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Several Newly Insured Citizens Under Obamacare - Face Difficulties Finding Doctors

by Vanessa Jones on November 27, 2014 at 6:42 PM
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 Several Newly Insured Citizens Under Obamacare - Face Difficulties Finding Doctors

Millions of Americans bought health insurance through the Affordable Care Act, though in some markets doctors are not too open to take on patients who have insurance through the federal exchanges created by Obamacare.

  "I think doctors have a couple of problems with the exchange policies," said Dr. Austin King, an otolaryngologist and president of the Texas Medical Association.


People often don't understand their insurance coverage, so staff members have to educate them, "and that adds to the hassle of seeing these patients," King said.

Doctors are also cautious about the law, which provides subsidized coverage for a period of 90 days before their policy is cancelled without premiums being paid. Doctors felt that after giving care to people with subsidized coverage, the policy may not be valid or may be cancelled due to failure to pay premiums.

  Recent news reports also indicate that some doctors in states like New York and Florida are reluctant to accept Obamacare patients because reimbursement rates are well below those of traditional health insurance plans.

"We are hearing from a lot of physicians about the fees which they're being paid by the exchange plans which is substantially lower than the fees that is paid by the same companies in the commercial plans. That's one of the reasons why a lot of physicians don't want to participate in the exchange," said Dr. Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. "I've heard fees as low as 50 percent of the Medicare rate," he added.

For consumers buying health plans on the New York State of Health, trying to find a doctor is difficult because provider fees are low and very often the provider directories are inadequate.

New York Attorney General Eric Schneiderman has requested consumers who shop on the health insurance enrollment open season "not to rely solely on provider lists offered by insurance companies." He advises consumers to check with both their providers and their health plans before signing up and "not rely solely on provider lists offered by insurance companies."

Obamacare consumers also face problems like lack of timely access to care and shortage of physicians in urban and rural areas, which is very normal.

  These are "significant issues in our health care system, ones consumer advocates like me have been working on for many years," said Anthony Wright, executive director of Health Access California in Sacramento.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities in Austin, Texas, also said: "There are going to be people who have a hard time finding doctors. And I don't know if it's because doctors don't want to take Obamacare, or if it's always been hard to find psychologists who speak Spanish, for example."

Covered California - the state insurance exchange of California has very limited and narrow provider networks.

"People need to know what they're buying," Wright said. "They need to know, 'Is their doctor in the network?'"

People signed up "not realizing that their physician that they had already been going to for years may not have been in that network," said Katie Dageforde, assistant general counsel at the Tennessee Medical Association.

The National Association of Insurance Commissioners, a standards-setting organization, is currently revising its model regulation for network adequacy. Consumer advocates said that regulation may pressurize states to put pressure on those with limited and narrow networks to expand its' physician and care services.

Reference: Karen Pallarito


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