given it's a ppo model, you watch it. however, one of the things that is noted is that because of the low membership, you have a lot of variability in the rates from year to year. and that's why you see some variability between reporting periods. one of the things again drawing out . heche just to add to the discussion had no admits in the last 3/4. >> on slide it should be 65.2. >> yes. i'm sorry. there was an error. >> these are admissions into the er. if we move on to page 7. 9 days per thousand. this again is reflected of the small enrollment, but if you compare it to your other two health plans, you will notice that blue shield is at 169 and kaiser 185. so what does that mean? if you would set uhs is the baseline, you would find if they would make blue shield the baseline, you would expect them to be about 300 admits and kaiser about 280. they exceeded even if they are one. they are above and beyond what you would predict for utilization. now as far as the average, as you remember, uhs is a length of time of average

it's a ppo level plan that had everything. i wasn't missing anything. i was foet anied the letter suggested another plan would be forth coming that would be comparable. i could stay wut had to wait to see what they're going to ofrment a couple weeks letter that plan had in nut work benefits only instead of out of network and in network. so cutoff half of the ability to see people outside of the network there is an epo, epo never traditionally needed refersalss but the pathway network was going to be so much smaller than current network of doctors which meant everyone i currently went to, everyone my employees went to was no longer going to be participating in network only, which meant we can keep our doctor but would have to pay out of our own pocket not going to our deductible, increasing from 2,000ses today $2500. >> i'm going stop you there. a lot of people don't understand this ppo and epo terminology. you're a physician. impacted in terms of yourself and your patients. did you ever think when obamacare was passed this would happen? >> no. absolutel

some of the plans are accessing under the ppo contracts we didn't sign up with the exchange products. that may be where some of the numbers are coming from. that's not as broad as they are broadcasting. >> stick around. we will fix this. coming up has the mainstream media declared war on republican women? wait until you see what one research team discovered. >> up next new evidence that the white house may have a truth problem. kelly files hadoes a major abou face in a story about a member of president obama's own family right after this break. don't miss this. >> the white house said in 2011 there was no record of them ever meeting now the boston globe is being told by the white house how can you make that kind of a mistake? ♪ [ camera shutter clicks ] now, that's cardworthy. [ n ] all right. here we go. ♪ cardworthy. [ female announcer ] this holiday season, visit shutterfly.com for all your cardworthy moments. [ female announcer ] i'm bethand i'm michelle. and we own the paper cottage. it's a stationery and gifts store. anything we purchase for the paper cottage goes on our ink car

they have been able to find one that had that ppo. it may be a product of what state and exchange. they'll be the growing pains of obamacare. >> one of the other problems that has been arising. if the side is far from fixed, forms people are filling out, people are thinking they are enrolled when they are not. >> that's going to be a huge problem. the obama administration has been focussing on the first half of the website. the half that the consumer will see. like you said, you go and look at your plans, and send your application in. you think of the website, the second half being where the application goes from your computer to the insurance company. they know your name, social security number and whether they paid your premium. that half is not working as well as anyone hoped, the obama administration or the insurance companies. they are concerned that you, as the consumer will thing you have coverage, but if the information didn't get through, you are not covered. the administration are working on the problem, trying to get it repaired. they don't provide specifics in conferenc

and i was totally shocked by that, because it was a high ppo level plan. it was a comprehensive plan. it wasn't missing anything. when i was notified it was not going to be renewed, the letter suggested that another plan would be forthcoming, that would be comparable and i could stay within the same insurance carrier but i had to wait to see what they were going to offer. a couple weeks later, that letter came in describing the new plan which now had in network benefits only instead of both out of network and in network benefits, so it cut off half of my ability to see people outside of the network, and it was only in network requiring referrals which was very surprising. it was called an epo and epo level plans traditionally never needed referrals so this was another obstacle to happen. but the pathway network which was the new network of participating in network doctors was going to be so much smaller than my current network of doctors, which meant everyone that i currently went to, everyone that my employees went to, was no longer going to be participat

some plans, blue shield are access are under ppo contracts. that may be what some numbers are coming from.. >> we're going have another look. thank you. >> coming up, has main stream media declared war on republican women? what research team discovered this week. and up next, new evidence of the white house with a truth problem. the kelly file investigates a major about face of president obama's own family. right after the break. don't miss it. >> white house said in 2011 there is no record of them ever being there. that it's -- how do you make that mistake? ick with innovation. stick with power. stick with technology. get the new flexcare platinum from philips sonicare and save now. philips sonicare. so you can see like right here i can just... you know, check my policy here, add a car, ah speak to customer service, check on a claim...you know, all with the ah, tap of my geico app. oh, at's so cool. well, i would disagree with you but, ah, that would make me a liar. no dude, you're on the jumbotron! whoa. ah...yeah, pretty much walked into th

