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Today on NPR:

"I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates. You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on," he says.

Three insurers offered plans on Connecticut's ACA marketplace in 2014 and Gerard is only accepting one. He won't say which, but he will say it pays the highest rate.

The NPR piece goes on to describe how state healthcare officials are concerned about whether whether we might be headed toward a tiered healthcare system as a result of not enough doctors accepting the plans on the exchanges.

A few days ago I published a diary that seemed to foreshadow all of this.  In the comments, I was told summarily that my complaints had nothing to do with the ACA, just the incompetence of private insurers.  But maybe not so fast.

In a nutshell, I had my insurance company assign me to two different doctors in succession.  In both cases, the company in question (Molina) believed that both these doctors  accepted Molina Marketplace (the ACA Exchange plan).  It turned out, in both cases, they were wrong, the doctors did NOT accept this insurance.  In the case of the second doctor, Molina called the office to verify that they took the insurance, and were told the doctor did accept that insurance.  Then, several weeks later, another rep was told they didn't.

At the time, I thought, gee, I hope there is nothing about the ACA that is making these doctors stop taking the insurance.  Now, it's possible that they never took the insurance, and this was just an error on the part of the insurance company.  But two days later, I hear this story on NPR, about doctors deciding they can't or don't want to accept the ACA plans because the rate or reimbursement is too low.  It's possible that what I experienced is another instance of exactly this phenomenon: physicians cutting the ACA loose because the reimbursement rates aren't high enough.

Whether or not my story is connected to these developments or just a fluke, the ACA seems to be facing a challenge here: if it can't pay rates that make doctors want to accept it, those of us with insurance through the ACA are going to find ourselves, as the article says, with insurance, but unable to visit a doctor.

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Comment Preferences

  •  Tip Jar (5+ / 0-)

    "Fighting for us, good. Winning, better. Talking about fighting? Not so good."--Atrios

    by andrewj54 on Sun Aug 03, 2014 at 03:31:24 PM PDT

  •  Not all doctors accepted all insurance before. (10+ / 0-)

    This is nothing new.

    "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Sun Aug 03, 2014 at 03:41:12 PM PDT

    •  Did you look at the NPR piece? (4+ / 0-)

      It talks about officials in CT being concerned that not enough doctors are taking the insurance to make the exchanges viable.

      Of course not all doctors take all insurance.  That's not the issue.  The question is whether enough doctors will accept the insurance that people can get care through it.

      "Fighting for us, good. Winning, better. Talking about fighting? Not so good."--Atrios

      by andrewj54 on Sun Aug 03, 2014 at 03:48:55 PM PDT

      [ Parent ]

  •  The ACA doesn't pay any rates. It's not an insu... (8+ / 0-)

    The ACA doesn't pay any rates. It's not an insurance plan, it's a law.

    Some plans sold through healthcare.gov and/or state exchanges pay a lower reimbursement rate than plans not sold on an exchange. It could become an issue, however the law is still new and the market is adjusting. It will work itself out. In the short run, it might take premium increases to allow insurers to pay higher reimbursements but as the cost control measures of the legislation begin to take hold and reform the industry, the cost of care will drop.

    Also, not sure what you mean by your health insurer "assigning" you doctors. You get to pick your doctors, they just need to be in your insurers network if you wish them to pay for it. But your free to see any doctor you wish.

    •  I selected the doctors. (1+ / 0-)
      Recommended by:
      BlueMississippi

      I had the rep from the company do the work of making the actual change.  I could have done this online myself.

      And the truth is, we don't know whether it will work itself out or not.  Clearly, from the NPR piece, the officials in Connecticut are concerned.

      "Fighting for us, good. Winning, better. Talking about fighting? Not so good."--Atrios

      by andrewj54 on Sun Aug 03, 2014 at 03:46:42 PM PDT

      [ Parent ]

      •  I work for a large health system and (4+ / 0-)

        as I said, it's a concern but not a doomsday scenario. In fact the simple fix is a 10-15% premium increase next year. The good thing about the way the premium subsidies work is they are figured by calculating what percentage of monthly income someone should pay for their insurance based off their income, so if someone is at 250% of the fpl, they pay no more than something like 6-7% of their income monthly. Which means a portion of the premium increase will be covered simply by the gross dollar amount of the subsidy increasing and it won't all pass through to the customer. It will cost the government more but shouldn't result in huge sticker shock for customer compared to the prior year.

        The healthcare industry is a $3.3 trillion a year industry, it will take more than 6 months or even a
        couple years before there are gains made in decreasing the cost of care.

        •  Ok, thanks for the information. (1+ / 0-)
          Recommended by:
          Wednesday Bizzare

          Glad to hear you think it will all shake out in the end.

          "Fighting for us, good. Winning, better. Talking about fighting? Not so good."--Atrios

          by andrewj54 on Sun Aug 03, 2014 at 04:05:16 PM PDT

          [ Parent ]

          •  No, it won't "shake out" in the end. (1+ / 0-)
            Recommended by:
            BlueMississippi

            As the cost to "the government" (i.e., taxpayers) increases as subsidies increase, tax rates will necessarily have to increase.  The middle class will not be on board when it comes to their taxes being raised by a significant amount ... especially when their insurance premiums and deductibles (with or without subsidies) are also significantly increased.

            "Two things are infinite: the universe and human stupidity, and I am not sure about the universe." -- Albert Einstein

            by Neuroptimalian on Sun Aug 03, 2014 at 09:03:58 PM PDT

            [ Parent ]

    •  And the ACA is not only a law, its a program. (2+ / 0-)
      Recommended by:
      Metric Only, BlueMississippi

      And the program does pay subsidies.

