Doctors not accepting Obamacare?

[jesaco]

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..

 

[2B]

Welcome to the forum.

The PPACA (aka Obamacare) has a number of "wrinkles." Some of the plans offerred on the Federal or individual state sites may have appealing costs but their coverage of doctors or hospitals are limited because they required very low reimbursement rates for treatment. Some of these plans have also listed doctors and hospitals as part of their networks that have rejected these low reimbursements. This is also the case in plans offerred outside of the exchanges but not as prevalent. My followings comments apply to any plan you may look at.

First, unless you are chasing the subsidy there is probably no advantage to buying your policy off an exchange. You can find policies on eHealthinsurance.com that are in the same cost range without the extra forms.

When researching a plan, check to see if your primary care physician is on the plan. Then verify this by calling your primary care physician's office. If you are currently seeing a specialist, do the same. After verifying your current doctor(s) are on the plan, look at the availability of specialists and facilities. You need to see a decent sprinkling of every specialty and a couple of your closest hospitals.

The one thing the PPACA did was make it possible for everyone to buy a personal health insurance policy. This had been the case in Texas but there were no subsidies. The cost is about what I'll have to pay by buying a private policy off of eHealthinsurance.com. What many are finding out is that the "affordable" part may not be there even with a subsidy. If you are going into retirement, you need to make sure your budget includes the cost of the policy and the substantial deductibles. Some here (millionaires too) arrange their taxable incomes to qualify for the subsidies.

 

[Sue J]

Our insurance cards say the plan name and "EXCH" right on them so our providers knew they were Obamacare. We had no questions asked and no issues at all related to how we obtained our insurance.

But you do have to be very careful when you evaluate plans. Some of the networks are very small or have plenty of providers, just not ones in your area. I'm currently checking out our options for 2015 via the preview at healthcare.gov and finding things like a large local insurer that has a specific smaller network for the Obamcare plans. Our doctors are listed but not our lab. Not a deal breaker, just something to consider.

 

[MichaelB]

Obamacare is regular insurance, just like any other.

Insurance companies create and manage hundreds of networks, always with the objective of controlling or regulating access to health care. It is their primary cost management tool.

Prospective customers must now be allowed to determine if a specific health care provider is in a particular policy network. This is the first time consumers have been guaranteed access to this information. It's still not easy, but it is an improvement.

Policies with lower premiums tend to have smaller, more restricted networks. Documented cases of service providers refusing patients with exchange based policies are fewer than reports cases.

 

[steelyman]

While I know it is commonly accepted (even by the President), I do not like that term, and prefer to use the Patient Protection and Affordable Care Act (PPACA).

 

[MRG]

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.


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

 

[LarryG]

To the OP's question, yes there are doctors that do not take ACA plans. I recently had to choose a new urologist as my previous one moved. I have a BCBS PPO with HSA plan purchased through my former megacorp (so not an ACA plan). I searched for a new, in-network urologist on the BCBS web site. I called them to make an appointment, and they specifically asked me for detailed info on exactly what BCBS plan I had. When we confirmed that this urologist did indeed take my plan, I asked the person about what plans they didn't take. He replied that they take most plans, except for the ACA plans.

My intent here is not to bash the ACA, just reporting a recent experience trying to find a new specialist doctor.

So yes, check carefully to insure that the doctor(s) and other providers you prefer to use are part of the health insurance plan you plan to purchase (ACA or not), as they very well might not be.

 

[M Paquette]

Different plans have different provider networks. Cheaper plans generally have smaller, more restrictive networks composed of providers willing to accept the payments the plan offers. More expensive plans may offer larger payments that more providers are willing to accept.

There's nothing new here.

Back at GigaCorp, we had several plans available to employees. The most expensive plans were accepted almost everywhere. The cheapest plans were accepted only at one specific HMO, with only emergency stabilization covered for out-of-plan providers.

Insurers often offer multiple plans with the same coverage, copay, and deductibles, for different markets. The differences between these plans is on the back end, in the provider network. Always check the provider network before buying. Expect to pay more for a larger provider network.

Note that the provider network covered is more than just yoyr doctor. Labs, hospitals, specialists, rehab clinics, and such will also be part of the provider networks. Be an informed shopper, and check the network of providers before you buy.

