AS THE DOCTORS SEE OBAMACARE (AND THIS IS JUST THE BEGINNING): DAVID PITMAN
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Abysmal payments. Lack of information. Even questionable business practices.
Those are all complaints physicians have had in the early stages of working with health insurance companies selling plans through the Affordable Care Act’s (ACA) health insurance marketplaces, also known as exchanges.
MedPage Today asked several attendees at this week’s American Medical Association’s interim meeting about their experiences with the new plan offerings. Responses from those with experience dealing with them on the whole weren’t positive.
“Neither the patients nor the physicians know if they’re in network or not,”said Steven Larson, MD, of Riverside, Calif., chairman of the California Medical Association’s Board of Trustees.
It has been a common complaint thus far, as plans have been slow to report or update provider networks for exchange plans.
Michael Sexton, MD, of Novato, Calif., said some physicians have received a letter stating they are in network for a plan unless they say otherwise. “One doctor told me he saw a document from a plan — with his [own] signature on it — that he never saw before.”
Richard DePersio, MD, from Powell, Tenn., said that one health insurer had contacted his practice about working with him, and he hadn’t heard of the plan before. Even worse, they offered rates lower than what Medicaid pays.
“I think everybody has an uncomfortable feeling about what is happening,” DePersio said.
Some providers have reported rates as much as 70% below what commercial plans pay, with negotiations starting at Medicaid payment levels. A survey released last month from the Medical Group Management Association reported 55.5% held an “unfavorable” or “very unfavorable” view of the impact the ACA’s health insurance exchanges on them.
With these stories starting to mount, the fear is that patients — with their insurance card in hand — either won’t be able to find a doctor who is seeing patients with that plan, or will have to travel great distances to find someone who does.
“Nobody’s gonna know how to access the system,” DePersio said. “I’m not sure how this is gonna work.”
John Antalis, MD, from Dalton, Ga., worried that newly covered patients will go back to seeking care from their usual places — the emergency room — which leaves the healthcare system no better off than it was before.
In an effort to involve more providers for its ACA exchange plans, the Blue Cross plan in Northwest Georgia included a clause in its provider contracts saying they must see exchange customers as well as traditional patients.
“At this point, we are at a negotiation stage with them,” Antalis said.
The group Doctors for America, which advocates for affordable health coverage for all, released a statement Wednesday pinning the blame for inadequate networks on health plans.
“The bottom line: insurance companies are responsible for the networks of providers in their plans. Insurers are required to provide a list of their networks for the new marketplace, which many insurance companies have not yet done,” Executive Director Alice Chen said. “We encourage insurance companies to help Americans in this time of great change by moving quickly to publish those lists, and ensuring they meet the needs of the people they serve.”
At a hearing before the Senate Finance Committee earlier this month, Sen. Robert Menendez (D-N.J.), questioned Health and Human Services Secretary Kathleen Sebelius about complaints his office has received about providers not receiving contracts or terms of participation from health plans.
Complaints have also come from the Medical Society of the State of New York, which has said insurance companies were not providing physicians relative fee information, or were not letting them know if they are part of an exchange plan or not.
Sebelius told Menendez only qualified health plans are on the ACA’s exchanges, and those plans have networks deemed adequate by regulators.
There is little oversight of the exchange plans, said Sexton, who chairs the AMA’s Council on Legislation. Many states don’t want anything to do with the ACA and have turned their backs on regulating parts of the law.
The Centers for Medicare and Medicaid Services is overwhelmed with implementing the law. “It’s an extreme challenge for them to manage some aspects of the exchange,” Sexton said. The AMA is developing model legislation for states to provide better oversight of exchange plans, he added.
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