Doctors not accepting Obamacare?

[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]

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]

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]

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]

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.

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[FUEGO]

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.

 

[bmcgonig]

Seems like these problems wouldn't exist with Kaiser at all would they? Assuming ur there already or wanted to go that way, the old pre Obamacare Kaiser would be the same as the post Obamacare Kaiser.

Blue Shield in CA now has an EPO instead of a PPO is many counties. The PPO has many more doctors etc., You can't get the PPO under Obamacare, just the EPO.


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[FUEGO]

I noticed some 3 tier network plans. Preferred in network, in network, and out of network. Copays are near zero for preferred network, much higher (basically full freight) at non-preferred in network.

 

[photoguy]

Blue Shield in CA now has an EPO instead of a PPO is many counties. The PPO has many more doctors etc., You can't get the PPO under Obamacare, just the EPO.

I have blue shield PPO purchased on the exchange in CA. We specifically picked this over the EPO.

 

[ERhoosier]

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

Glad you're feeling fortunate, but I'm not vouching for this survey supporting any specific HI options as being good or bad. I only posted the link because there is so little 'real-world' HI-related consumer info available. IMHO- Its pretty rough 'data' on HI service. For example, this survey was NOT plan-specific in its data collection. It is very possible that, for similar HI premiums costs, an individual might be better off with the top plan from a lower-rated company than a better-rated company's lower-end plan. Folks still need to shop around to see what plan is best for them.

 

[MRG]

I agree it's just a small set of data. I only have a small set of data to compare with so I may be scewed.

One important factor in HI(and many businesses) is the call center, not how long your on hold, but are there competent people you deal with. I've been inside many call centers, the good ones are most always good, the poor ones just always stink. Doesn't matter what product you buy the call center can determine much of your experience.

I only had 2 HI companys to choose from, one at the top and one at the bottom of the attached. My experience with them while shoping was educational. One could answer questions, the other, well they didn't know what cost sharing was, who was in network, or........ This was reenforced during the year when I had questions or issues. I received excellent customer service.

Yes you have to shop, very carefully. I did pay up for a better network. I knew that was important (for me), through the course of the year I discovered pleasantly how important.

Again thanks for the post it's the first data I've seen. I agree more "grain" would be great but it's a start.

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[bmcgonig]

I have blue shield PPO purchased on the exchange in CA. We specifically picked this over the EPO.

When I go to covered ca there is only one choice for my zip code, that's EPO. I just checked a different zip and the PPO is available there. So it's zip code related I guess.


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[grasshopper]

Auh, my grandfathered plan for the next year and a half, can take 50K in LTCG every year, SS, convert to Roths, and fer get about the ACA.

 

[M Paquette]

Seems like these problems wouldn't exist with Kaiser at all would they? Assuming ur there already or wanted to go that way, the old pre Obamacare Kaiser would be the same as the post Obamacare Kaiser.

Correct. I had Kaiser with my employer and on COBRA. I qualified for individual coverage with them after a few tries (pre-ACA), and am currently covered under an ACA Bronze HSA-eligible plan with them.

Over all this time, with three different policies, I have the same doctors, same MRN (medical record number, the Kaiser ID card number), same labs and pharmacy, and same hospitals. All that's changes over time are insurance-side details, like payments, copays, and deductible amounts.

 

[photoguy]

When I go to covered ca there is only one choice for my zip code, that's EPO. I just checked a different zip and the PPO is available there. So it's zip code related I guess.

Interesting. I wonder why they are dropping for some zip codes and not others (I would have expected them to make a california wide decision). Do you know if they offer the PPO in your zipcode off exchange?

Also we when signed up I think the difference between the EPO and PPO was only in the out-of-network coverage. I.e. they have the same in-network providers but the PPO plans had explicit max OOP for out-of-network.

 

[sengsational]

Interesting. I wonder why they are dropping for some zip codes and not others (I would have expected them to make a california wide decision). Do you know if they offer the PPO in your zipcode off exchange?

Also we when signed up I think the difference between the EPO and PPO was only in the out-of-network coverage. I.e. they have the same in-network providers but the PPO plans had explicit max OOP for out-of-network.

Being spotty by geography seems like it might have arisen from spotty provider signup in that geography. In other words if none of the doctors in Richville sign up for the crummy reimbursement plan, that town doesn't have the plan offered.

 

[AnIntentionalRoad]

When we signed up for our BCBS Silver plan last Dec info on which doctors were in-network wasn't available (we're in Illinois).

After we picked a plan, two of our doctors sent us a letter saying they were no longer going to take our ACA plan.

So, we ended up dropping the ACA plan in May as we were paying for something we weren't using and got a much cheaper temporary plan for the rest of the year. Right now we are shopping for a private plan for 2015.

 

[AnIntentionalRoad]

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 wonder if this is a red state/blue state issue. We live in a heavily Republican area and I suspect not taking ACA is a way for Republican Doctors to directly boycott ACA.

I have no idea if this is true but I have suspicions.

 

[EastWest Gal]

If enough of the population ends up the ACA plans (early retirees, young adults, small business owners, dole proprietorships, entrepreneurs, the doctors who refuse to take ACA plans will find themselves with fewer patients. From what I've seen in my Spam doctor political emails, doctors who aren't taking ACA insurance are doing for pure anti-Obama politics.

I'm willing to find a new doctor if they are that unreasonable about health insurance. High priced doctors are not necessarily the best doctors. They're just high priced. One of my friends was chief resident at UCSF and she deliberately chose a career in a free clinic for homeless children.


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[timo2]

Maybe the insurance companies need to provide the doctors for their plans?

"Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent"

http://www.nytimes.com/2014/11/18/u...n-region&region=top-news&WT.nav=top-news&_r=1

 

[samclem]

Maybe the insurance companies need to provide the doctors for their plans?

"Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent"
http://www.nytimes.com/2014/11/18/u...n-region&region=top-news&WT.nav=top-news&_r=1

What do share prices of insurance companies have to do with getting more doctors? Are they paying the docs in shares?

If the law makes it easy for insurance companies to make a lot more money--well, that's what they wanted, and what they bought.