Some doctors from Texas, California, Georgia, Connecticut and New York have complained to medical associations. It will make it very difficult for consumers to get the care they need.
"As it is, there is a shortage of primary care physicians in the country, and they don't have enough time to see all the patients who are calling them," said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington.
If providers are paid less, he said, "Are (enrollees) going to have difficulty getting physicians to accept them as patients?"
Insurance officials agree that they have reduced rates as they have to keep the premiums affordable, they feel that doctors can manage the lower pay as they will be seeing more patients. Primary care doctors say they can barely cope with the number of patients they are already seeing.
Doctors are not aware of the plans they are listed in and which ones pay a lower rate. "If you're a physician and you've negotiated a rate from insurance, shouldn't it be the same on or off the exchange?" said Matthew Katz, the executive vice president of the Connecticut State Medical Society. "You're providing the same service."
"We're not motivated to gouge the doctor," said Kim Holland, the Blue Cross Blue Shield Association executive director for state affairs. "We depend on good relationships with quality physicians. ... I can't imagine any product we offer is going to have a physician rate that would discourage them from seeing a patient."
But some physicians see things differently. Contracts between insurers and doctors vary, and some allow insurers to adjust rates unilaterally or to assign doctors to multiple plans.
"I've participated with Oxford since 1985," Dr. Paul Orloff, a physician who's the president of the New York County Medical Society, said of Oxford Health Plans. "They don't send me a contract every year to sign. They don't send me the rates. You don't know the rates. It's the only game in town, so you sign. They have a right to unilaterally change the rates at any time during the contract."
Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.
People "may experience wait times to get in, but that is not unique to people in exchange plans," said Sara Rosenbaum, a professor of health law and policy at George Washington University, She said she was not very worried about the physicians compensation, "I don't mean to suggest that physicians don't deserve to do well," she said. "But physicians are very well-compensated people, no matter what."
Many doctors have not decided whether they will participate in the new plans. A survey by the Medical Society of the State of New York found that 40 percent of more than 400 physicians who had responded said they'd chosen not to participate in a health insurer's exchange plan, and one-third said they did not know whether they were participating or not.
Advocates say consumers should be careful of information in plan directories and confirm participation with their doctors.
Hannah Punitha (IRDA Licence Number: 2710062)
Roni Caryn Rabin, November 2013