ObamaCare Clusterfuck: Warning from Colorado: "[I]t is the responsibility of the patient (not the doctor) to check on the network status of their provider"
Just what you want to think about in an emergency, right? Whether your provider is in- or out-of-network! And yet your decision, sick in the back of an ambulance, could bankrupt you! There's a good deal of controlled but justified anger in this LTE from Judee Cathrall, in Dillon, Colorado:
Obamacare is a good thing — but not for all Summit County residents. Those lucky enough to have a grandfathered health plan and those on Medicare and Medicaid are in excellent shape. But those whose employers switched into an HMO plan, and those seeking insurance on the Colorado exchange or directly from an insurance company, are at a disadvantage.
The large deductible and out-of-pocket expense may or may not be a deterrent for those who consider themselves healthy. However, the fact that St. Anthony Summit Medical Center (Summit County’s only hospital) is not a provider on any of Anthem HMO policies, including the most expensive Gold plans, is a major concern. All Colorado Exchange policies and all new Anthem Colorado offerings outside the exchange are now HMO policies.
In an emergency, an ambulance, the ER and subsequent admission would be covered [but could be balance billed!] since under the new law ambulance service is required to deliver a patient to the nearest ER. The plans work if the ambulance/ER is considered an emergency and not just a “convenience.”
However, if your hospital stay is not an emergency, all bets are off. While most Summit County primary care providers have signed up for the HMOs, their admitting privileges would likely be to St. Anthony Summit. That non-emergency stay (for whatever reason) would not be covered in our non-network hospital.
Also, if you are going to have a baby, your local hospital of choice is not in the network. Want to have your baby in Vail (so that you will be covered)? Make sure your obstetrician has admitting privileges there.
If you need tests — MRI, CT, x-ray, lab work or out-patient surgery — expect to travel to Vail as St. Anthony Summit is, once again, out of network.
Why should a Summit County resident need to use a hospital in Vail, Kremmling or Leadville when our taxes subsidized the Summit medical center? Our county contributed free land and waived and reduced fees to bring the hospital here. Now, the hospital chooses not to provide services to all who live and work here. All other hospitals in the Centura system are in the network, but St. Anthony Summit is not. A non-emergency use of its services means that you will pay 100 percent of the cost — but that cost does not even count against your deductible or your out-of-pocket.
I bet there are county- and state-subsidized hospitals all over the country; perhaps even (say) in Chicago. It would be interesting to know how many taxpayers stumped up to keep hospitals in their counties, and then don't get to have the benefit of having the hospital they paid for in their network.
The situations I have presented — and the potential consequences — have been checked out with representatives from both the Colorado Exchange and Anthem. Both also advise that it is the responsibility of the patient (not the doctor) to check on the network status of their provider. 
More insanity from ObamaCare's model of "mandatory shopping." It's always good to shop! Even when you're giving birth in the back of an ambulance!
UPDATE  A Dromaius points out in comments, this is not new. Here again, my weakness as a poster is that I have virtually no experience either with the health care system or with purchasing insurance! However, it does seem to me that ObamaCare has added an additional layer of complexity, and also, by narrowing the networks, increased the risks for the patient, so that, at least, is new. In fact, the networks are now so borked that even the doctor might now, so if you hold on to your decision until you get unloaded from the back of the ambulance, you might not get the right answer anyhow.