Anonymous wrote:

Anonymous wrote:The whole point of that plan is to leverage Inova's local presence for maximum benefit. You don't buy that kind of plan to go out of network. It's like being mad that your car can't cross a lake.

But what happens if you need a specialist that isn't in Inova network?

People don't understand that many customers buying Obamacare exchange plans are left high and dry if they develop a condition that requires a specialist, and there's no in-network option.
http://khn.org/morning-breakout/in-network-access-to-specialists-not-always-available-on-some-obamacare-plans-study-finds/

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What's the in network deductible?

I thought the point of PPO plans was you had to stay in network. Our PPO has a really high out if network deductible as well. We have to pay cash for our child's psychiatrist and psychologist, neither of whom take insurance at all.

+1. Complaining that a PPO has poor out-of-network benefits is like complaining that you have pay out of pocket if you go outside your network on an HMO. It reflects a fundamental misunderstanding of insurance programs that has nothing to do with Obamacare.

The point is that they are saying they are a PPO with out-of-network benefits, but the deductible is so sky-high that you're "encouraged" to stay in-network. The problem comes about when they don't have a specialist and you are forced out of network.

I think we're still waiting for OP to come back and show us where it says they don't have anyone in-network in a particular specialty. Even if it's the case, though, typically PPOs will have an appeals process by which you may be able to get coverage for out-of-network providers at the in-network rate if they truly have no specialists available in-network that could treat the insured.

Anonymous wrote:The whole point of that plan is to leverage Inova's local presence for maximum benefit. You don't buy that kind of plan to go out of network. It's like being mad that your car can't cross a lake.

But what happens if you need a specialist that isn't in Inova network?

Anonymous wrote:

Anonymous wrote:The whole point of that plan is to leverage Inova's local presence for maximum benefit. You don't buy that kind of plan to go out of network. It's like being mad that your car can't cross a lake.

lol, this. The person who started this thread is stupid. You don't look at an out of network deductible for a plan like this. Duh.

You are the stupid one. (I can't believe the way people who don't understand the shortcomings of Obamacare throw insults around.) The problem is there are real failings with Obamacare. They have limited in-network providers, and customers are not really fully insured because THEY DO NOT HAVE ALL SPECIALISTS IN NETWORK. It makes it appear that as long as you stay in-network, you'll be fine, but you don't always have that option.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What's the in network deductible?

I thought the point of PPO plans was you had to stay in network. Our PPO has a really high out if network deductible as well. We have to pay cash for our child's psychiatrist and psychologist, neither of whom take insurance at all.

+1. Complaining that a PPO has poor out-of-network benefits is like complaining that you have pay out of pocket if you go outside your network on an HMO. It reflects a fundamental misunderstanding of insurance programs that has nothing to do with Obamacare.

Wait, the OP is complaining about out-of-network costs? Health insurance 101 may be in order.

You need a class yourself. That's all fine and good if the in-network providers are adequate, but when they're missing a specialty, they are forcing their customers out of network - and essentially saving themselves a ton of money.

Anonymous wrote:

Anonymous wrote:What's the in network deductible?

I thought the point of PPO plans was you had to stay in network. Our PPO has a really high out if network deductible as well. We have to pay cash for our child's psychiatrist and psychologist, neither of whom take insurance at all.

+1. Complaining that a PPO has poor out-of-network benefits is like complaining that you have pay out of pocket if you go outside your network on an HMO. It reflects a fundamental misunderstanding of insurance programs that has nothing to do with Obamacare.

The point is that they are saying they are a PPO with out-of-network benefits, but the deductible is so sky-high that you're "encouraged" to stay in-network. The problem comes about when they don't have a specialist and you are forced out of network.

Anonymous wrote:

Anonymous wrote:What's the in network deductible?

I thought the point of PPO plans was you had to stay in network. Our PPO has a really high out if network deductible as well. We have to pay cash for our child's psychiatrist and psychologist, neither of whom take insurance at all.

+1. Complaining that a PPO has poor out-of-network benefits is like complaining that you have pay out of pocket if you go outside your network on an HMO. It reflects a fundamental misunderstanding of insurance programs that has nothing to do with Obamacare.

Wait, the OP is complaining about out-of-network costs? Health insurance 101 may be in order.

