Doctors not accepting Obamacare?

[John Galt III]

Regarding dental insurance and PPACA: I notice the Healthcare.gov website lets you shop for dental insurance, gives you premium amounts, and a list of prices, coinsurances, deductibles, etc. But nowhere is it clarified, unless I missed it, whether or not cost sharing or premium subsidies will apply to dental. From what I saw, the website does not state whether or not there will be subsidies and cost sharing for dental, but I am assuming there will not be. While looking at regular health ins plans on hc.gov, I can click into something that shows my cost sharing, but there is no analogous click to let me see any dental cost sharing or subsidies, while browsing the dental options. Anyone know for sure? Thanks.

 

[zinger1457]

In my case the policies offered to me in ACA (un-subsidized) were at a much higher premium than what I've been paying privately on the outside, for basically the same policy. Not sure I see the tie in to ACA polices resulting in lower reimbursement cost to doctors.

 

[FUEGO]

I asked my primary care doctor and they seemed confused as to why they wouldn't accept the insurances from big name insurers like BC, Aetna, UHC, (what's available through the exchanges). Of course there might be some insurers they don't accept at all, but I didn't get the impression that they were planning on discriminating based on exchange/non-exchange procured insurance.

I asked our dentist if he accepts the dental plan from the state's Children's Health Insurance plan (our kids will get dental included in their health insurance). Yes. No copay or maybe $5 for procedures they said. Way better than what we pay now if there's a procedure.

 

[rbmrtn]

From what I saw, the website does not state whether or not there will be subsidies and cost sharing for dental, but I am assuming there will not be. While looking at regular health ins plans on hc.gov, I can click into something that shows my cost sharing, but there is no analogous click to let me see any dental cost sharing or subsidies, while browsing the dental options. Anyone know for sure? Thanks.

I think it depends on how the dental is obtained. Some health plans include a dental option so it is included in the premium. If you get a stand alone dental plan in addition to a medical plan, there is a premium for each. I believe your subsidy is applied to your total premium. BUT, the subsidy is calculated based on the second cheapest silver plan, if it doesn't include dental then the cost of dental is not being included in your subsidy ( I think ). I never thought dental was worth it so I never bought it , same with vision option.


https://www.healthcare.gov/coverage/dental-coverage/

From kaiser FAQ, Health Reform FAQs | The Henry J. Kaiser Family Foundation

It looks like pediatric dental benefits are only offered through stand-alone plans in my state Marketplace. Will my tax credit premium cover the cost of the stand-alone dental plan?
No, the premium tax credit will not be increased to also cover the cost of a stand-alone dental plan.

 

[photoguy]

Shop, that's how to avoid the issue.

My ACA plan last year included(in my area) all major hospitals, my doc and many others. I was hospitialized twice. Saw 4-5 specialists, all for my copays(lower than Megacorps). I went max OOP in June, haven't paid a dime since then.
Point is sounds like your plan doesn't cover the provider's you need. Has nothing to do with 'Obamacare', same thing happened before ACA.

Are there any independent sources that rate the networks? So far all we have been doing is looking providers on their website and seeing which doctors are available. It would be nice if there was a more systematic rating.

Also there's always a possibility that we missing some speciality because we don't know what to look for. E.g. you think you are ok because there's an orthopedic surgeon but you forgot to check for a anthesiologist.

 

[REWahoo]

In the November issue Consumer Reports ranked health insurance providers/networks by state.

 

[Mulligan]

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.

When you do your shopping, there is a link on healthcare.gov that lets you see the network of participating doctors. It is your responsibility to make sure that you book your appointments with doctors that accept your insurance, or live with the consequences. That's easy when you're an outpatient, but if you're in the hospital, it's more problematic. There's other thread on this forum that relate horror stories about some extra doctor standing around in the OR while the real surgeon did the work, and the other doctor was out of network. If I go to the hospital, I'm going to put a sign around my neck that says, unless you take my insurance, turn around and leave!

Maybe an additional post it note securely positioned over the incision point with a declaration of... Any surgical staff not covered by my insurance carrier will be considered gratuitous work. Sign and initial sticky note before entering.


Sent from my iPad using Tapatalk

 

[photoguy]

In the November issue Consumer Reports ranked health insurance providers/networks by state.

Thanks. I don't have a subscription anymore but I found this link on their website for rankings:

Health Insurance Search Results - Consumer Reports Health

The criteria are consumer satisfaction, prevention, treatment (for common conditions), and accreditation (not sure what this means). They don't report on network size but I assume this would be rolled into the listed criteria (or affect them indirectly).

 

[sengsational]

...
The law (via implementation reg's) requires them to keep HI in force during the grace period, and only need inform the providers during months 2-3 of the grace period.
...

Thanks for clarifying that it's in the law that they must inform doctors. The insurance companies still might be sneaky, since I'm sure they had a hand in writing the legislation.

My current insurance company (BCBS NC) is as slimy and slipery as they get. They just deny random claims, now that I've met my deductible and they need to start paying. I call and ask for them to explain the denial and instead of admitting fault or even saying they're sorry, they just say,
"we'll send it through again, and don't call back until 45 days from now". Meanwhile, the doctor is not getting paid, and my account, which I am ultimately responsible for, is getting whacked with 18% interest charges.

