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New 'Obamacare' health plans may exclude major hospitals

By Catholic Online (NEWS CONSORTIUM)
December 9th, 2013
Catholic Online (www.catholic.org)

Limited access to some of the nation's leading hospitals, including two world-renowned cancer centers, await those who are signing up for Obamacare in the states of Texas, New York and California. Many of the new healthcare exchanges will not offer users the option of checking into Memorial Sloan Kettering in Manhattan or MD Anderson Cancer Center in Houston, two of the nation's top cancer centers, or Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals in the country.

LOS ANGELES, CA (Catholic online) - The move by insurers to limit consumers' choices and steer them away from hospitals that are considered too expensive, or even "inefficient," experts say, reflects the new competitive landscape of the insurance industry since the passage of Obama's 2010 healthcare law.

This is sure to stir up controversy in the new year. Frustrated consumers will begin to realize what is not always evident when buying a product as complicated as healthcare insurance: that their new plans do not cover many facilities or doctors "in network," i.e. facilities and doctors that are not among the list of approved providers.

Under some U.S. health insurance plans, consumers can elect to visit medical facilities that are "out of network" - but may incur out-of-pocket expenses.  In addition, those who go to the provider of their own choice will need referrals to prove that it is medically necessary.

"We're very concerned. [Insurers] know patients that are sick come to places like ours. What this is trying to do is redirect those patients elsewhere, but there is a reason why they come here. These patients need what it is that we are capable of providing," Thomas Priselac, president and chief executive officer of Cedars-Sinai Health System in California says.

One of the biggest goals of "Obamacare" was to make subsidized healthcare plans that are being sold on the new exchanges as affordable as possible, while also mandating that certain benefits, like maternity care, were covered and that people with pre-existing medical conditions could not be denied access.

"Everyone is in favor of competition until they see what it looks like. Then they think, maybe it's better for someone else just to pay for the whole thing," Tim Jost, a health policy expert says. In the face of the new changes, insurance companies have had to come up with new ways to cut the cost of their products.

"It's like buying a Mercedes-Benz or a Chevy. You have to decide whether you want to pay for the highest product out there, which is probably pretty good quality, or the less expensive product," Jost says.

These new regulatory restrictions, Jost says, limits the availability of certain facilities that are seen as too expensive - in part because they may attract the sickest patients or offer the most cutting edge medical care - is seen as the best way to control costs.

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