      "Fighting for us, good. Winning, better. Talking about fighting? Not so good."--Atrios

      by andrewj54 on Sun Aug 03, 2014 at 03:58:03 PM PDT

      [ Parent ]

  •  Nearly every worker... (5+ / 0-)

    ...in America has taken a pay cut.

    We all love doctors, but there is no reason why they shouldn't take a pay cut also.

    Don't worry, when the lease on the BMW is up, doctors will come around.

    If not, then we'll train more. If we cut the cost of medical school, doctors wouldn't need to charge so much.

    •  It'll take another decade or more ... (0+ / 0-)

      before the pool of available doctors can be increased, regardless of the method(s) used ... and that's assuming a significant number of sufficiently intelligent students are even interested.  Medical school is a VERY hard row to hoe.

      "Two things are infinite: the universe and human stupidity, and I am not sure about the universe." -- Albert Einstein

      by Neuroptimalian on Sun Aug 03, 2014 at 09:07:33 PM PDT

      [ Parent ]

  •  We should have single payer instead of Obamacare. (4+ / 0-)

    What's wrong with Obamacare is there's no guarantee that doctors will take it--a problem single -payer would solve.

    So many books--so little time. Economic Left/Right -7.88 Social Libertarian/Authoritarian -6.97

    by Louisiana 1976 on Sun Aug 03, 2014 at 03:42:33 PM PDT

  •  Doctors have to decide with whom they will (4+ / 0-)

    align, patients or insurance companies.  The patient generates the payment, irrespective of the payment source.  Doctors know that.  They grumble about expenses and income fluctuations like all the rest of us.  This is a change we are in the process of rolling with, just as we're rolling with a radically changing employment landscape.

    Building a better America with activism, cooperation, ingenuity and snacks.

    by judyms9 on Sun Aug 03, 2014 at 03:46:15 PM PDT

  •  OK (6+ / 0-)
    Three insurers offered plans on Connecticut's ACA marketplace in 2014 and Gerard is only accepting one. He won't say which, but he will say it pays the highest rate.
    So one or both of two things will happen.  If patients still want to see Dr. Gerard, they'll pick the plan in which he participates.  Remember that if you're getting a subsidy, your rate probably won't change.  On the other hand, if you weren't seeing him, you won't ever see him or know he exists.  So you'll go somewhere else.

    On one hand, Dr. Gerard has to decide if he can make do without those patients.  On the other hand, the major determinant of the profitability of an exchange plan is its ability to attract large numbers of subscribers: if not seeing Dr. Gerard and all the other Dr. Gerards out there causes the plan to lose subscribers, they'll go cut a deal with him.  If he's got a big practice, he probably has some clout in this department.  If he's a small practice, he has less clout.  If he's being interviewed for this article because he is ideologically hostile to the ACA (we don't know, but NPR is an MSM outlet and pulls this sort of shit all the time; they started with the decision to write an article that "the ACA is failing" and cherry picked anecdotes to support it) he likely doesn't understand how to negotiate with the insurance company as a customer and farms this out to his business manager.

  •  I don't know about CT, but (2+ / 0-)
    Recommended by:
    Metric Only, worldlotus

    in CA (Los Angeles, specifically) we were offered a variety of different plans, some HMOs (fewer options, doctors probably paid less), some PPOs (more options, doctors probably paid more), and some even richer plans. The better the plan, the more it costs. That's just like in real life.

  •  Eight plans from three insurers in my state (0+ / 0-)


    These were all at the silver level;  there were 22 Bronze plans in the mix as well.  

    When it was time for me to select, I looked at the provider lists, chose a plan that (I thought) included the place I go for healthcare, and chose it.  Unfortunately there are two centers with very similar names and dissimilar services, and mine was not on the list.  

    It would have been bad news, except that I rather like my new doctor and my May, June and August scripts will be written by the same meds doc, as opposed to what happened before.  

    "Politics should be the part-time profession of every citizen who would protect the rights and privileges of free people and who would preserve what is good and fruitful in our national heritage." -- Lucille Ball

    by Yamaneko2 on Sun Aug 03, 2014 at 09:56:56 PM PDT

  •  Humana GA (0+ / 0-)

    Thus far has had a wealth of Drs and hospitals that accept it.

    What I found in helping others enroll is how much the insurers, type of plans/coverage and in network docs varies from state to state and county by county.  

    I'm fortunate.

    I was diagnosed with cancer recently and with it have a team of Drs (primary, surgeon, oncologist, radiation plus two hospitals) which have been in network.  

    I have found that it can be difficult confirming who accepts which insurance, you need to carefully confirm using the provider's street address to be sure.  Usually this is done through the insurance company.

    Some Drs have a person on staff who is knowledgeable but surprisingly I've found some who could not tell me which insurance they accept.  

    Before I selected my ACA plan I made sure my primary and gyn were in network by carefully checking both with the insurance company and the Drs offices.  It's a pain, shouldn't be so hard but the system by which the different parties keep track is inefficient and flawed.

    The other thing I learned and as noted above, Docs may take one type of plan from an insurer but not another, usually it's the HMO plans they refuse.

    Overall I've been very happy with my in network docs and my insurer given my recent diagnosis.  After years in the private insurance shark tank I've found Humana to be exceptional and never thought I would say that about a private insurer.

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