Health insurance that restricts employees from receiving care outside of employer owned ho

[floatRN]

I work for a hospital that is part of a large and growing healthcare system consisting of multiple hospitals. Currently, employees have health insurance through a large national health insurance company. We have coverage for any care provided by hospitals within the insurance company's network. We do get a smaller copay if we stay within our healthcare system.

Starting in 2019, we will only be covered for care if we stay in a new "custom network." This new network consists of only our healthcare system as well as just a few other hospitals. Three very large nearby hospitals and many smaller community hospitals will not be covered except for life threatening emergencies.

I think this is unfair to employees. It also seems very convenient that the uncovered hospitals are our biggest competitors.

Does anyone else's employer do this?

[Libby1987]

My current employer offers near zero OOP healthcare insurance if care is received within its own system. That's not fair compared to what? To my former much smaller company that had such high premiums and huge deductible without office and prescription coverage that the non licensed staff literally could not afford to use it or seek healthcare? Not fair compared to the tens of millions without coverage or inadequate coverage?

This is not a fairness issue. Hearing an educated professional claim it's not fair is worrisome not only because it's better insurance than many have but also due to the free choice of employers one has as well as the giant screaming elephant of healthcare access being tied to employment. That's what is unfair and the Haves continue to support this long held societal norm.

[sammi2006, ADN, BSN, RN]

My employer is also starting to do the same thing starting in 2019. In an ideal world it would be great. But we don't live in an ideal world. Espcially if you live in a rural community that already has a shortage of specialists. I agree that it is very unfair. I recently underwent treatment for cancer, most of that treatment out of town because of a lack of specialists, and starting next year my insurance will not cover visits with those providers.

[Accolay]

That used to work great until Obamacare all but eliminated catastrophic coverage. I had a great plan, low premiums, covered the basics and a doable out of pocket maximum. Until I got a letter saying the plan was going away. I looked for a reasonably-priced catastrophic plan on the ACA exchange. Didn't exist.

I think this has been covered before, ad nauseum. They got rid of those plans because they didn't cover up to the standard before the ACA, despite the low payments.

**Accolay Steps onto Soapbox**

Having no insurance also works well for lots of people too... until they get sick or hurt. Thankfully the fine is going away in 2019, so I wonder how many more people we'll see in hospital without insurance next year?

The US stands almost alone compared to the rest of the developed nations. We have the most expensive health care in the world, and we rank the lowest among developed nations including infant mortality. We rank 37th overall. Are there any Americans or medical professionals around here that this bothers?

Don't get me wrong, the ACA is weak and expensive. but if we had an administration that cared and if the GOP wasn't vying for it's destruction I think the richest nation on Earth could probably get it fixed. Where's that old American exceptionalism I always hear about? Or we can go back to what was there before the ACA. Anyone still remember how bad that sucked? Vote!

[Kooky Korky, BSN, RN]

Be glad you have coverage at all. I work PRN and DH is self employed. In my state, there are only 2 options for private insurance for owners of small businesses. We got a letter yesterday that stated that our monthly premium will rise from $2700 per month to $3850 per month.

That's right, people. I said PER MONTH. For a family that didn't meet our deductible, had no surgeries or expensive treatments.

We are lucky that DH can pay this, though I am DISGUSTED by it. But I want to know how in the hell most small business owners can possibly afford health insurance in a country where it is tied to employment. This is a broken system, people.

What is the cure?

[Phisha]

Yes. I agree w/ original poster. This is my current situation. I work for a major health insurer. I am forced to use their coverage. I had a HELL of an experience with a previous employer who I had forgotten that I received care from in the past. Despite HIPAA, the ENTIRE hospital staff with the exception of 1 doctor who personally took me to the side and expressed how strongly he disagreed with the unethical behavior....well, I was bullied with unrelenting sadism. One of the hardest things I've ever done in my life, but that job paved my career in healthcare. I sought a lawyer, only to find out that the company would only get a fine that is the equivalent of peanuts. I had a friend who was also abused in the same way by the same company at a location in the next county. It's so painful, but ever since, any employer that does not give me the option to seek treatment in a way that colleagues would be able to have access to my medical info....I just pay out of pocket and it's sooooo stressful! I have health issues right now that have reached a crisis point and I am deathly afraid to seek help for the problems through my health coverage, but since it's impacting my work performance I am going to have to do it. I shouldn't have to worry about this....HIPAA law is flawed and we need politicians who will look at this. Employers should have to suck up the extra cost to allow employees to seek TRULY confidential treatment!!! Ugh! Don't even get me started on this topic!

[Phisha]

VOTE! And keep track of what your representatives are doing AFTER voting and don't be afraid to call their offices. They do respond! It takes time and effort but our country and health system are in crisis! Can't tell you how many jobs in healthcare I've worked WITHOUT insurance! It's sick!

[BedsideNurse]

Thank God I have insurance through my husband because I see people I work with having to see some of the same physicians that come into the unit to see our patients. Who in the world wants to get a colonoscopy from someone you see 1-2-3x a week at work? One nurse who had to get a lump removed from her breast ended up recovering after hours in our unit. OMG. Unfortunately with the insurance offered at the hospital it's pretty much unaffordable to go any other route, and there is NO privacy. Just horrible!

[Horseshoe, BSN, RN]

Thank God I have insurance through my husband because I see people I work with having to see some of the same physicians that come into the unit to see our patients. Who in the world wants to get a colonoscopy from someone you see 1-2-3x a week at work?

I worked for years at an endoscopy center. Most of the employees had their colonoscopies done there. When I asked why, they said because by working with these physicians, they knew for a fact which ones they could trust the most, and knew that we would all take really good care of them. And that was true.

Nevertheless, when my turn came, I went elsewhere. I just didn't want people I worked with every day seeing me in that vulnerable position, even though I know they provide great care. Different strokes.

[gonzo1, ASN, RN]

And we were just notified this week that our hospital is starting this in 2019, along with changing to a different insurance company. If you use an approved provider within the hospital group you will pay less.

I worked at a hospital 15 years ago that did this, but hadn't encountered it since.

One cool thing. We will now get telemedicine for free instead of 40 $. I'm good with this. We don't have to go to the hospital we work at (I don't want them to see me naked) but there's a lot of other hospitals within our umbrella.

[chocoholic999]

What I want:

1. work in the best facility possible

2. receive care in the best facility possible

so yes, I would be fine with receiving care from my employing organization.

My experience has been that when your employer CANT provide the service (doesn't offer peds, say, or neurosurgery) they will pay full-reimbursement rates to out-of-network providers