Bottom line: Physicians and
healthcare systems have to make money to stay open (just like any other
business), and Obamacare is a looser with its low reimbursement rates. I find it
interesting that USA today will never call the Affordable Care Act “Obamacare”
when the article has a negative fib. Just saying……we can all call it Obamacare!
Some doctors wary of
taking insurance exchange patients
Jayne O'Donnell,
USA TODAY 7:18 p.m. EDT October 28, 2014
Now that many people
finally have health insurance through the Affordable Care Act exchanges, some
are running into a new problem: They can't find a doctor who will take them as
patients.
Because these exchange plans often have lower reimbursement
rates, some doctors are limiting how many new patients they take with these
policies, physician groups and other experts say.
"The exchanges have become very much like Medicaid,"
says Andrew Kleinman, a plastic surgeon and president of the Medical Society of
the State of New York. "Physicians who are in solo practices have to be
careful to not take too many patients reimbursed at lower rates or they're not
going to be in business very long."
Kleinman says his members complain rates can be 50% lower than
commercial plans. Cigna and Aetna, however, say they pay doctors the same
whether the plan is sold on an ACA network or not. United Healthcare
spokeswoman Tracey Lempner says it's up to their physicians whether they want
to be in the exchange plan networks, which have "rates that are above
Medicaid." Medicaid rates are typically below those for Medicare, which in
turn are generally lower than commercial insurance plans. To prevent
discrimination against ACA policyholders, some insurance contracts require
doctors to accept their exchange-plan patients along with those on commercial
plans unless the doctors' practices are so full they simply can't treat any
more people. But lower reimbursement rates make some physicians reluctant to
sign on to some of these plans or accept too many of the patients once they are
in the plans.
"I definitely feel
like a bad person who is leeching off the system when I call the doctors'
offices," she says. Shawn Smith of Seymour, Ind., spent about five months
trying to find a primary care doctor on the network who would take her with a
new, subsidized silver-level ACA insurance plan.
Last week, Smith found a practice that would accept her as a
patient. Caroline Carney, chief medical officer of MDwise, Smith's insurer,
says some doctors "might be participating with us, but just not able to
take on new patients. It's at the doctor's discretion."
Jon Fougner, a recent Yale Law School graduate, sued Empire Blue
Cross this month
because he couldn't find a primary care doctor in his new ACA exchange plan.
Fougner's experience
underscores how important it is for consumers to check out doctor and hospital
networks for plans before they purchase them -- and to call doctors to make
sure they are accepting new patients with their policies.
Among 30 doctors he called, Fougner said, they either weren't
taking new patients, weren't in the plan or didn't return calls, or the contact
information proved incorrect.
"It's absolutely their right to take whatever plan they
want to take," Fougner says of doctors. But he says he found Empire's
records are often "erroneous
about whether the doctor takes the plan and/or other information essential to
seeing the doctor."
Empire declined to comment as the litigation is pending.
Insurers are also moving to smaller networks of doctors and
hospitals in their exchange plans. These "narrow networks" help them
reduce costs, but they can also lead to problems when consumers look for
doctors who will take them.
Among complaints from doctors about how the whole system is
working:
• If consumers have a
federally subsidized plan, they get a 90-day grace period before plans are
canceled if they don't pay their premiums. That means doctors have to pursue
patients to pay for their services for most of that time as insurance companies
refuse to pay the claims.
• Plans sold on the exchanges with the lowest premiums require
consumers to pay the most out of pocket. Many of these customers have insurance
for the first time and don't understand how much they have to pay, so doctor's
offices have to spend a great deal of time explaining benefits packages, says
Ripley Hollister, a primary care doctor in Colorado Springs.
Doctors' offices want it
to be clear on insurance cards that a patient has an exchange plan so they know
whether they want to accept the plan and whether the person is receiving
subsidies — which can reduce out-of-pocket costs — or has high cost-sharing.
Doctors in Texas are trying to get the state to require insurance cards to make
clear whether the plans were purchased on the exchange and what metal level
they are, says Austin King, president of the Texas Medical Association and a
head-and-neck surgeon.
Meanwhile, the National Association of Insurance Commissioners
is developing a new standard for what is an adequate number of doctors and
hospitals in insurance networks. Beginning next year, the Centers for Medicare
and Medicaid Services will be certifying that these networks for plans sold on
HealthCare.gov are big enough. Under the ACA, consumers who have trouble
finding a doctor covered by their exchange plan can file a complaint on
HealthCare.gov, CMS says.
There is some good news: The number of counties with two or more
insurers is up from 81% for the last open enrollment to 95% this year, which
Department of Health and Human Services spokesman Kevin Griffis says
"should mean more doctors to choose from."
No comments:
Post a Comment