Doctors not accepting Obamacare?

[sengsational]

Quote:

Originally Posted by MooreBonds "Not as horrible as I originally thought"? How would you feel if your revenue might randomly drop because someone hasn't paid insurance premiums? And how would the doctor know you haven't paid your insurance premiums before they render the care? Does the insurance company send out a memo to all doctors in the area with your name? The insurance company doesn't know ahead of time who you have appointments with or when those appointments are.

Less horrible, yes. Because I thought the doctor would need to collect directly from the patient for three months, and I learned it was less...only one month. The result is "less horrible"?

Checking if a patient is insured and "paid-up" before rendering service was the added red-tape I mentioned. It's not great, but it is just an internet query. I KNOW one doctor's office of mine types in my insurance card number the moment I step up to the window (they showed me a printout saying my deductible hadn't been met, so wanted cash on the barrel head). Turns out the crappy system that BCBS NC was showing the deductible since I dropped my daughter in July and my big expenses were in April (life change = got a corporate job ). But I digress.

It's not that ALL revenue from the non-premium payers is gone for that month, it's just that the doctor (or more likely the practice...most of the doctors around here would be completely insulated since they are in mega-practices), yeah, so the practice would show worse receivables. They will make up for those bad debts next time they negotiate rates with the insurance company. I just can't get all that worked-up about those practices...they will remain profitable.

[2B]

Quote:

Originally Posted by MooreBonds "Not as horrible as I originally thought"? How would you feel if your revenue might randomly drop because someone hasn't paid insurance premiums? And how would the doctor know you haven't paid your insurance premiums before they render the care? Does the insurance company send out a memo to all doctors in the area with your name? The insurance company doesn't know ahead of time who you have appointments with or when those appointments are.

My primary care doctor's people check my insurance every time I visit since the PPACA passed. I went to a specialist and they also checked my insurance before seeing the doctor. They knew that I was covered and verified what I'd have to pay.

I'm not sure if the insurance company would tell the doctor if someone stopped paying. It seems like they would. If a person was cut off, they might claim they still had insurance but the doctor could say they need full payment at the time of service.

[marko]

Just got (an expected) letter from my doctor. Starting December 1, he is NOT accepting insurance at all! He's setting up a new practice where a visit is $50 to be paid at the time of visit.

He figures the new regulations and general insurance hassle costs him so that he had to charge $200 to get the $50. Now he has two secretaries (instead of a room full of insurance chasers) and a credit card machine.

I may be off on the actual numbers but that's the gist of it.

[travelover]

Quote:

Originally Posted by marko Just got (an expected) letter from my doctor. Starting December 1, he is NOT accepting insurance at all! He's setting up a new practice where a visit is $50 to be paid at the time of visit. ............

Sounds familiar - I think this was the way it worked when I was a kid.

[growing_older]

Quote:

My primary care doctor's people check my insurance every time I visit since the PPACA passed.

My primary care doctor and my kid's pediatricians have ALWAYS checked my insurance EVERY visit, since long before PPACA. This is not new. They used to make a paper copy of my insurance card EVERY visit, but recently they just scan it. Insurance companies have been skirmishing with medical billing offices long before PPACA. Delay and random denial and obscure rule changes are standard tactics that have been used for many years.

[sengsational]

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Originally Posted by growing_older Delay and random denial and obscure rule changes are standard tactics that have been used for many years.

(directed at those tactics)

[MooreBonds]

Quote:

Originally Posted by 2B My primary care doctor's people check my insurance every time I visit since the PPACA passed. I went to a specialist and they also checked my insurance before seeing the doctor. They knew that I was covered and verified what I'd have to pay. I'm not sure if the insurance company would tell the doctor if someone stopped paying. It seems like they would. If a person was cut off, they might claim they still had insurance but the doctor could say they need full payment at the time of service.

There's a big difference between "checking your insurance card" and "actually logging into the Insurer's network to verify if you are paid-up on your health insurance". I don't quite know how many times a doctor's office will do the latter. Without directly logging into the insurer's database, they have no way of knowing that your insurance is paid-up. I doubt the insurer will have a field of phone operators standing by to take calls at all hours, day and night, and on weekends (including, but not limited to, emergency room visits, which might involve several different healthcare providers in the same hospital).