But back on the original topic of this sub thread, I see now that the doctors have one out of 12 months of exposure to collections from patients. Not great, but not asw horrible as I originally thought. I guess if the patient is not paying premiums, money might be tight enough to ignore the doctors' urgings for payment. The other problem is that there is another step in the administration (the premium payment validation step). Just what we need more red tape.

 

[ERhoosier]

I asked my primary care doctor and they seemed confused as to why they wouldn't accept the insurances from big name insurers like BC, Aetna, UHC, (what's available through the exchanges). ....

Sounds like these folks are not in the billing area, or at least not familiar with the issue facing them. Two years ago my doc's office had the same mistaken outlook. Now looks like I'm losing my doc of 20+yrs over HI changes.
Each company sells multiple different HI products (plans). Used to be that providers participated (joined to be in network) for all products from a certain company, but that has been changing rapidly. Net payment (reimbursement) rates docs/hospitals get often vary between HI plans offered by the same company. Exchange plan pay rates are almost always lower than typical private (commercial) HI rates in any specific region. It's a big way HI companies use to control costs.
A Doctor’s Perspective On Obamacare Plans | Kaiser Health News

Some doctors wary of taking insurance exchange patients

Plus, as mentioned previously, providers can be left unpaid for services to folks with Exchange HI who have stopped paying their premiums (due to the 90 grace period in subsidized ACA Exchange plans).
The Fourth Obamacare Shock Wave Is About To Reach Us - Forbes

Sadly, with increasing numbers of docs' practices being taken over by hospitals or HC 'systems' many individual docs no longer have the choice of which HI plans to accept or not. It's become a corporate decision.
Hospitals buying more doctors' practices

 

[MooreBonds]

But back on the original topic of this sub thread, I see now that the doctors have one out of 12 months of exposure to collections from patients. Not great, but not asw horrible as I originally thought.

"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.

 

[swakyaby]

Regarding the OP's question, I recently called my GI doc's office to schedule a repeat colonoscopy. The office worker asked me if my insurance had changed since my last procedure 5 years ago. Since I had enrolled in a Blue Shield ppo plan this year, I said "yes" and provided the requested subscriber ID number. She immediately responded, "That's Covered California!" in an accusatory derisive voice. Somewhat stunned, I said it was not, that I paid a high insurance premium for it. She then rechecked the number and proceeded to schedule an appointment. So for a brief 30 seconds, I felt what it was like to be treated like a disgusting gutter rat. If it weren't for the fact I really like my GI specialist, I would stay away from that office.

I have since talked to several other medical providers, and they have mentioned that many of their patients are having trouble finding specialists who accept Covered California insurance (ACA, Obamacare) because of low reimbursements. So the patients resort to traveling significant distances to receive specialist care. So while they eventually find the care they need, it seems that for some it's pretty inconvenient.

 

[John Galt III]

RBMRTN, Thanks. The health plan I plan to use does not have adult dental, so it looks like, yes, the dental premiums and costs they are showing at hc.gov will not be reduced by a subsidy/ cost sharing. I may opt to self-insure for dental this year.

I think it depends on how the dental is obtained. Some health plans include a dental option so it is included in the premium. If you get a stand alone dental plan in addition to a medical plan, there is a premium for each. I believe your subsidy is applied to your total premium. BUT, the subsidy is calculated based on the second cheapest silver plan, if it doesn't include dental then the cost of dental is not being included in your subsidy ( I think ). I never thought dental was worth it so I never bought it , same with vision option.


https://www.healthcare.gov/coverage/dental-coverage/

From kaiser FAQ, Health Reform FAQs | The Henry J. Kaiser Family Foundation

It looks like pediatric dental benefits are only offered through stand-alone plans in my state Marketplace. Will my tax credit premium cover the cost of the stand-alone dental plan?
No, the premium tax credit will not be increased to also cover the cost of a stand-alone dental plan.

 

[Clone]

Did someone mention the Inquisition?

I certainly did not expect that!


The challenge I have with medical insurance is complete overload of information and opinions. I have been in a High Deductible plan for a number of years through mega-corp. It is provided during retirement. I understand what the costs have been, and how my HSA functions to pay that max out of pocket. Now things are changing slightly, and some folks (retired from same megacorp) are squealing about the premiums going up. I see letters that could be interpreted as limiting coverage, but yet do not see any evidence or hear of any problems with that. The increase in premiums is very slight, and I believe that the 'outrage' from a few folks is mostly grandstanding. (Something like $20/month.)

Thus, perhaps unfortunately, I believe that I have good insurance (with the known high deductible limitations), right up to the point where I end up with an unexpected bill.

I think there are a lot of people in the same mode. Everything is fine, until it isn't.

 

[MRG]

Are there any independent sources that rate the networks? So far all we have been doing is looking providers on their website and seeing which doctors are available. It would be nice if there was a more systematic rating.

Also there's always a possibility that we missing some speciality because we don't know what to look for. E.g. you think you are ok because there's an orthopedic surgeon but you forgot to check for a anthesiologist.

Not that I'm aware of. Great idea!

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

 

[sengsational]

"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]

"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]

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]

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]

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

(directed at those tactics)

 

[MooreBonds]

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]

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]

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]

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.