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Some healthcare providers turning away patients with marketplace plans

The Affordable Care Act has allowed many people to choose their own healthcare insurance benefits through the federal and state exchanges instead of having to rely on their current or former employers to provide these benefits. While a recent survey by The Commonwealth Fund noted more than half of marketplace enrollees have been able to use their plans to receive healthcare, there are many healthcare providers across the country who are refusing to see people with exchange plans. According to the Miami Herald, some doctors who are listed as part of marketplace plans’ insurance networks aren’t seeing patients with these plans because the physicians may not receive timely reimbursement from the plans. While avoiding these patients may be easier for some physicians, who often have to play it safe to stay in business, the number of patients with marketplace plans may only grow. Education may be key to ensuring patients are able to find the right providers and receive care.

Many patients being denied care by physicians

The issue stems from how much money these doctors will receive for providing care – some of these insurance plans only cover a small percentage of care costs, such as 50 or 60 percent, leaving the rest to patients to cover. These high-deductible plans can end up putting a lot of pressure on patients to pay doctors, and physicians can see long times in between payments because of it. Physicians already receive low reimbursement from Medicaid, and, according to Fox News, some healthcare professionals have been noting their concern about how marketplace plans may end up causing lower access to care. Forbes noted physicians have received relatively low reimbursement from Medicare and Medicaid for years and have taken similar measures to reduce the number of patients they see with these types of coverage. 

Jay Millson, executive vice president of the Florida Academy of Family Physicians, told the Miami Herald physicians and doctor’s offices are trying to protect their revenue streams by not taking the plans. However, this strategy has been causing numerous problems for patients, insurers and doctors alike.

Sal Morales, a Floridian who bought a health plan this past enrollment period, said he experienced hostility from practice staff when his insurance was checked.

“They got into a screaming match,” Morales said regarding the conversation he witnessed between a practice employee and his insurer, “with the receptionist, a lab technician and even the doctor – and me at the dividing wall, listening to all this, with about 17 patients in that little room listening to the fact that I had what I thought was the worst insurance on the face of the earth.”

An op-ed in USA Today by Dr. Kathryn Chenault, a neurologist, noted health insurance costs are rising and members in the healthcare community are trying to find ways to keep these costs under control. Because of the ACA, marketplace plans are the ones that may be most effected by some of the most common cost-control measures. Some insurers are narrowing networks, increasing patients’ out-of-pocket costs and reducing the types of medications and care enrollees can receive. Chenault wrote it is the ACA that is driving doctors to refuse patients with marketplace plans, and that healthcare reform has put many physicians in the awkward situation of having to choose between seeing more patients and receiving adequate reimbursements.

According to the Miami Herald, there are some physicians in Florida in particular who support the ACA and don’t ask patients where they receive their healthcare coverage. However, the newspaper reported, one of the most important things is education for patients and physicians about these plans. 

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Erin Woulfe
Erin Woulfe
Erin Woulfe likes to write about things that matter. Keeping her finger on the pulse of what’s happening in the public sector world, she blogs about the latest legislative news and employee benefit trends that affect our school, city and county clients. She’s been with NIS since 2002. “I love connecting to our clients and providing them with the tools they need in order to administrate their plan,” says Erin. “Whether that be materials to educate their employees on certain benefits, how to effectively communicate change within an organization or just providing tips and how-to’s to help them make their job easier.”

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