 

[Lakewood90712]

Before going on COBRA , I searched the Covered CA exchange. For PPO , United Healthcare was far lower in cost for PPO. Has to be a reason, smaller network , etc. The Insurance exec's move from co. to co. so nobody has a silver bullet , they all have similar cost of operation. The so called " not for profit" co's aren't not any lower, they just have no share owners.

 

[skyvue]

I must be missing something. My current insurance (not ACA) almost never pays the full amount my doctor charges them. My doctor or healthcare provider then sends me a bill for what is left over and I pay it. Wouldn't they do the same for an ACA policy that didn't reimburse the full amount?

Bill would show something like:

Services Rendered: $200
Insurance Payment: $150
Patient Owes: $50

 

[easysurfer]

I have a Bronze plan. BCBS Choice PPO to be more specific. When I signed up last year, my doctor was in the network. When I got my bill, to my surprise, my doctor was no longer on the plan.

To answer your question, BCBS sent me a breakdown showing that some of the lab work (blood, glucose test) was covered as in network. $0 covered for my doctor bill.

This time around, I'm looking for a BCBS PPO plan (not one with Choice) as that tends to have more doctors in-network.

 

[Fermion]

I must be missing something. My current insurance (not ACA) almost never pays the full amount my doctor charges them. My doctor or healthcare provider then sends me a bill for what is left over and I pay it. Wouldn't they do the same for an ACA policy that didn't reimburse the full amount?

Bill would show something like:

Services Rendered: $200
Insurance Payment: $150
Patient Owes: $50

That is not the way I usually see things done.

On our insurance through an employer, it looks like this:

Services Rendered: $200
Insurance Payment: $55
Patient Portion: $0

 

[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.

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!

 

[2017ish]

My wife's group will not accept it. The risk shifting of the three month grace period was the kicker.

 

[sengsational]

My wife's group will not accept it. The risk shifting of the three month grace period was the kicker.

Your wife's "group" is with doctors or an insurance company?

The 90 day grace period, new to me until this post, so I looked it up, appears to be a risk on an insurance carrier. The bottom line, and correct me if I'm wrong, but the insurance company has to keep a policy active for 90 days past when the premium payment is due and doesn't get paid. Talk about a dumb law...Maybe the entire nation should make the January through September premium payments, then just coast for 3 months, hehe! Next year, all the coasters need to do is by insurance from another company.

But I digress. This basically has nothing to do with doctors accepting or not accepting PPACA policies, as far as I can tell.

 

[2017ish]

Your wife's "group" is with doctors or an insurance company?

The 90 day grace period, new to me until this post, so I looked it up, appears to be a risk on an insurance carrier. The bottom line, and correct me if I'm wrong, but the insurance company has to keep a policy active for 90 days past when the premium payment is due and doesn't get paid. Talk about a dumb law...Maybe the entire nation should make the January through September premium payments, then just coast for 3 months, hehe! Next year, all the coasters need to do is by insurance from another company.

But I digress. This basically has nothing to do with doctors accepting or not accepting PPACA policies, as far as I can tell.

Providers are on hook for the second and third month. Here is one article discussing it (of many) http://www.medscape.com/viewarticle/822216 And yeah, I've read the statutory language as well....

 

[jesaco]

Thank you for all your replies. all replies have been very helpful. Hoping to join all of you next year as a ER..regards to all.

 

[sengsational]

Providers are on hook for the second and third month. Here is one article discussing it (of many) http://www.medscape.com/viewarticle/822216 And yeah, I've read the statutory language as well....

So THAT'S how it works! You gotta hand it to those sneaky insurance company b*stards! I don't pay the INSURANCE bill, and the DOCTOR gets stiffed! Give me a BREAK!

So it works like this?

1) The insurance policy premium account goes into "past due" status.
2) The policy holder goes to the doctor, and the doctor can't tell (or maybe it's even illegal to inform the doctor about past due premium account?).
3) The insurance company quits paying claims, so the doctor is left holding the bag?

Very interesting indeed, TN_Steve!

 

[robnplunder]

Off topic, I know. Is it my eye sight or MichaelB's avatar looks like Whoopie Goldberg in disguise?