we can't have the exchanges offering such low rates for patients moving out of the ppo market. >> what will happen then for those californians who find themselves with no choice but to join a program under the exchange? >> well, we're dealing with what's called narrow networking. it's coming about because the physician is making a decision whether or not to participate, and by plans, only contracting with a smaller number of doctors for some of the exchange products. if you put enough people in those plans and you don't have enough doctors participating, you end up with a bottleneck, which means you're not doing what this was all about, improving access to care. >> last question for you. cover california claims they have over 60,000 unique physicians available under the cover california plans. do you buy that number? >> i really don't. and we've been trying here at california medical association to understand those numbers. i can tell you in my community, i can't find a specialist yet who is actually signed up with any of these contractors. some of the plans, for instance, blue shield,

blue shield are accessing us under ppo contracts when we didn't sign up with the exchange product. that may be where some of the numbers are coming from. it's not as broad as they are broadcasting. >> stick around. we'll fix this throat by the b block. coming up, has the main stream media declared war on republican women? wait until you see what onech t week. next, new evidence that the white house may have a truth problem. "the kelly file" investigates a major about-face in a story involving a member of president obama's own family. that's right after the break. don't misds this. >> the white house said in 2011, i believe, there was no record of them ever meeting. now the boston globe is being told by the white house -- and i assume you can elaborate. they lived together briefly when the president was in law school. how can you make that kind of mistake? [ male announcer ] research suggests cell health plays a key role throughout our lives. one a day men's 50+ is a complete multivitamin designed for men's health concerns as we age. with 7 antioxidants to support cell health. one a

--e to protect yourself from >> we're trying to be the zap those of the commercial mail ppos of thestry commercial real estate industry. >> it is 26 minutes past the hour but that is time -- that means it is time for on the markets. picture see that mixed there, all eyes and ears awaiting the feds decision to borrow. in the meantime, u.s. stocks down, commodities as well. we'll bring you all -- more on the markets in 30 minutes. more of "money moves," up next. ♪ them gois "money moves where we focus on innovative alternative as dutch investments. israel is a hot tech sought in tel aviv stock these changes motivated. the ceo of the exchange is stepping down. herpoke with her about tenure and the advice that she is giving to her successor. >> one of the things that i'm really proud of is that we became a market. it is not something that you , it is something that we should use to our drainage, fuly tell do is success the story of israel over and over again. >> speak to many technology company, many who offer audios in the u.s., or of ipos in the u.s. recently. if they do not think about l

montgomery county and the district working together, virginias wade wilson remained the same for the ppo-- virginia's minimum wage will remain the same for the future.ate of al foreseeable i would not be surprised if a lot of people see they can do better in maryland, and that would not help virginia out very much. >> innocent next step in a igher minimum wage, or in 2015. under the new governor. >> thank you. search -- theice fda revealing the truth about vitamins. >> adc pediatrician was sentenced today or downloading abc sevenwatching news at 5:00 p.m. on your side. pediatriciand.c. was sentenced for 18 months in prison today per child per zogby. >> his conviction cap the reporters away from the courthouse today. s 11sat in court here a people went to the stand to tell how this doctor had paid wendy thousand dollars for their mother's operation, or paid someone to read, or convinced a child that life was worth living. here he was about to be sends for downloading top or doug or feet. n outstanding doctor. you can call them at 3:00 in the morning and he is there. >> she is among the 11

ppó >>> welcome back. get ready to meet three little girls who share something unique.e identical triplets born ten days ago in california. their rare because multiples don't run in their family, and mom and dad didn't use fertility drugs, and the doctor says it's already looking ahead. >> going to considering, going to graduate from high school, bring home bad boys. >> well, the gang expected to go home in a few weeks. >> tonight i'm joining bill o'reilly on "mad as hell." at 8:00 p.m. eastern time. we'll answer e-mails. thank you for being here. now it's time to go over to shep. >> some bad luck have toes could be dead within days after they took aim at the wrong target. ahead, the hunt for the radioactive criminals. >> plus, hackers hit some of the world's most popular web sites, facebook, google, twitter, and there's word they've stolen millions of our passwords and user names. plus, did russian diplomats steal your tax dollars? by scamming the system to get medicaid benefits? there are brand new charges out today, and what until you hear what they're accused of buy

