Some patients in California are finding out that once they’ve managed to sign up for a health insurance plan through the state exchange, it still may be difficult to determine whether or not a doctor actually accepts their insurance plan.

From the LA Times:

After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor’s office.

A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.

Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.

Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin’s lymphoma and discovered a suspicious lump near her jaw in early January.

But when she went to her oncologist’s office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.

“I’m a complete fan of the Affordable Care Act, but now I can’t sleep at night,” Nelson said. “I can’t imagine this is how President Obama wanted it to happen.”

Nelson received a temporary extension from her new insurer through March 31 after numerous complaints to the company and public officials, but says she will look into other policies before the close of open enrollment, according to the LA Times.

The LA Times report goes on to provide other examples of patients who have experienced similar confusion and frustration.  One was referred to a specialist and found that at least four doctors did not accept her plan, despite the fact that the state exchange and insurer listed them as participating in her HMO network.  State regulators eventually intervened and she was finally able to visit a specialist.

More generally, the issue of in-network availability is one that has been raised on numerous occasions as a potential concern for consumers, as insurers look for additional cost-cutting measures under the new health care law.

Other states have also seen more limited networks.

From CNN Money:

Now that health plans are for sale on the exchanges, one thing is clear: To accept everyone regardless of health, cover all the law’s essential benefits, and keep prices competitive, insurers have had to cut corners. One way is by setting high deductibles (see the table at the bottom).

Another is limiting how many hospitals and doctors are considered in-network much more than a typical policy does. “There are only so many levers you can push, particularly in a short time frame,” says Sabrina Corlette of the Georgetown Health Policy Institute.

According to a recent McKinsey study of mid-priced exchange policies being sold in 20 urban areas, 70% of plans exclude at least a third of large hospitals in the area from their networks. Narrow networks are almost three times more common than they were among individual plans in 2013, the study found. The one insurer selling so far on the New Hampshire exchange has deemed more than a third of the state’s hospitals out of network. In Washington, Seattle Children’s Hospital has sued the state’s insurance commissioner because the facility is excluded from many exchange plans.

But as a recent Washington Post report previously noted, narrow networks certainly did not begin with Obamacare.  However, the new law is likely accelerating the trend.

Some have argued that narrow networks help to control costs and lower premiums for customers, and view it as an effort in stimulating competition.

From TIME, Keeping Your Doctor Under Obamacare Is No Easy Feat:

But while some might say insurers are sacrificing patient choice and quality in service of the bottom line, there’s another way to look at the narrow networks being offered through Obamacare. “Everyone needs to commit to thinking about ways to reduce the unsustainable year over year increases in the cost of health care,” says [Steve] Shivinky of Blue Shield [of California]. Doctors and hospitals are now under new pressure to lower prices to get access to the flood of new customers shopping for insurance through the law’s exchanges.

“This is market competition,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation who studies the insurance market. “Whether you like it or not, this is what we signed up for.”

But not all consumers will necessarily see it the same way.  Especially those patients with medical conditions who might have been depending upon their preferred choice of doctors.

Others may simply be patients who have trouble finding medical providers within a reasonable distance from their home.

Most reports say it’s still too soon to really know the full impact of such details on patients yet.  But with more people signing up for the coverage, this is an issue that’s likely to gain more attention with consumers over time.


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