[Buckeye]

Quote:

Originally Posted by marko Just got (an expected) letter from my doctor. Starting December 1, he is NOT accepting insurance at all! He's setting up a new practice where a visit is $50 to be paid at the time of visit. He figures the new regulations and general insurance hassle costs him so that he had to charge $200 to get the $50. Now he has two secretaries (instead of a room full of insurance chasers) and a credit card machine. I may be off on the actual numbers but that's the gist of it.

I wish more doctors would do this! I think it is the wave of the future.

Get service, pay reasonable price for it immediately.

[FUEGO]

Quote:

Originally Posted by marko Just got (an expected) letter from my doctor. Starting December 1, he is NOT accepting insurance at all! He's setting up a new practice where a visit is $50 to be paid at the time of visit. He figures the new regulations and general insurance hassle costs him so that he had to charge $200 to get the $50. Now he has two secretaries (instead of a room full of insurance chasers) and a credit card machine. I may be off on the actual numbers but that's the gist of it.

Not bad. That's about what we pay for non-preventative care on our high deductible plan. $50 on a $200 charge (the balance being discounted due to insurance negotiated rates).

[FUEGO]

Quote:

Originally Posted by Buckeye I wish more doctors would do this! I think it is the wave of the future. Get service, pay reasonable price for it immediately.

And the doctor's average accounts receivable aging is zero days instead of months with the insurance companies.

I think my doctor has a 1:1:1 ratio of doctors or nurse practitioners to nurses/aides to billing/secretarial staff. It'd be nice to cut out some of that last segment of overhead.

[jesaco]

Checked with our company's health insurance cost if I retire and get cobra, the cost is about $2,200/month for a family coverage, Talk about sticker shock!!!..Since I will not be able to get subsidy (with PPACA) next year due to lump sum, I might have to get Cobra or see if it would be cheaper on PPACA without subsidy. I would be able to get the subsidy in 2016 since most of my investments (about 80%) is in taxable accounts and income will all come from withdrawals. I love my doctor but if he does not accept PPACA, I hope I could find a good one that accepts it.

[Corporateburnout]

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Originally Posted by RICKJJ Checked with our company's health insurance cost if I retire and get cobra, the cost is about $2,200/month for a family coverage, Talk about sticker shock!!!..Since I will not be able to get subsidy (with PPACA) next year due to lump sum, I might have to get Cobra or see if it would be cheaper on PPACA without subsidy. I would be able to get the subsidy in 2016 since most of my investments (about 80%) is in taxable accounts and income will all come from withdrawals. I love my doctor but if he does not accept PPACA, I hope I could find a good one that accepts it.

$2200/month is pretty expensive.

I retired in June and my employer's coverage ends at the end of January. My Cobra rates are $948 (2014 rate so I imagine it would increase in 2015) for DW and me. I plan to compare prices on the exchange at open enrollment but most likely I won't find anything cheaper than my COBRA rates. I also have dental @ $55 a month for COBRA and $80 as a retiree. I plan to compare the dental insurance rates also on the exchange.

[sengsational]

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Originally Posted by sengsational When I shopped for my PPACA plan last year I noticed that every plan on the exchange was also on the BCBS NC site. There is nothing on my insurance card that would indicate whether I shopped directly on the BCBS NC site or PPACA site.

After looking at hc.gov, I now see how SOME insurance companies make it so some doctors can "not accept Obamacare"; they sell a sub-standard product on the exchange.

For instance UnitedHealthcare in my area sells a plan with the moniker "Compass". That is a plan with a much smaller network than some of their other plans.

My primary care doc is in the good UHC network, but not in the crappy "Compass" network. So now I need to decide if I buy BCBS NC again and keep my current primary care doc (and deal with the slime-ball tactics of BCBS NC) or switch to UHC and find a new primary care doc.

[outdoorgirl02]

I enrolled in an exchange plan last year after confirming my doctors and specialists were in network for the plan I chose. Imagine my surprise when I had 3 different doctor visits in the first few months who were no longer accepting health insurance from the exchange EVEN THOUGH they were part of the network when I bought the plan. Talk about frustrating!

Luckily, it was in February and I was able to cancel the exchange plan and purchase an individual plan directly through an insurance company. The new plan was only slightly higher and includes all my doctors and has a much bigger network of providers.

