November 12, 2013, - 3:52 pm
It Gets Worse: Doctors Can’t Afford to Stay in Biz Under ObamaCare; Still Don’t Know Which Doc is in Which Network
I’m not going to be able to take a full day of [ObamaCare] exchange patients and keep my doors open.
–Michelle Berger, MD, an Austin, Texas ophthalmologist.
Bend Over: Doctor Obama of the University of Community Organizing Medical School is Ready to Operate on You
It’s bad enough that the ObamaCare website, Healthcare.flub, is still a bleeping disaster. Now, it turns out that doctors are in the dark about which doctors and hospitals are in which providers networks. So much for Obama’s BS claim that “if you like your doctor, you can keep your doctor.” It’s as true as his “if you like your plan, you can keep your plan.” In fact, your doctor doesn’t know if he/she can still see you. And those who do are balking at the rates they’ll be paid. In many cases the payments are so low that doctors don’t know if they’ll be able to remain in business under ObamaCare. This is the socialized medicine we feared but that Obama said wouldn’t happen. Well, it’s happening. The death panels, the death sentences for those with cancer, the docs who can’t set their own prices. It’s all here.
More than a month after HealthCare.gov and 15 state-based exchanges opened for business, consumers and even physicians are finding it isn’t easy or even possible sometimes to find out which doctors and hospitals are in the plans’ provider networks. “Some states, they have it, and for some, it isn’t available. It ‘s a big unknown for the patient,” says Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, whose members manage doctors’ practices. “It’s very much up in the air.”
That means insurance shoppers often can’t choose plans that their doctors participate in — or that include doctors near them. It also means doctors may not be able to confirm they’re in a plan when consumers ask them. While consumers may now occasionally find a doctor listed on their commerical insurance plan isn’t accepting patients or is no longer on the network, at least they can reliably find provider lists and doctors at least know what plans they currently participate in.
Gilberg says he wouldn’t buy a plan “if I didn’t know if my physicians were in the network or the hospital was in the network.” . . . The uncertainty stems from the general glitchiness that remains for some state exchanges and the federal site, HealthCare.gov, which is selling plans for 36 states that didn’t set up their own exchanges. It’s also due to the fact that insurers are still deciding what doctors they want on their networks and often haven’t even informed doctors if they are including them on their networks.
Some insurers have clauses in contracts with their existing doctors that say the doctors have to participate in any plans the insurers offer in that state. Doctors who don’t want to participate on the exchange plans might have had to opt out, which some may not have realized, says Sam Unterricht, a Brooklyn ophthalmologist who heads the Medical Society of the State of New York. And many doctors and hospitals are still negotiating with insurers over rates.
A survey released last week by the New York medical society found 40% of 405 doctors said they didn’t know how they wound up on insurers’ exchange plans. Just 6% said they chose to be on plans and 16% said they had to participate as part of a contract. The rest said they declined to participate. Three quarters of the doctors said they had never received a fee schedule from insurers for the plans.
In an attempt to cut costs, insurers are also cutting the number of hospitals and doctors they include in networks, and that’s a process that may continue through December. . . . In one rural area of Tennessee, there will only be two insurance carriers, and one isn’t listing any doctors yet. Another is a new co-op insurer and is still building its medical network, says broker J. Darlene Tucker, based in Scotts Hill, Tenn. . . .
Some doctors say they’re still waiting to hear what rates insurers are paying — or they are appalled they are so low. Michelle Berger, an Austin-based ophthalmologist, says she has only heard from one of the insurance companies she works with and she signed a contract to be on Blue Cross of Texas’ exchange plans. She did so before she saw the fees she would be paid, which she says are only slightly better than Medicaid. “I’m not going to be able to take a full day of exchange patients and keep my doors open,” she says. . . . In Sugarland, Texas, internal medicine physician Elizabeth Torres says she doesn’t know what plans she’s listed on, but she does know her profit margins are so thin she won’t be able to accept many patients at rates that are lower than Medicare. . . .
Around some other states:
• In New York, broker James Schutzer found a 2,025-page spreadsheet of doctors when he looked up hospitals on the NY State of Health exchange recently. When he went on Empire Blue Cross’ site, he got the same spreadsheet and a “Find a Doctor Alert” that noted the individual and small group health products are “under construction.”
Unterricht says the accuracy of the provider lists will be suspect, too, because doctors may unwittingly be on an insurers list since they already accept their commercial plans. “Some may not accept new patients right away, and some may not accept new patients at all,” he says.
• In California, the provider network for individual plans became searchable Wednesday, and there’s still no access to the plans for small businesses in the Small Business Health Options Program or physicians in the networks. The state had to start from scratch building the medical network because there was no consistency in medical coding, says Sacramento broker Laurie Rood. Programmers didn’t realize each insurance company had a different physician code.
Yup, it’s a giant clusterbleep disaster. And it’ll only get worse. Who the heck will go into medicine when payments are so low? Not the best and brightest. You want the local loser from community college to do your heart transplant? Good luck with that.
Keep Bending Over for Doctor Obama. And while you’re at it, BEND OVER SOME MORE.