Back to OP: good info, thanks. As my ER approaches, I have been asking my dentist, and general doctor to see if I will be covered under PPACA. I believe I need to pay my dentist out of pocket. My general doctor is "in" PPACA network and will cover me. Go ask you doctors, that's my advice.

 

[MichaelB]

Off topic, I know. Is it my eye sight or MichaelB's avatar looks like Whoopie Goldberg in disguise?

Monty Python, The Cardinal, The Spanish Inquisition.

No one expects the Spanish Inquisition!

The confusion is understandable.

 

[meierlde]

Off topic, I know. Is it my eye sight or MichaelB's avatar looks like Whoopie Goldberg in disguise?

Back to OP: good info, thanks. As my ER approaches, I have been asking my dentist, and general doctor to see if I will be covered under PPACA. I believe I need to pay my dentist out of pocket. My general doctor is "in" PPACA network and will cover me. Go ask you doctors, that's my advice.

It should be noted that dental insurance is not included except for children under the ACA. However it is available on the open market. There is not as much of a pre-existing condition since the insurance tends to have a farily low maximum annual pay out.

 

[Bestwifeever]

Monty Python, The Cardinal, The Spanish Inquisition.



The confusion is understandable.

Did someone mention the Inquisition?

The Spanish Inquisition - YouTube

 

[ERhoosier]

So THAT'S how it works! You gotta hand it to those sneaky insurance company b*stards! I don't pay the INSURANCE bill, and the DOCTOR gets stiffed! Give me a BREAK!

So it works like this?

1) The insurance policy premium account goes into "past due" status.
2) The policy holder goes to the doctor, and the doctor can't tell (or maybe it's even illegal to inform the doctor about past due premium account?).
3) The insurance company quits paying claims, so the doctor is left holding the bag?

Very interesting indeed, TN_Steve!

Actually this 90 day grace period is part of ACA law, NOT the insurance companies being "sneaky b*stards". Appears they stand to loose $$ along with the providers for those unpaid premiums AND subsidy $ already received. 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. During the grace period, payments to providers are held subject to HI premium payment by the patient. If the HI premiums are not paid up by the 90 days, the insured is responsible for any provider payments and their HI premiums. So providers can indeed be left "holding the bag" in many cases- at least during part of the 90 days. But it appears this grace period provision cannot be done on an ongoing basis to continually pay only 9 monthly premiums each year. The grace period does not "reset" unless/until the missed payments are made.
http://www.cms.gov/CCIIO/Resources/...NR_OperationsPolicyandGuidance_5CR_100313.pdf

Should be noted that the above only applies to those covered under Exchange Plans who are receiving a subsidy. Those NOT getting a subsidy do not seem to be covered by this ACA 90 day grace period.

 

[ERhoosier]

..... 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? ......

This seems to vary a lot by region. Some folks report few issues while in other areas having Exchange Plan makes it somewhat problematic to find a good in-network doc/hospital. For 2105 my region now has 7 different companies participating but only one company's network includes all of the 4 major area hospital systems. Most include just 1 or 2. And some companies have changed which main hospital system they contract with since last year. A real PITA to keep track of if you are trying to pick your 2015 HI plan to let you keep seeing your same doc next year

 

[athena53]

It should be noted that dental insurance is not included except for children under the ACA. However it is available on the open market. There is not as much of a pre-existing condition since the insurance tends to have a farily low maximum annual pay out.

I looked at dental insurance and was unhappy to find that they didn't cover much except cleaning for the first 6 or 12 months (depending on the policy). I get that they don't want you to wait till you need a root canal and then buy insurance, but I'd been covered continuously (and getting checkups 4X/year because I have implants) for years. I chose not to buy it. But, IMO, this is their way of excluding pre-existing conditions and getting a guaranteed profit the first year.

Anyway, another data point on the OP: I retired in May and bought a private policy through Coventry because I figured we wouldn't qualify for subsidies because I was paid through 7/1 plus earned, unused vacation and we have investment income. When I called my regular doc for an appointment and told them I had Coventry, they said they accept the private version but not the Coventry purchased through the Exchange. No problems with reimbursement from my checkup-it was all covered.