Change doctors for lower premiums?

[explanade]

When I enrolled for the ACA starting in October, I found a plan, one of the lowest on CoveredCA, which my doctor/medical group (which whom I've been for years) accepted.

For 2015, the insurer said they would no longer offer plans on the CA exchange.

That was about a month ago but now, their plan comes up when I do a search, except the plan is about the middle of the range of Bronze plans, not towards the bottom, price-wise.

Plans have all gone up in price, starting from about $10 more a month. But the plan I enrolled in is about $50 more for 2015, assuming they're going to offer a plan on the exchange, despite what they'd said previously.

Meanwhile, the medical group says they're in negotiations with the insurer. They have not finalized agreements for 2015 with any of the plans offered on the exchange.

So there are a couple of uncertainties there, if I wanted to keep the same doctor.

I searched the network of the cheaper plans offered on CoveredCA. Hard to say if the doctors are better or worse than the one I have. Guess their practices are willing to accept lower reimbursement rates and thus, are in the network of the cheaper plans.

It would cost $50 or more a month to stay on the old plan, keep the current doctor.

I've been with him and the medical group (with a previous doctor who's since retired) for decades. Well with him for about 5 years or so. There's a comfort level, though I go to the doctors maybe 2 or 3 times a year, which includes the annual physical.

So obviously I'd want to keep premiums at a minimum, since I don't anticipate meeting the deductibles barring a catastrophe.

I've been Googling these doctors on the cheaper plans. Some have Yelp ratings, most have info. on their education and so on. On paper, none have particularly better qualifications. They're all board certified in Internal Medicine, not Ivy League graduates but had residencies in hospitals one would recognize.

So I don't know, I'd prefer to keep the same doctor but I'd like to save at least $600 a year in premiums too.

Has anyone changed doctors because of the ACA plans they chose and/or because of the change between employer-insurance and ER insurance?

Seems a lot of people here opt for COBRA, which at least in my case was a lot more than most ACA plans. More benefits of course, like no deductibles, low copays, etc. but I don't visit the doctor enough to benefit from those benefits.

 

[haha]

Isn't this pretty much a personal decision? One that reflects your personal priorities and habits?

I can't see what an outsider could possibly add.

Ha

 

[MRG]

No, I bought a bigger network so my doc, a bunch of other specialists, and another hospital is included.There all part of a public Co. so I have everything covered(I hope). That said my doc is great and the specialists too. The hospital, I won't go there unless I'm run over in the parking lot.

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[explanade]

To distill it down to questions:

1. Have you had to or considered changing doctors in ER to save premium costs?

1a. If you've changed doctors, how are you selecting new PCPs, online search? What kind of criteria are you using when selecting the PCP?

2. Have you encountered cases of providers in your area not being in the networks of ACA plans?

 

[rbmrtn]

To distill it down to questions:

1. Have you had to or considered changing doctors in ER to save premium costs?

1a. If you've changed doctors, how are you selecting new PCPs, online search? What kind of criteria are you using when selecting the PCP?

2. Have you encountered cases of providers in your area not being in the networks of ACA plans?

1. I would change insurance plans for a cheaper premium. The doctors just come with the plan. They are board certified and licensed to practice medicine. I can't really see what difference it makes.

1a. I don't think the average person really has any way to evaluate a doctor. Some states have reprimands/disciplinary actions available ( LA does Verifications | State Board of Medical Examiners). Most are not made public. I wouldn't use yelp.

2. Actually I would say most are in the ACA plan, but networks can vary from county to county and by zip code

 

[brewer12345]

Why does everyone have such hangups about switching docs? As long as you avoid the outright quacks, WTF is the difference?

 

[ERhoosier]

Why does everyone have such hangups about switching docs? As long as you avoid the outright quacks, WTF is the difference?

Perhaps no difference for healthy folks who only need an annual physical. But it can be quite important for folks with serious chronic conditions. Big difference between having a top notch cardiologist who knows you well just a couple miles up the road vs a marginal (but still certified) doc 29 miles across town. As anyone who's been the 'victim' of marginal health care can tell you, there can be a HUGE difference in quality among 'non-quack' docs.

That said, switching docs vs switching HI is a personal decision more and more are facing every year.

 

[brewer12345]

Perhaps no difference for healthy folks who only need an annual physical. But it can be quite important for folks with serious chronic conditions. Big difference between having a top notch cardiologist who knows you well just a couple miles up the road vs a marginal (but still certified) doc 29 miles across town. As anyone who's been the 'victim' of marginal health care can tell you, there can be a HUGE difference in quality among 'non-quack' docs.