what the administration is saying is that we think we made a bad choice for the ppo options, and theyded away the deductibles. we actually think that you are better off than those that might have provided this. gerri: i want you to get me back to the idea that these computer systems are not completed. and then if you can get coverage, you may find out and sign up, and then you will get into the system and find that you don't have the kind of doctor that you need. ultimately, doctor, where it is going? what happens next? and how do we resolve these issues? >> there are a lot of consumers who think that they signed up for coverage and do not actually have it. it could be upwards of 30%. i am being told only about 10 to 15% have paid this premium. so the number that you are seeing on who has enrolled in the plants, large portion will not be enrolled, not only because they haven't signed up, but some of them just won't go through and pay their premiums. medicare is talking about doing a paper reconciliation, and so they have tens of thousands of pieces of paper, asking if you can reconcil

the belief here is the companies are going to veer away from the hmos and the ppos and veer toward highertibles and higher copays. eric, check this out. this means -- this is from a risk management survey company. it says that 40% of employers increased copays and deductibles in 2013. 47%. 43% of employers are considering increasing them in the next three to five years. those two numbers together, that's 90% of companies, which is why there was in 2013 a 13% increase of employees out of pocket costs in 2013, and they're expecting a 10% increase of employees out of pocket cost and 2014. the bottom line is that, as the companies start pulling some money back, you're going to have to contribute more, even if you're paying less for your plan, once you go to the hospital to actually use the plan, it doesn't kick in for a few thousand dollars. which is why you're paying more out of pocket. >> i learned two things. it's going to cost me for for healthcare going forward and number two you have really good hand writing. thank you so much. i. >> obamacare has a lot of vulnerable democrats feeling s

i just knew i took care of the apo and ppo levels. they take care of the hmo and pointed services but i didn't understand pathway. i went to their web site and i looked this up. what i saw was that actually these pathways were very restrict it. we have now an inability to refer patients as an ophthalmologist i will need a neurologist. if that neurologist is not enough network, going to give the patient with optic nerve at us and sudden loss of their site the ability to see a fine physician that i have sitting on my right? we have to fix this and that to fix this now. we have no time to play with this. patient's lives are at stake. acute care situations need a specific doctor to refer the patient too. it's not enough to send them to an emergency room and by the way many hospitals are not in these networks either. thank you so much for your time and i hope i can count on you to fix this. thank you. >> thank you. dr. novack. >> sure chairman and members the committee thank you for having me back again. when president obama made the case

epo plan was not going to have the same network of physicians that my current plan did, both epo and ppo have the same network. the hmo physician or a smaller, different network. so some doctors by the contract have the ability to be in one or the other network, but by some contracts they have to be in all products. so what happens now was there was this term about i needed to be careful as the administrator and i need to inform my employees that ended to check to be sure that all of their doctors that they currently sought in network. now, mind you, the saint insurance company makes it a bit difficult because you would assume if your doctor was in network before, why wouldn't your doctor be a network afterwards? but that is what the catch was. the new network was given a fancy name. it was called pathway with variations. pathway acts, pathway acts enhanced or simply pathway. i didn't understand that. i may purchase the position. i never pathway before. i just knew that i took care of the epo and ppo levels but i took care of the hmos and the point of services. but i didn't understand ha

it is basically the military's hmo and ppo. congress has kept expanding those benefits. there is good reason. but, health care costs are going up fast for all employers and not just the defense department. pension liabilities are a huge deal for all employers, not just the defense department. because of the politics, when the pentagon says, please allow us to raise the monthly fee on our insurance program, or, please allow us to reduce retirement benefits for people now coming in, there are very powerful lobbies and it has to historically hit a brick wall. in the budget deal that just passed, behind closed doors, away from these lobbying groups, there actually is some flexibility for the military to go after the health care costs and retiree benefits. some. host: in the budget deal in the defense authorization bill just passed this past week and debated on the house floor, the chairman of the armed services committee actually said in that debate that the full sequestration process was the biggest threat to national defense. here is some of what he had to say. guest: i sp

