illusion.  

BTW...Its not my government, it is the government.  I'm not under the illusion that I have any influence over it.  I'll leave that magical thinking to you.

Quoted from Box A Rox

No Cissy, unfortunately it IS your govt.  It provides for you whether you like it or not.  It provides fire protection
police services, road, bridge and infrastructure maintenance that you use every day.  It regulates utilities, it
educates your kids, it is an everyday part of your life.  

Quoted from CICERO

It doesn't provide anything.  It takes my money whether I like it or not.  You have it backwards again.  You always assume that these things your government provides would not exist if they first didnt forcibly take your money to provide them for you.  

You take away cimpulsory taxation and then see how many of these "services" will be provided.  Man, you are a statist through and through.

Quoted from Box A Rox

OK Cicero OK!!!  I get it.  Today start your new plan.
  ONLY DRIVE ON PRIVATE ROADS. (Roads you pay for.)
ONLY SEND YOUR KIDS TO PRIVATE SCHOOL.  (The ones you pay for)
ONLY DRINK WATER FROM PRIVATE WELLS (Wells you pay for)
TURN AWAY ANY MUNICIPAL OR VOLUNTEER FIRE PROTECTION IF YOU HAVE A FIRE.  (Only use your own
personal financed fire company)
ONLY USE PRIVATE UTILITIES... ELECTRIC, SEWER, WATER, even when you are away from home. Don't
stop and use a public restroom.
This is just a small sample...
SO CISSY... LET US KNOW HOW IT IS WORKING OUT FOR YOU!

Quoted from CICERO

Can't.  Your government forces me to pay their ransom and inflate the money supply and artificially keep interest rate low so I can never accumulate enough money.  It's a brilliant system of enslavement. It would take many slaves to ignore your violent system before those things you suggested could ever happen.

Quoted from Box A Rox

So... you will continue to use OUR GOVT ROADS and piss & moan about paying for that benefit.  
Too bad the rest of us can't just ban you from using OUR ROADS, OUR WATER, OUR SEWER, ETC.

Quoted from Box A Rox

So... you will continue to use OUR GOVT ROADS and piss & moan about paying for that benefit.  
Too bad the rest of us can't just ban you from using OUR ROADS, OUR WATER, OUR SEWER, ETC.

Quoted Text

You’re required to get pre-authorization for expensive services.
Your EPO will require you to get permission from it for some health care services before you’re allowed to get the care. If a particular service requires pre-authorization and you don’t get it, your EPO can refuse to pay.

Pre-authorization helps your EPO keep costs down by making sure you really need the services you get. In plans like HMOs that require you to have a primary care physician, your PCP is responsible for making sure you really need the services you get. Since your EPO doesn’t require you to have a PCP, it uses pre-authorization as a mechanism to reach the same goal: the EPO only pays for things that are truly medically necessary.

EPO plans differ as to what types of services must be pre-authorized. Most require pre-authorization for things like MRI and CT scans, expensive prescription drugs, surgeries, hospitalizations, and medical equipment like home oxygen. Your EPO’s Summary of Benefits and Coverage should tell you more about the pre-authorization requirement, but you should suspect that any expensive service will need to be pre-authorized.

Although your doctor may volunteer to get pre-authorization for you, it’s ultimately your responsibility to make sure you get a service pre-authorized before you receive the health care. If you don’t, your EPO has the right to refuse to pay for the care, even if the care was medically necessary and you got it from an in-network provider.

Pre-authorization takes time. Occasionally, you’ll have the authorization before you even leave the doctor’s office. Usually, it takes a few days. In bad cases, or if there’s a problem with the authorization, it can even take weeks.

Quoted Text

Like their cousins, PPOs and HMOs, EPO health plans have cost-containment rules about how you get your health care. If you don’t follow your EPO’s rules when you get health care services, it won't pay for the care.

An EPO health plan's rules center around two basic cost-containment techniques:

Where and from whom you get health care services is limited to providers that the EPO has negotiated discounts with.
Health care services are limited to things that are medically necessary or that make your health care costs lower in the long run, like preventive care.
How Does EPO Health Insurance Work?

Cost-sharing requirements in an EPO are low.
Cost-sharing like deductibles, copayments, and coinsurance are kept to a minimum with an EPO. In fact, some EPOs don’t require any deductible or coinsurance at all, and just charge a small copayment at the time of service. Because of its low cost-sharing and low premiums, an EPO is one of the most economical health insurance choices.

You must use in-network providers.
Every EPO has a list of health care providers called a provider network. This network offers every imaginable type of health care service including doctors, specialists, pharmacies, hospitals, labs, x-ray facilities, speech therapists, home oxygen, and more.

In an EPO health plan, you can only get health care services from in-network providers. If you get care out-of-network, the EPO won’t pay for it; you’ll be stuck paying the entire bill yourself. Accidentally getting out-of-network care can be a very expensive mistake when you have an EPO.

