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Obamacare: Good luck finding in-network doctors

Obamacare: Good luck finding in-network doctors

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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Idiots like Danielle Nelson deserve to get what they voted for, good and hard.

    kevino in reply to snopercod. | February 5, 2014 at 9:19 am

    And while I feel sorry for Nelson because having that disease is tough enough without also worrying about coverage, her story is important:

    1. Remember stories like this and use them as personal anecdotes when liberal idiots argue that government should run everything. (Single payer will be proposed again.) Remind them that governments screw up and intentionally mislead the public, but they are never held accountable. This individual was promised one thing, the State failed to deliver, and she is SOL. When you talk to an insurance company and they agree to something, have a witness on the line and get documentation. If they try to deny coverage after they promised they would, you can get them to honor their agreement. (I’ve won every time.)

    2. The Affordable Care Act doesn’t make care affordable. (See the CBO report.) However, there are provisions that make care affordable. The easiest way to make healthcare more affordable is to make it bad. That’s what is happening here. This individual is going to die, and while that is a tragedy, in a state run healthcare system, that is a cost savings. Another example of this is the panel who are going to set new standards for Medicare patients — lower standards. They will deny treatment to seniors. Healthcare will get cheaper, and Social Security financing will get better. The downside, of course, is that seniors will die younger and not get expensive treatment at end-of-life.

How you do deal with that kind of stupidity/insanity/willful blindness? Nelson: “I’m a complete fan of the Affordable Care Act…..” REALLY, lady? Then you deserve to stay awake at night and worry about how it’s going to take care of you.

“I am not an ObamaCare Doctor. But, I play one on TV…in the Rose Garden.”

Bitterlyclinging | February 5, 2014 at 8:37 am

Its only a temporary impediment. The State will mandate that all physicians accept Obamacare, take what they are paid and like it.
After all, the State grants them their sinecure, their licenses and rights to practice, and whatever the State giveth, the State can taketh away.

    Unfortunately, I believe you’re right. The same thing happened in 1962 when a group of N.J. doctors led by Dr. J. Bruce Henriksen said they would refuse to accept Medicare. A bill was introduced into the New Jersey legislature which said if they refused to care for a patient, their licenses could be taken away and they could be put in jail. Source:

    this has already been mentioned, iirc in 2011 by one of the ranking dems. hoyer maybe?

    Very ture: the State will mandate acceptance, Doctors will sue, and while the issue is being worked out, many doctors will leave the state or retire.

    How many people do you think will undertake eight years of difficult study and incur debts of up to $250,000, spend up to seven years internship at lower pay (depending on specialty), and undertake the responsibilities of running a small business if they can’t earn a substantial income in return?

    ObamaCare will either be repealed or our doctors will be replaced by those educated in the Third World who are happy just to get the green card.

oh you mean exactly as us evil gop racists said it would happen ????

“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.”

She voted for it, she got it. Total LInfo. Didn’t she hear Pelosi say they had to pass the bill to find out what’s in it?

“I’m a complete fan of the Affordable Care Act, but now I can’t sleep at night,”

What? So are you a fan or not?

Kinda reminds me of the Woody Allen lines from Annie Hall (which he borrowed):
“The food is terrible.”
“Yes, and such small portions.”

Or the Animal House classic:
“Thank you sir, may I have another?”

“I can’t imagine this is how President Obama wanted it to happen.”

Echoes of “If only Uncle Joe *knew* about conditions in this gulag, certainly it would be fixed!”

    Bruce Hayden in reply to Vancomycin. | February 5, 2014 at 2:08 pm

    Obama may not have wanted it to happen, but he was instrumental in making it happen. What must be remembered is that we have someone in the Presidency who had never really accomplished anything of merit in his life, except getting elected. He had never actually implemented legislation, run a business, etc. Rather, he got to where he is now completely through rhetoric. And, I think that we are seeing this here – his apparent attitude that all he needs to do is make speeches, and everything will work out, by magic, or the force of his speeches.

    So, I don’t think that he really cared one way or another, but rather, just figured that he could give some more speeches, and everything would be fine. I further think that it is unlikely that he knew, or maybe even knows to this day, much more than the bullet points about this legislation. That is what he has all those flunkies for – but, again, had no experience in hiring such, so no one should be surprised if they never brought this sort of thing to his attention (besides his well documented distaste for hearing bad news from his people).

Also from the article:

“Any huge implementation like this comes with a lot of moving parts,” said Health Net spokesman Brad Kieffer. “There is a learning curve for everyone, and we expect as time goes on these issues should dissipate.”

In other words, them sick folks will eventually die off, and the rest will get the message to shut up and eat their peas.

“I’m a complete fan of the Affordable Care Act. “But, I will have to file a claim before I know what’s in it.”

2nd Ammendment Mother | February 5, 2014 at 10:53 am

And like it or not, most of our doctors are foreign born and choose to practice in the US because of the freedom they have to practice medicine….. I wonder which countries are going to start offering all those doctors incentives to settle in their countries?

Henry Hawkins | February 5, 2014 at 1:32 pm

Rural America gets screwed by Obamacare. My son lives in the middle of nowhere, town called Calumet MI, in the UP. He’s on Obamacare. Nearest in-network MD for his plan is in Marquette MI, 115 miles away, but that office is not taking new patients currently.

Intended or not, Obamacare’s lack of networks/hospitals will force people to the metro areas. This demographic dynamic is already in effect for people chasing other entitlements.

Americans needn’t live with being the product of their own choices anymore. The Gubbermint will glady f**k it up for you.

One doctor recently published his open letter to Aetna terminating their relationship. (I forgot where I saw it this morning). Summarizing, he said they had had a good relationship for over 25 years that he felt was good for his patients, but their new payment schedule and restrictions on testing, etc., in his opinion interfered with the doctor-patient relationship in a way that harmed care. He alleged they never asked or notified him of the changes, and he never agreed to accept their new ObamaCare reimbursements, but Aetna had advertised his practice as being in their network of coverage.

He said he was already turning away patients showing up with Aetna, and requested they stop using his name falsely to sell insurance on the exchange.

Mulitply this by around 100,000, and you will have seen the future.