Pirate's Cove

USA Today has a history of recycling news from the past when it comes to “climate change”, rarely ever with any new information. In this case, they are telling us something we knew almost a year ago, but have added what has been going on for almost a year

Some doctors wary of taking insurance exchange patients

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. (snip)

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.

There are lots of problems with the plans, one of which is that the Ocare providers have intentionally limited the available pool of medical practitioners. Then you factor in the low reimbursement rates.

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.

I’m sure there are lots of people who have had good experiences. There are surely lots of have had experiences similar to Smith and Fougner.

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.

And when they get done explaining what a deductible is and how it works, the consumer will then realize “holy cow! I don’t have $5081 (the average Ocare deductible for a Bronze plan)  to spend.”

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.

If they file a complaint, then what? Will CMS force doctors to take on Ocare patients?

Crossed at Right Wing News.