NY Health Exchange
November 20, 2014 12:06 PM Subscribe
Looking for information on some of the NY Exchange Plans (NYC)
Last year, when I bought my plan from the Health Exchange, only one company (United Healthcare) had contracted with the hospital in NYC where most of my doctors are located and where I have my tests/labs/imaging done. This year, lots of plans include those same doctors, and all of the plans are less money than UHC. The ones my doctors will take in 2015 are Affinity, Oscar, and Empire. So,
Empire is pretty well known, but can anyone tell me anything about the other two that might influence my choice?
I know that some plans save money by having you go to inconvenient labs/imaging centers or get your prescriptions from a particular place, and I'll be calling both those companies to find out if that is the case. Can you think of other questions I can ask now to save myself aggravation later on?
TIA
Last year, when I bought my plan from the Health Exchange, only one company (United Healthcare) had contracted with the hospital in NYC where most of my doctors are located and where I have my tests/labs/imaging done. This year, lots of plans include those same doctors, and all of the plans are less money than UHC. The ones my doctors will take in 2015 are Affinity, Oscar, and Empire. So,
Empire is pretty well known, but can anyone tell me anything about the other two that might influence my choice?
I know that some plans save money by having you go to inconvenient labs/imaging centers or get your prescriptions from a particular place, and I'll be calling both those companies to find out if that is the case. Can you think of other questions I can ask now to save myself aggravation later on?
TIA
I would say to double check once you've narrowed down the plans which ones your doctor actually takes with a phone call to their office. I chose Emblem last year specifically because it was the only one besides United Healthcare that my doctor took according to both Emblem's information, and also (IIRC) according to my doctor's website.
Unfortunately it was inaccurate information and I had to find another orthopedic surgeon for the year.
I was not happy with Emblem overall. They called me several times and sent many emails asking me to rate their customer service and for random marketing, but when I tried a few times to set up automatic payments on their glitchy website, no one in their customer service could help me get it working.
I'm very absent minded, so of course my insurance got cancelled for non-payment. This also happened because the only way they notify you of late payments is via snail mail (which I seldom check) even though throughout the duration of your policy they are calling you and sending you emails for reasons other than your account status. I made the mistaken assumption that if my account were past due one of the many phone calls or emails I received what have let me know.
posted by newpotato at 2:09 PM on November 20, 2014
Unfortunately it was inaccurate information and I had to find another orthopedic surgeon for the year.
I was not happy with Emblem overall. They called me several times and sent many emails asking me to rate their customer service and for random marketing, but when I tried a few times to set up automatic payments on their glitchy website, no one in their customer service could help me get it working.
I'm very absent minded, so of course my insurance got cancelled for non-payment. This also happened because the only way they notify you of late payments is via snail mail (which I seldom check) even though throughout the duration of your policy they are calling you and sending you emails for reasons other than your account status. I made the mistaken assumption that if my account were past due one of the many phone calls or emails I received what have let me know.
posted by newpotato at 2:09 PM on November 20, 2014
Best answer: Ooh I love talking about NY health insurance... :) Check out my question from last year: NY Health Exchange Plan: Oscar, Health Republic, Metroplus. Help please?
It didn't get too many responses - there just wasn't much known and I think it's a pretty limited pool of us Mefites who are in the market for it, so I'm not surprised you haven't gotten too many responses here.
One question for you: are you sure your doctor isn't in Health Republic? My understanding is that both HR and Oscar use the same basic Magnacare network, so it would be surprising if a doc were in one but not the other. Or maybe you've ruled out HR for some other reason?
I ended up choosing HR and I've overall been happy with it and will stick with it for next year.. (Like in your case, my gyn, whom I was sad to give up last year because she was only in-network on United and I couldn't justify the extra expense) is now in-network for HR too, so that's great for me. So far no unhappy surprises with labs.