It’s ultimately your responsibility to know which providers are in-network with your EPO. For example, you can’t assume that, just because a lab is down the hall from your EPO doctor’s office, that lab is in-network with your EPO. You have to check. Likewise, don’t assume that the imaging facility that did your mammogram last year is still in-network with your EPO this year. Provider networks change. If you make that assumption and you’re wrong, you’ll have to pay the entire mammogram bill yourself.

There are three exceptions to the in-network requirement:
The EPO doesn’t have an in-network provider for the specialty service you need. If it happens to you, pre-arrange the out-of-network specialty care with the EPO—keep your EPO in the loop.

You’re in the middle of a complex course of specialty treatment when you become an EPO member and your specialist isn’t part of the EPO. Your EPO will decide whether or not you may finish the course of treatment with your current physician on a case-by-case basis.
True emergencies. If you’re having a stroke, heart attack, or other true emergency, you should go to the nearest emergency room whether or not it’s in-network with your EPO. Most EPOs will cover the cost of emergency care received at the nearest out-of-network facility as though it was in-network care. However, if you need to be admitted to the hospital from the ER, your EPO may ask the out-of-network ER to transfer you to an in-network hospital for admission.
You don’t have to have a primary care physician.
Your EPO health plan won’t require you to have a primary care physician, although getting a PCP is still a good idea.

You don’t have to get a referral to see a specialist.
Neither will your EPO require you to get a referral before seeing a specialist. This makes it easier to see a specialist since you’re making the decision yourself, but you need to be very careful that you’re seeing only specialists that are in-network with your EPO.

You’re required to get pre-authorization for expensive services.
Your EPO will require you to get permission from it for some health care services before you’re allowed to get the care. If a particular service requires pre-authorization and you don’t get it, your EPO can refuse to pay.

Pre-authorization helps your EPO keep costs down by making sure you really need the services you get. In plans like HMOs that require you to have a primary care physician, your PCP is responsible for making sure you really need the services you get. Since your EPO doesn’t require you to have a PCP, it uses pre-authorization as a mechanism to reach the same goal: the EPO only pays for things that are truly medically necessary.

EPO plans differ as to what types of services must be pre-authorized. Most require pre-authorization for things like MRI and CT scans, expensive prescription drugs, surgeries, hospitalizations, and medical equipment like home oxygen. Your EPO’s Summary of Benefits and Coverage should tell you more about the pre-authorization requirement, but you should suspect that any expensive service will need to be pre-authorized.

Although your doctor may volunteer to get pre-authorization for you, it’s ultimately your responsibility to make sure you get a service pre-authorized before you receive the health care. If you don’t, your EPO has the right to refuse to pay for the care, even if the care was medically necessary and you got it from an in-network provider.

Pre-authorization takes time. Occasionally, you’ll have the authorization before you even leave the doctor’s office. Usually, it takes a few days. In bad cases, or if there’s a problem with the authorization, it can even take weeks.

You don’t have to file claims.
You don’t have to hassle with bills and claim forms when you have EPO health insurance since all of your care is provided in-network. Your in-network health care provider bills your EPO health plan directly for the care you receive. You’ll just be responsible for paying your deductible, copayment, and coinsurance.
EPOs have some traits in common with HMOs and some traits in common with PPOs. As such, you might consider an EPO to be a cross-breed between an HMO and a PPO. To learn more about how EPOs compare to HMOs and PPOs, check out “EPO Health Insurance—How It Compares to HMOs & PPOs.”

Quoted Text

Definition:

Some health insurance requires that you pay a percentage of the cost of covered health-related services after you have met your annual deductible. This is known as coinsurance and most often is about 20% to 30% of what your health plan approves. Your health plan will pay the remaining 70% to 80%.

Also Known As: co-insurance

Examples:

Mr. Jones has a family health plan with a $500 annual deductible and 20% coinsurance. In February, his wife and two children got checkups from their family physician. Mr. Jones paid the physician for these services, which cost $510. In March, one of the children got sick and the cost of the office visit was $50. Since the annual deductible was met, the health plan paid the doctor $40 (80%) and Mr. Jones paid the doctor $10 (20%)

Quoted Text

Some supporters of the Affordable Care Act say the smaller size of the provider networks isn't the problem so much as clear information about what doctors and hospitals are available.

Quoted Text

Anthem Blue Cross faces another suit over Obamacare doctor networks
Anthem Blue Cross face more narrow network complaints
Anthem Blue Cross, the leading health insurer by enrollment in the Covered California exchange, is facing more complaints about its narrow physician networks. (David McNew / Getty Images)
By CHAD TERHUNE contact the reporter

Anthem Blue Cross faces more litigation over narrow networks in Obamacare coverage
California is investigating Anthem Blue Cross, Blue Shield of California over their medical provider lists
Amid growing scrutiny statewide, insurance giant Anthem Blue Cross faces another consumer lawsuit over its use of narrow networks in Obamacare coverage.