[Retire2013]

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Originally Posted by RICKJJ Hello, been reading for a while but posting for the first time. I changed my primary doctor and when I called for an appointment, The first thing they asked is if my insurance (unitehealhtcare) is a regular insurance or Obamacare. I read a lot of doctors do not accept or refuse patients whose insurance is under the Obamacare. Is this true? Did anyone had the same experience? wanted to ER next yr at age 59 but afraid to retire without a reliable health insurance and planned to enroll in ACA upon retirement. Thank you for any input. This site has helped me a lot and has inspired me to think about ER..

I've switched primary care doctor because my former general practitioner did not accept "Obamacare" --- I ER in early 2013. I found another family practice that accepted ACA (i.e., "Obamacare") this practice is professional, punctual, and less than 4 miles from my home. If I show up at the time of my appointment I will be seen within 8 minutes.

I also found orthopedic surgeon, physical therapist, and gynecologist who accept ACA. If you sign up for ACA, after you've chosen an insurance company, simply go to its website to look for its in-network providers. You should have no difficulty at all finding medical providers that accept ACA.

I am EXTREMELY HAPPY with the health care that I've received in 2014 through ACA. ACA has enabled me to ER with peace of mind with respect to healthcare. Let's hope the law does not get repealed or scaled back etc.

Good luck with your ER plan. ER is awesome!!!! I enjoy every minute of it.

[ERhoosier]

Quote:

Originally Posted by sengsational After looking at hc.gov, I now see how SOME insurance companies make it so some doctors can "not accept Obamacare"; they sell a sub-standard product on the exchange. For instance UnitedHealthcare in my area sells a plan with the moniker "Compass". That is a plan with a much smaller network than some of their other plans. My primary care doc is in the good UHC network, but not in the crappy "Compass" network. So now I need to decide if I buy BCBS NC again and keep my current primary care doc (and deal with the slime-ball tactics of BCBS NC) or switch to UHC and find a new primary care doc.

All Exchange plans must be ACA compliant, which means offering the same basic benefits and spending the same (by 'metal' level) fraction of total premiums received on HC benefits delivered. So the competition between companies is mainly on cost of HI premiums. Most effective way to cut HI premium costs under ACA is to lower provider reimbursements. Lower reimbursement means smaller networks. Some see this as offering "sub-standard" HI products, but most pundits and 'experts' feel this an expected, even desired, result of HC reform. And many, many HC consumers are shopping only (or mainly) on price. The HI industry is basically offering what the gov't and most consumers want...or perhaps just what they can afford.

JD Power does an annual survey of member satisfaction with HI companies, with results collated by region. These results are for commercial HI since Exchange products have not been out that long.
Press release-
2014 Member Health Plan Study | J.D. Power
Results-
2014 Member Health Plan Study (by Region) | J.D. Power

[sengsational]

Thank you for that link. The offerings in my area all got average or below average in all categories. So we've got a fairly poor choice in health insurance providers.

It looks like this system is sorting into 3 tiers. What I called sub standard, meaning the network includes only doctors that are willing to take less money, and the middle tier for people who purchase non exchange policies, and then the highest price doctors who don't take insurance at all.

So buying on the exchange gets you doctors who will accept lower payments. Those doctors may be new, or they may be not so good. Disappointing to see such a constrained network for exchange based policies instead of the normal network.

[MRG]

Thanks for the link ERhoosier. Confirms what I thought, despite limited competition, I'm fortunate to have very good options.

Sent from my SAMSUNG-SGH-I337 using Early Retirement Forum mobile app

[FUEGO]

Quote:

Originally Posted by sengsational So buying on the exchange gets you doctors who will accept lower payments. Those doctors may be new, or they may be not so good. Disappointing to see such a constrained network for exchange based policies instead of the normal network.

Or they might be able to accept a lower reimbursement because they have a lower operating cost due to successful use of technology or locating their office in a lower rent area. Some medical office space is Taj Mahal quality, and guess who ends up paying for it?

My doctor's office is in an industrial area between the plumbing supply company and the granite countertop company. Rent there is probably 1/2 or 1/4 the rate of Class A space next to the hospital a half mile away and parking is free and plentiful at my doctor's office. They don't seem to be lesser qualified (some board certified's, prez of state medical society, etc), and in fact have grown from 4-5 doctors to over 10 doctors/ANP's in the last decade.

[Quantum Sufficit]

Now you can understand why, as a physician, I am retiring from medicine at 48. It is getting worse by the day. I should have worked for a state government and gotten a fat pension.