Anonymous wrote:The whole point of that plan is to leverage Inova's local presence for maximum benefit. You don't buy that kind of plan to go out of network. It's like being mad that your car can't cross a lake.

lol, this. The person who started this thread is stupid. You don't look at an out of network deductible for a plan like this. Duh.

The whole point of that plan is to leverage Inova's local presence for maximum benefit. You don't buy that kind of plan to go out of network. It's like being mad that your car can't cross a lake.

Anonymous wrote:What's the in network deductible?

I thought the point of PPO plans was you had to stay in network. Our PPO has a really high out if network deductible as well. We have to pay cash for our child's psychiatrist and psychologist, neither of whom take insurance at all.

+1. Complaining that a PPO has poor out-of-network benefits is like complaining that you have pay out of pocket if you go outside your network on an HMO. It reflects a fundamental misunderstanding of insurance programs that has nothing to do with Obamacare.

Anonymous wrote:OMG, it's going from bad to worse. One of the so-called "affordable" exchange plans is promoting itself as a PPO - with out of network benefits. Drill down, and you'll see they'll pay for 50% of out of network benefits only after you have met a separate deductible of $20,000! And that's for an individual - a family has a deductible of $40,000. Plus, they admit that they do not necessarily have every specialty in network, and you could be forced out-of-network. At the same time, a low-income person gets their insurance free, no premiums.....no deductible.....no co-pays. This entire legislation is a travesty - and seems to have been designed to demolish the middle class.

Seriously , Ive only talked about this Travesty the last 2 years. I'm not in DC. It's been this way the whole time for other parts of the Country.
Yes, Obumma designed it to demolish the middle class. What took you so long to come to the realization is the scary part. It's part of the reparations that Blacks have been talking about for so long. Ass wipe HRC is pushing ACA hard to maintain freebies for the Blacks and Latinos. It will get much worse under her administration before it gets better. All us Middle Class will end up in Bankruptcy at some point, making the elite all the more powerful. You can't fault Romney for telling the truth. We've reached the tipping point where more people receive Freebies in the electorate. They will continue to vote for Candidates that maintain Freebies.

The best we can hope for is that Trump wins, dies from a stroke and Ivanka takes over, LOL

#NeverHillary

Anonymous wrote:

Anonymous wrote:Which plan, specifically?

Check out Innovation Health, in Virginia. Depending on the metal level, the "main" deductible (for in-network) varies, up to the $7000 max OOP. But if you look at the other column, for out-of-network benefits, it shows $20,000 ind/$40,000 family.

Innovation Health is an INOVA/Aetna partnership. It's practically an HMO, so obviously out of network costs are going to be extremely high.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

No one is paying that, dear.

Why do trolls think people will buy their lies? We're not Russians, we don't fall for this sort of propaganda like you all do.

Of course it's true. Calling me a troll doesn't change the facts.

Please provide proof.

Since you said "please," I'll do it. (It shows 2016..... Couldn't find a 2017 chart, but trust me when I say prices haven't gone down!) Go down to fourth row for the $20k individual deductible....$40k fsmily is a few lines lower. And THIS is what Obama calls affordable care?
https://ih.innovation-health.com/Global/FileLib/Consumer_Business/CS07679_final_highres.pdf

Is this coverage offered through the Marketplace pursuant to the ACA? If it is, don't go with crappy, expensive coverage provided by Aetna. The Marketplace options available to us through BCBS are quite good, with reasonable annual premium increases the past two years.

This isn't just the exchange. I think I know what plan you are referring to and I think that's the plan centered around the Inova system. It's a good health system, but you are right that the out of network benefit isn't good.

That said, I think that's the same plan that Inova employees have.

Anonymous wrote:OMG, it's going from bad to worse. One of the so-called "affordable" exchange plans is promoting itself as a PPO - with out of network benefits. Drill down, and you'll see they'll pay for 50% of out of network benefits only after you have met a separate deductible of $20,000! And that's for an individual - a family has a deductible of $40,000. Plus, they admit that they do not necessarily have every specialty in network, and you could be forced out-of-network. At the same time, a low-income person gets their insurance free, no premiums.....no deductible.....no co-pays. This entire legislation is a travesty - and seems to have been designed to demolish the middle class.

Where does it say that they don't have every specialist in Network?