That said, switching docs vs switching HI is a personal decision more and more are facing every year.

IME, they are all quacks to some extent.

 

[MRG]

Many are quacks, some are really good. I don't plan to switch, unless I have to. I probably have an unnatural fear as my previous DR. tried his best to kill me. The DR. I see now treated me for the same condition things were much different.

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[Silver]

I have changed PCP's a few times for a variety of reasons, most recently because they were not in my HCI's network.

It is more important to me in choosing a HC plan is that it is a PPO and not a HMO. I do not want to have to see my PCP and ask (sometimes beg) to see a specialist, which is almost always required in a HMO. It is not uncommon for the PCP to deny a specialist referral if they think they can handle whatever the medical issue is. They will usually not hesitate to refer if it is a surgical problem.

No referral is required with a PPO.

I have a friend who has COPD whose PCP will not refer to a pulmonologist. She thinks she would do better with a specialist, and I agree, but the PCP wants the business I guess.

I chose to pay more for HCI from the ACA site for a PPO.

 

[explanade]

Only thing that comes to mind is that a new doctor/the medical group, would have to get my records, review them, become familiar with my medical history.

There are a couple of doctors in the networks I've been browsing who have a lot of responsibilities beyond their practice. Some are professors while others have titles at some hospitals. Some others still have been authors or have won awards.

Nice things to have on their CV but could some of these doctors who keep busy be giving their practice short shrift? Or these activities outside the practice means their office hours are limited?

My orthopedic surgeon had a busy surgery schedule so I remember having to reschedule pre and post up consults or even waiting well beyond the scheduled times to see him.

Then again, my PCP, who doesn't have outside activities, also has made me wait sometimes.

 

[razztazz]

. I probably have an unnatural fear as my previous DR. tried his best to kill me.

Your's too, eh? The reason I hate to change doctors is because they are so hard to train.

 

[John Galt III]

I'm with my current PCP because my former PCP left the practice for reasons unknown to me. I liked my former PCP. I decided to give the new PCP a chance. So far so good. I think it can be very important what PCP and/or specialist one uses, both in accurate diagnosis and what treatment is or isn't prescribed. I've had a few drastic differences of opinions from different doctors in the past, about what needs or does not need to be done.

 

[sengsational]

I fired my original PCP because he mailed me a prescription for a statin when my LDL was 112, but my TC/HDL (better indicator) was real good (2.5, recommendation <5). Bozo.

The PCP I have now is OK...shoots from the hip maybe a bit too quickly, but it's the devil you know vs. the devil you don't know.

...a new doctor/the medical group, would have to get my records, review them, become familiar with my medical history.

I wouldn't worry too much about that. Your current PCP acts like s/he remembers your case, but it's because just before s/he walked into the room, your chart was scanned. Docs have a 'million' patients, and they can't possibly remember nuance of each patient. That's why you have a chart. Even with the doc that you consider knowledgable about your particular health situation, you had to provide a reminder..."yeah, but we did that test last year and it came back negative" (flips open chart, says "oh, yeah, I 'remember' now".

All that is to say your might consider switching less important.

But also consider if you've got someone who will "do what you want". For instance, let's say you detect what you think might be issues associated with an underactive thyroid. Will your doctor push back if you try to add a more detailed thyroid test to your annual physical? If not, you might keep your current doc. UnitedHealthcare has a doctor rating that gives them a stamp of approval if they "keep costs down". I translate that to "restrict services"! That's what you want to avoid. You want costs controlled elsewhere, not when your health is concerned, hehe!

 

[timo2]

Why does everyone have such hangups about switching docs? As long as you avoid the outright quacks, WTF is the difference?

I've observed relatives of mine sticking loyally with a Dr. waaay too long, to the detriment of their health. I joined Kaiser just so I could have different doctors so I didn't end up with an inappropriate Dr. for too long.

 

[ERhoosier]

I wouldn't worry too much about that. Your current PCP acts like s/he remembers your case, but it's because just before s/he walked into the room, your chart was scanned. Docs have a 'million' patients, and they can't possibly remember nuance of each patient. That's why you have a chart. Even with the doc that you consider knowledgable about your particular health situation, you had to provide a reminder..."yeah, but we did that test last year and it came back negative" (flips open chart, says "oh, yeah, I 'remember' now".

All that is to say your might consider switching less important.