A group of Anthem policyholders sued California's largest for-profit health insurer Tuesday in state court, accusing the company of misrepresenting the size of its physician networks and the insurance benefits provided.

A similar suit seeking class-action status was filed June 20 against Anthem, a unit of WellPoint Inc., The Times has reported.

Confusion over doctor lists is costly for Obamacare enrollees in state
Confusion over doctor lists is costly for Obamacare enrollees in state
Chad Terhune
Samantha Cowart of Fallbrook sued Anthem in Los Angeles County Superior Court last month, accusing the company of misleading customers. Like nearly 1 million Californians, Cowart had a policy that was canceled last fall because it didn't comply with requirements of the Affordable Care Act.

To ease her transition, Anthem enrolled her in an exclusive provider organization plan that limited her access to out-of-network care even more than the PPO plan she had for 16 years. But Anthem sent her an insurance card in February labeling her coverage as a PPO.

As a result, Cowart said, she incurred several thousand dollars in medical bills that Anthem wouldn't cover.

“I didn’t have the regular PPO I thought I had,” Cowart said. “It was a bait and switch.”

In response to the two lawsuits, Anthem said "materials at the time of enrollment and in members' explanation of benefits have clearly stated that the plan was an EPO plan which may not have out of network benefits."


The company added that Blue Cross Blue Shield Assn. rules required the PPO designation on EPO member cards because coverage for emergencies is available in other states. Anthem said it later received a waiver from the rule and it issued new ID cards to clear up any confusion.

Separately, California regulators are investigating whether Anthem and Blue Shield of California violated state law in connection with inaccurate provider lists and making it difficult for patients to obtain timely care.

To hold down premiums under the health law, Anthem and Blue Shield cut the number of doctors and hospitals available to patients in the state's new health insurance market.

cComments
that should read, "...I am NOW having to deal with my family not having doctors..." Also, here are more details about what they really did: http://www.consumerwatchdog.org/tags/anthem-blue-cross
KATHLEEN89
AT 5:30 PM JULY 10, 2014
ADD A COMMENTSEE ALL COMMENTS     
19

Both companies have acknowledged that mistakes have been made with respect to their networks and some confusion was inevitable during such a massive overhaul. The two insurers say they have contacted doctors repeatedly to confirm their network status, and they have both added more providers since January.

In a speech last month in Los Angeles, Anthem Blue Cross President Mark Morgan said the level of consumer complaints remains fairly low considering the overall enrollment under the Affordable Care Act.

Anthem led the state with about 425,000 people enrolled through Covered California, the state's health insurance exchange.

“Mind you even one complaint is one too many," Morgan said in his speech last month. "I’m not comfortable with anything above zero. But in the grand scheme of things with all the changes that have occurred we feel good.”

Similar allegations have been lodged against rival Blue Shield of California as well.


In May, two San Francisco residents sued Blue Shield in state court, accusing the company of misrepresenting that their policies would cover the full network.

A Blue Shield spokesman declined to comment on that case but said, "We believe enrollees should be as informed as possible about the products they select."

These exclusive-provider organization, or EPO, health plans have been particularly troublesome for some consumers who were accustomed to having more conventional preferred-provider organization, or PPO, policies.

One of the major differences is that patients with an EPO plan typically have little or no coverage if they see an out-of-network medical provider and they are often responsible for the full charges.

A PPO plan is typically more generous and provides some coverage for out-of-network care.

Many Californians say those differences in cost sharing weren't disclosed fully and that ongoing problems with the accuracy of insurance company provider lists have made it difficult to determine whether a doctor or medical practice is part of a network.

As a result, some policyholders have incurred large, unforeseen medical bills that they thought would be covered under their new health insurance.

Peter Lee, executive director of the Covered California exchange, has said the state agency is taking a hard look at EPO plans as part of its negotiations with insurers for 2015 rates and coverage.

In particular, exchange officials say they want to avoid consumers being surprised after seeking treatment.

"EPOs will continue to play a role," said exchange spokeswoman Anne Gonzales. "But we're going to have to do a better job educating people about how these networks work. We recognize the EPO model can be confusing."

Covered California is expected to announce details about next year's health plans, networks and rates later this month.

Some supporters of the Affordable Care Act say the smaller size of the provider networks isn't the problem so much as clear information about what doctors and hospitals are available.

“The problem has been the transparency and reliability of the networks," said Micah Weinberg, a health-policy analyst at the Bay Area Council, an employer-backed group.

"That's the problem that we need to fix. If we focus on narrowness we will be focusing on the wrong thing," Weinberg added.