I think HR's network is somewhat larger than Oscar's actually. Beyond that, these are the reasons I did and would choose HR over Oscar:
- HR is a not-for-profit cooperative (I believe woman-headed) versus a venture funded for-profit company with all the top leadership roles dominated by men (this is based on articles I remember from last year);
- Oscar's website is extremely opaque on what it offers and its provider network. If anything I think it's less informative than it was last year, which makes me think they haven't been able to follow through on some of their promises about transparency and digitization of access to healthcare and health information, which was a big part of their 'platform.';
- HR's plans generally have a lower total out of pocket max (12 months of deductibles + max out of pocket limit)
- HR's gold and platinum plans have no co-pay for mental health outpatient visits (i.e. therapy and psychiatry).
I'm really pleased with HR's expanding network. They also added free access to Statcare, ER doctors on call via the phone or a smartphone app, which I ended up using twice this year and which was great. Statcare MDs can actually give you prescriptions and everything. I am just waiting to see what HR's negotiated rate with the one specialist I've been to so far is - for my PCP it looks like it was only $40 (I pay $0 for pcp visits). If it's comparably low for the specialist I consulted, I'm thinking of moving from the PrimarySelect Gold Plan to the Total Independence Gold Plan, which actually has both a significantly lower premium and a lower total OOP max than the Platinum plan. (But it has a much higher deductible before it covers anything at all).
Anyway, I could go on and on. I'm happy to talk more (over memail or e-mail) or to share last year's spreadsheet with you if you want (see last year's question).
My advice basically is: verify if your doctor might take HR, and then I recommend HR. If not, then I think I would go with Oscar just because I believe it's the only one of the three that you mentioned where you don't need a referral to a specialist, if that matters to you, but do double check that their in-network hospitals are comparable to Affinity and Empire (that's a main reason why I didn't end up with MetroPlus last year despite their significantly cheaper costs).
If the Empire plan you're looking at is one of the ones that gives you access to the Freelancers Union Medical Clinics, and you're geographically close to one of them, I can't recommend them strongly enough. While I briefly had access, they were like a dream of health care services. I'm not sure whether by themselves they are worth the higher costs/lower flexibility of the Empire Plans, but if you're leaning that way anyway it could be a major pro.
For your last question - questions to ask, I think I would explore:
1) whether you need a referral to a specialist, and consider how much that would cost you in time and visits to your PCP
2) which hospitals are in network, in addition to which doctors
3) if they give you some kind of free telephone or smartphone access to doctors who can advise you and prescribe for you
Good luck! I would love to see an update with what you end up deciding and why - both for myself and because I think there's really not enough information and reflection out there.
posted by Salamandrous at 11:05 AM on November 21, 2014 [1 favorite]
It didn't get too many responses - there just wasn't much known and I think it's a pretty limited pool of us Mefites who are in the market for it, so I'm not surprised you haven't gotten too many responses here.
One question for you: are you sure your doctor isn't in Health Republic? My understanding is that both HR and Oscar use the same basic Magnacare network, so it would be surprising if a doc were in one but not the other. Or maybe you've ruled out HR for some other reason?
I ended up choosing HR and I've overall been happy with it and will stick with it for next year.. (Like in your case, my gyn, whom I was sad to give up last year because she was only in-network on United and I couldn't justify the extra expense) is now in-network for HR too, so that's great for me. So far no unhappy surprises with labs.
I think HR's network is somewhat larger than Oscar's actually. Beyond that, these are the reasons I did and would choose HR over Oscar:
- HR is a not-for-profit cooperative (I believe woman-headed) versus a venture funded for-profit company with all the top leadership roles dominated by men (this is based on articles I remember from last year);
- Oscar's website is extremely opaque on what it offers and its provider network. If anything I think it's less informative than it was last year, which makes me think they haven't been able to follow through on some of their promises about transparency and digitization of access to healthcare and health information, which was a big part of their 'platform.';
- HR's plans generally have a lower total out of pocket max (12 months of deductibles + max out of pocket limit)
- HR's gold and platinum plans have no co-pay for mental health outpatient visits (i.e. therapy and psychiatry).