But also consider if you've got someone who will "do what you want". For instance, let's say you detect what you think might be issues associated with an underactive thyroid. Will your doctor push back if you try to add a more detailed thyroid test to your annual physical? If not, you might keep your current doc. UnitedHealthcare has a doctor rating that gives them a stamp of approval if they "keep costs down". I translate that to "restrict services"! That's what you want to avoid. You want costs controlled elsewhere, not when your health is concerned, hehe!

Good points. Big part of a good PCP is communication- which is a 2-way street. Obviously no doc can remember every specific about literally 100's (or 1000's) of patients, but they should at least review the chart before they see you. No biggie if you have to remind him/her about a detail, like some specific test you had which doc did not know about. Maybe results just did not make it into your chart (paper or electronic). But PCP acting like they met ya for the 1st time on every repeat visit.....well that's not a good sign.
Personally, I do NOT want a PCP who always will "do whatever I want". I want honest communication. I ask questions and share my thoughts (quickly!), then listen to doc's answers. After all I am paying (directly or indirectly via HI) for his/her knowledge and guidance. Sometimes orders for tests get missed (like clerical error) and test really should be done. Doc should admit that & get the test ordered. Sometimes getting another test might be OK (close call), although may or may not be covered by HI. Some tests are basically a waste, like those adding no useful info or of unproven reliability/benefit. But sometimes ordering more tests is not the right thing to do- even potentially harmful. Just like treatments, all testing has a risk-reward balance. Doc needs to explain these too.

 

[RetireAge50]

I've only been to the doctor a few times and never the same one twice. I hope this will continue in my later years.

 

[easysurfer]

I didn't go the ACA route, but got my coverage for 2015 via ehealthinsurance.

I ended up choosing a plan with a higher premium but my doctor is in-network whereas with the less expensive plan, the doctor is considered out of network. I really like my doctor as he has a really good bedside manner and actually takes time out to listen.

In my case, I'll end up paying about $150 more a month in premiums. But I'd be covered mostly (in-network coverage) for stuff like an annual physical, flu shots. This year, none of that was covered and I forked over about $400 out of my pocket.

 

[explanade]

So $1800 for the year to keep your doctor. Must be really good.

Most Bronze plans do cover annual physical.

Don't know about flu shots, which I've never taken.

 

[FUEGO]

I'm personally planning on going for a limited network plan as long as the savings are worth it (right now they are). I visit the doc once a year for a physical, and he (along with hundreds of other doctors within 5 miles) are in the limited network silver plan near me.

If at some point I develop a condition that requires a larger network to get good treatment, I may pay up.

 

[easysurfer]

So $1800 for the year to keep your doctor. Must be really good.

Most Bronze plans do cover annual physical.

Don't know about flu shots, which I've never taken.

I've had some shaky doctors in the past

The kinda reminds me of looking for features vs costs in a car. What's most important to one person may not be for another. No one perfect answer.

Actually, the way I figure, the amount is more like $1400 a year instead of $1800. ($150 x 12) - $400, as the math.

 

[Bestwifeever]

I've had some shaky doctors in the past

The kinda reminds me of looking for features vs costs in a car. What's most important to one person may not be for another. No one perfect answer.

Actually, the way I figure, the amount is more like $1400 a year instead of $1800. ($150 x 12) - $400, as the math.

Your doctor might leave the plan, the practice, or the profession, but you still get to pay the higher premiums. Tough decision.

 

[MichaelB]

If it is only to continue seeing a primary care physician, you could keep the cheaper plan and pay the doctor cash out of pocket.

 

[easysurfer]

Your doctor might leave the plan, the practice, or the profession, but you still get to pay the higher premiums. Tough decision.

Yes, a tough decision.

The way I figure, if the doctor leaves (the practice, profession, or moves to far away) then all bets are off and I'd probably go back to square one and start from the cheapest plan first.

But I do like having a doctor that I'm comfortable with when he puts on the rubber gloves

An analogy I guess is like those who invest if actively managed funds. (Yes, I guess there are those who don't index ). If the fund manager decides to jump ship what do you do? That happens all the time. Do you follow the manager? Or do you stick it out with your current fund company? or go to indexing?

 

[Live And Learn]

This is a tough one, and this is what I plan to do:

1. PPO all the way - no HMO
2. Look for a plan where my specialist doctors are in network for the new plan- don't care so much about the PCP since all he does is a quicky annual physical, 2x a year blood workup, and shots
3. Consider the cost alternatives of paying my one specialist as out of network vs working with him directly to come up with a fee schedule vs going with a higher cost ACA plan where he is in network. But there is no way I'd give up this specialist. I've been with him for 12 years and I know my care could not have been any better.