I'm planning to sign up for an ACA health insurance plan for the first time.
My biggest concern is about involuntary use of out-of-network services. If I am ever in a situation where I am admitted to a hospital that is in-network, I could be subject to billing from any number of doctors who are out of network. (This is an issue for non-ACA plans as well, but it gets more severe with narrow networks and low/no out of network coverage.)
http://www.latimes.com/business/la-fi-healthcare-watch-20150717-story.htmlhttp://healthaffairs.org/blog/2015/11/03/a-tale-of-two-deliveries-or-an-out-of-network-problem/My other concern is about identifying doctors who are in network. Some doctors take "Insurer Name" but aren't in network for the lower-cost ACA plans. I'm not sure that I can sort through that in a non-emergency, but urgent situation.
I'm thinking of taking coverage from an HMO (Kaiser) to partially solve both of these problems. I don't like Kaiser, but at least I know that everyone in the Kaiser building is part of their plan.
Also, California has a law which prohibits emergency room balance billing when the patient is with an HMO. I'm not sure if the law applies to non-HMO coverage. I don't think it covers non-emergency hospital charges.
My questions:
1) Has anyone already sorted through this and gotten an answer?
2) For the HMO option, what happens if I have an emergency, go to the hospital and need extended care? I know that the emergency portion is covered wherever I go, but do I need to find my way to an in-network hospital afterwards?
3) Can I be confident that all of the doctors/services in the Kaiser building are part of Kaiser's bronze coverage network?