I'm really pleased with HR's expanding network. They also added free access to Statcare, ER doctors on call via the phone or a smartphone app, which I ended up using twice this year and which was great. Statcare MDs can actually give you prescriptions and everything. I am just waiting to see what HR's negotiated rate with the one specialist I've been to so far is - for my PCP it looks like it was only $40 (I pay $0 for pcp visits). If it's comparably low for the specialist I consulted, I'm thinking of moving from the PrimarySelect Gold Plan to the Total Independence Gold Plan, which actually has both a significantly lower premium and a lower total OOP max than the Platinum plan. (But it has a much higher deductible before it covers anything at all).
Anyway, I could go on and on. I'm happy to talk more (over memail or e-mail) or to share last year's spreadsheet with you if you want (see last year's question).
My advice basically is: verify if your doctor might take HR, and then I recommend HR. If not, then I think I would go with Oscar just because I believe it's the only one of the three that you mentioned where you don't need a referral to a specialist, if that matters to you, but do double check that their in-network hospitals are comparable to Affinity and Empire (that's a main reason why I didn't end up with MetroPlus last year despite their significantly cheaper costs).
If the Empire plan you're looking at is one of the ones that gives you access to the Freelancers Union Medical Clinics, and you're geographically close to one of them, I can't recommend them strongly enough. While I briefly had access, they were like a dream of health care services. I'm not sure whether by themselves they are worth the higher costs/lower flexibility of the Empire Plans, but if you're leaning that way anyway it could be a major pro.
For your last question - questions to ask, I think I would explore:
1) whether you need a referral to a specialist, and consider how much that would cost you in time and visits to your PCP
2) which hospitals are in network, in addition to which doctors
3) if they give you some kind of free telephone or smartphone access to doctors who can advise you and prescribe for you
Good luck! I would love to see an update with what you end up deciding and why - both for myself and because I think there's really not enough information and reflection out there.
posted by Salamandrous at 11:05 AM on November 21, 2014 [1 favorite]
Response by poster: Thanks for the update, Salamandrous. I did see your question and was hoping there would be more responses this time now that people have been on the exchanges for a year. You make a good point that MeFi may not have so many people on the exchange.
I will definitely check HR as I like the idea of a non-profit with the added bonus of woman-led. I'm not sure why they didn't show up on my radar the first time, so I'm glad you mentioned it.
As to the other features, I do like the not having to get pre-approval for specialists. I've been seeing my same doctors for years, yet I spent a ridiculous amount of time getting my PCP to use UHC's system to get me in for my annual appointments. Talk about a waste of time.
Thanks again for your thoughtful response. I'll be incorporating your questions into my phone calls to the different insurance companies.
posted by AMyNameIs at 1:52 PM on November 22, 2014
I will definitely check HR as I like the idea of a non-profit with the added bonus of woman-led. I'm not sure why they didn't show up on my radar the first time, so I'm glad you mentioned it.
As to the other features, I do like the not having to get pre-approval for specialists. I've been seeing my same doctors for years, yet I spent a ridiculous amount of time getting my PCP to use UHC's system to get me in for my annual appointments. Talk about a waste of time.
Thanks again for your thoughtful response. I'll be incorporating your questions into my phone calls to the different insurance companies.
posted by AMyNameIs at 1:52 PM on November 22, 2014
This thread is closed to new comments.
While the coverage was good (with dental & vision, something no other plan was offering at that level), their customer service reps were woefully under-trained, and each time I called about the same question I received a different answer, was put on hold indefinitely, was passed around like a hot potato through different departments, etc.
Also check out what member services are available through their online portal - MetroPlus basically didn't have one, so basic things like checking your claims status or paying online weren't possible.
posted by war wrath of wraith at 2:07 PM on November 20, 2014