that is where you got the ppo's, because of the backlash.hmo's.ans really resemble let's go to lisa from kentucky. caller: hello? host: good morning. have been living with my significant other for the past 10 years. it is his home. during the course of the 10 years, i have been taking care of my elderly parents in north carolina. i have been watching the difference and how the health care laws have taken states in the different states. one governor is trying to cut everybody off. now i am stuck in a quandary. in 2008 and my mom last spring. my significant other has decided to end the relationship. i have to move back to north carolina to my sister's. housewife. a i heard you tell the lady from north carolina that i would -- i know i am not eligible for medicaid down there. i would not be eligible for subsidies. will i be stuck paying fines? guest: no. , youu don't earn enough will be exempted from the individual mandate penalty. you won't have to pay that. in north carolina, you will have trouble finding insurance unfortunately. host: south

ppo. -- expensive we have seen awareness around this issue from small and large employers. they say many times, i wasn't aware of this. we do get comments that are very incredulous that this would even be the case. terms of the additional confusion, there are myths around association plans. unless you have sticky notes within a group that is difficult to put unrelated or even fairly slosely related employer is together, the insurance group will still not group them together. part of that is the practical access to the insurance coverage, which the law, unfortunately, does not guarantee for the small employers. are there planning opportunities? yes. we see small employers trying to use those to avoid compliance with the law? not yet. i think part of the lack of awareness is a little bit of a reaction to the delays that have occurred. believe there have been delays and those delays will continue. for smaller businesses, there is a sentiment that the rules for the larger employers were delayed, which they were until 2015. however, for the smaller businesses they smell many of

they're now put into a very expensive ppo and they cannot afford it. it's $1,300 a month. so we have seen quite a bit of low awareness around this issue, even among not just small employers but large employers. they say many times, i wasn't aware of this, and we do get comments that are very incredulous that this would even be the case. in terms of the additional confusion, there are myths around association plans. unless you have stickiness within a group, it is difficult to put unrelated or even fairly closely related employers together. some insurance carriers will not write them even though they technically would be a control group for u.s. tax purposes. so keep that in mind. part of the problem is the practical access to the insurance coverage which the law, unfortunately, does not guarantee for the small employers. are there planning opportunities? yes. do we see smaller employers trying to use those to avoid compliance with the law? not yet. and i think part of the lack of awareness is also a little bit of a reaction to the delays that have occurred. the employers b

that is where you got the ppo's, because of the backlash.mo's.ans really resemble let's go to lisa from kentucky. caller: hello? host: good morning. have been living with my significant other for the past 10 years. it is his home. during the course of the 10 years, i have been taking care of my elderly parents in north carolina. i have been watching the difference and how the health care laws have taken states in the different states. one governor is trying to cut everybody off. now i am stuck in a quandary. in 2008 and my mom last spring. my significant other has decided to end the relationship. i have to move back to north carolina to my sister's. housewife. a i heard you tell the lady from north carolina that i would -- i know i am not eligible for medicaid down there. i would not be eligible for subsidies. will i be stuck paying fines? guest: no. , youu don't earn enough will be exempted from the individual mandate penalty. you won't have to pay that. in north carolina, you will have trouble finding insurance unfortunately. host: south c

it is basically the military's hmo and ppo. has kept expanding those benefits.ere is good reason. but, health care costs are going up fast for all employers and not just the defense department. are a hugebilities deal for all employers, not just the defense department. because of the politics, when the pentagon says, please allow us to raise the monthly fee on our insurance program, or, to reduceow us retirement benefits for people now coming in, there are very powerful lobbies and it has to store we hit a brick wall. juste budget deal that passed, behind closed doors, away from these lobbying groups, actually is some flexibility for the military to go after the health care costs and retiree benefits. some. in thehe budget deal defense authorization bill just passed this past week and debated on the house floor, the chairman of the armed services committee actually said in that debate that the full sequestration process was the biggest threat to national defense. here is some of what he had to say. >> i spoke with the chief of our army last week and he said, in

we cannot have the exchanges offering such low rates for patients who are moving out of the ppo marketthe individual market. if you put enough people in the plans and don't have enough doctors doing, you end up with a bottleneck. >> nothing the administration can do, bullied what, are they going to arrest doctors for not treating patients for $140 for a tonsilectomy? they can't control it. >> we'll talk to governor hu huckabee later in the show. and we remember those killed tragically at pearl harbor on the japanese surprise attack on pearl harbor. fdr called it day that will live in infamy, so how did spaghettios get involved? i don't know why they're getting involved in remembrances but decided to tweet out this picture yesterday and said, help us in remembering the day, honoring pearl harbor and sent out this picture of a spaghettio holding an american flag. >> so many killed and wounded and catapulted us into world war ii. >> wait a sec. i cannot get outraged about this. just because they're a there delicious pasta in a can company, doesn't mean they don't have a right to honor pea