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At least they told you something. Oxford just included an "important notice" form letter that my plan was cancelled and would be converted into an ACA compliant plan on my 2014 Renewal Date (which they did not specify). The only thing they told me about the new plan was "80% coinsurance; $1,500 deductible." (Note that even this tiny bit of information was wrong--it is actually 20% coinsurance.)

It was entirely up to me to research what they were actually doing.

The limited networks are a problem, but they're not a new issue. I had a similar thing happen to me several years ago, but the other way round: my NY-based coverage (offered through work, major national company) dropped all of NJ from its network -- and told me so by sending me a "Congratulations! We're expanding your coverage throughout NY State" letter that hid the "By the way you can't see any of your doctors again" in small type at the bottom.

It would be nice to at least have a network size ranking/rating system of some kind to help when comparing plans. It would be even nicer if anyone made an effort to fix the problem instead of just trying to repeal healthcare reform entirely for the 500th time...

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No. These limitations apply to ALL levels of plans offered by the major companies, except for AmeriHealth National Access plans.

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That's what I have been thinking.

However, in the event of a catastrophe,I would like the option of going to Memorial Sloan Kettering or Columbia-Presbyterian, and of seeing the best specialists in NYC.

There is only insurance company (and one bronze plan) in the entire state that would allow me to use these hospitals. Ironically, it's a local (NJ and Pa. only) company. None of the national or regional providers provides this coverage. That's pretty scary.

Bronze plan?

It is typical for the Bronze plans to have a very limited network. I have read of people who sign up and find the closest doctor is miles away and has very long wait times.


You could just get the highest deductible plan available for your age / sex, using the insurance basically as a catastrophic care plan only.

For your regular medical checkups and coverage, a concierge plan might work. They have been becoming more popular recently.

http://www.forbes.com/sites/paulhsieh ... e-correct-choice-for-you/

In response to this frustrating situation, more doctors are seeking an alternative practice model. They are establishing ?concierge? or ?direct pay? practices, where patients pay a monthly or annual fee for enhanced services, including same day appointments, 24/7 access to their doctor, e-mail consultations, and longer appointment times. Instead of the usual rushed 10-15 minute appointments, these doctors typically offer 45-60 minute visits allowing them to really delve into their patients? problems and craft individualized treatment and prevention plans.

Based on my research, it is becoming quite difficult for a New Jersey resident to buy private health insurance that would cover the cost of non-emergency care in any of the elite New York City hospitals.

For the second year in a row, my health insurance company (Oxford/United Healthcare) has cancelled my individual plan.

Last time, the new plan raised the deductible for out-of-network care to $5,000. This time, they completely eliminated ALL coverage for out-of-network care. In addition, all of their plans now require referrals from an in-network primary care physician to see any specialists.

At the same time, they have restricted the network to include only New Jersey physicians and hospitals, effectively cutting NJ patients off from access to the pre-eminent medical care available in NYC.

It appears that only one company--Amerihealth New Jersey--offers any non-emergency access to out of state hospitals through their National Access plans.


Please note: As far as I know, there is nothing in the Affordable Care Act that requires these limitations. No doubt, our resident Republicans will use this as another Obamacare-bashing opportunity, but I think insurance companies are taking advantage of the law's implementation to accelerate cut backs they would have made anyway.