Anyone have issues with doctors not taking ACA insurance?

[Paula Sims]

Hi there,
I called a new GI doctor today to schedule an appointment for stomach pains and a rare GI issue. The conversation went something like this:

ME: I'd like to make an appointment with Dr. Smith. I am a new patient.

OFFICE: OK, but we need to tell you we don't take all insurance. What insurance do you have?

ME: BCBS PPO

OFFICE: Well, please take out your card and check if it has special markings on it.

ME: OK, what are you looking for?

OFFICE: Does it have Gold, Silver, or XX, XX, XX designations?

ME: No

OFFICE: Does it have XXX-W <implied union markings> or XXX insignia?

ME: No, it's a regular card. Why? Sounds like you don't take ACA insurance.

OFFICE: No, we do not accept any ACA based insurances.

ME: Why not? <<getting a bit ticked for the people that have ACA but obviously won't be able to see this doctor>>

OFFICE: I don't know, it's a management insurance. You'll have to speak with the doctor about that. Now, when would you like the appointment?


I was steaming and would have found someone else but I can't wait wait the 3 months to get in to see the other doctor (who I'm not sure takes ACA insurances anyway) and he's a specialist in my GI issues.

That got me thinking -- anyone else have issues getting in with ACA doctors? Reactions?

Also, karma points the other way. Made me think of all those people who want school vouchers and made me think that some schools might not accept vouchers -- making the crazies all the madder.

Thoughts?

[Anansi1171]

1. I pray you make the appointment, ask the doctor directly and share what he says.

God bless capitalism and the warm-hearted American people.

[yeoman6987]

30. Their choice. Many don't take Medicare patients either.

[flamingdem]

43. Not always. It's about the network they're a part of

For instance UCLA doctors tried backing out, some of the busier ones, but they could not since Anthem made a contract with UCLA.

So ymmv

[etherealtruth]

2. I had some trouble finding an orthopedic surgeon ....

... with my fairly expensive employer sponsored insurance.

I do not doubt your story ... however, it is really not very different from mine

[NaturalHigh]

3. I'm fortunate to have very good insurance through my employer.

One of my doctors, though, told me that his clinic was not taking most of the ACA-type insurance policies because they pay the providers practically nothing. He told me that they are basically catastrophic-care policies as far as the clinic is concerned.

[bettyellen]

8. nonsense- there are many levels to the ACA and only ONE type is at all similar to catastrophic care

and in my market, they all cost less than half of what those policies used to if you got them independently.

[NaturalHigh]

9. I'm only telling you what I was told.

[bettyellen]

14. I'm just saying they are referring to the lowest tier of available plans

and the insurers have been working to add doctors where demand is greatest. some are getting higher reimbursement rates because the insurers HAVE to actually have doctors in network. unfortunately, it is a work in progress, especially for the lower tier.

[BrotherIvan]

46. I was told this by the insurance company itself

My insurance is no good in any other state, including emergencies. The number of doctors in the network are extremely limited, just the company taking advantage of all the loopholes. My ACA insurance is worthless trash.

[still_one]

4. I suspect they wouldn't take Medicare or Medicaid/Medical. Regardless, there should be enough good

Doctors and hospitals that do. I know that places like UCLA, UCSF, Stanford and most major clinics do in San Francisco.

[PoliticAverse]

5. Many ACA plans offer lower reimbursement rates to doctors resulting in less doctors accepting them..

This article discusses the issue:
http://www.kaiserhealthnews.org/stories/2013/november/19/doctor-rates-marketplace-insurance-plans.aspx

[savalez]

6. But you have Blue Cross Blue Shield?

There's no difference between that and if you bought the same plan straight form BCBS.

Sounds like you're about to meet Doctor RW Kookbird.

[antiquie]

16. The ACA Blues are not the same as direct purchase Blues

Many (most in some counties) of the doctors listed on CoveredCA in the different Blue plans turned out not to accept ACA. There are horrific stories of people unable to continue their life-saving care.

California consumers say duped by Blue Shields limited Obamacare plans
Consumers Sue Blue Shield Of California Over Doctor, Hospital Network
Anthem Blue Cross faces another suit over Obamacare doctor networks

[Sunlei]

7. most all the ACA/ any insurance requires you ask your Doctor listed on your insurance card.

yes, I think Doctors should 'be allowed' to take any insurance but of course if they are full they can refuse new people then.

I think its the insurance companies who don't want to let you go anywhere you wish.

[MADem]

10. Don't know a single solitary person who has had any issues like that w/the ACA.

I can't imagine any doctor being that stupid, frankly. It's a bill that WILL be paid--it's counterintuitive for a doctor to turn that kind of money away, especially since so many of them use PA's to increase their billable hours.

If I ever encountered such a thing, I'd tell them to look forward to a scathing series of reviews on Social Media, and sites like "Bad Doctor." Then I'd tell 'em to have a nice day!

I'd say Welcome to DU but I see you have been here quite a while.

[Yo_Mama]

19. You're wrong.

Most doctors are limiting these patients, or only accepting a certain number.

And it's not true at all that the bill will be paid, due to special rules about cancellations. Basically, the policy can only be cancelled after three months of non-payment. So the provider's office may check ins and see that the patient is "insured" - but that is a lie. The insurance company doesn't have to pay any claims for the last two months of premium non-payment. That's much more of an issue for a provider like a surgeon who has to bill expensive procedures.

I volunteer at a clinic which provides treatment to non-insured patients for free. Also we treat a lot of Medicare patients who can't find decent care. We accept most private insurance patients. But we are accepting absolutely no ACA patients at this time. One reason is that it is costing us far more to treat these patients, because all we get is denials. It costs us far less to treat an uninsured patient than it does to treat an ACA patient,

Now, I suspect this varies by state, and perhaps by ins co. But the problems are real.

You have to understand that the risk of malpractice claims from any particular patient increases as what their insurer covers decreases, because you take more risks.

[pnwmom]

25. You are saying that doctors give poorer treatment-- resulting in more malpractice claims -

when insurance covers a smaller proportion of the payment?

That doesn't say much good about the doctors you work for.

[Yo_Mama]

28. The doctor is working for free and I am working for free

NO ONE PAYS US, GET IT? THIS IS DONE BECAUSE PEOPLE NEED MEDICAL CARE.

Insurance companies are required to do certain things, under the law. They aren't doing them - problem 1.

Problem 2 - they aren't approving stuff they would have approved last year.

Problem 3 - They are systematically refusing to respond to the authorization requests, even with a denial.

Problem 4 - When I tell the patient to call the ins co because they have not respondied to FIVE requests for authorization (we send a new one in every 48 hours, because they are supposed to respond by then), the patient is told that they never received it.

Therefore, we have to document all this, give the documentation to the patient, and put in our records so that the doctor is covered legally. He did not get this, because he is a doctor, not a lawyer. So I had to break the awful news to him. Then when the patient calls the insurance company with our documentation, abruptly we get at least the denial, so we can go to the next step.

It's your indifference, not mine, that is ultimately going to kill these people. At least I am trying to deal with the situation.

I talked to the local pharmacists. They say it's the same for every patient. They are going nuts too.

The bottom line is, we can still effectively treat non-insured patients. We cannot effectively treat ACA patients, so we are refusing all new ACA patients. Our ability to treat Medicare patients is somewhat worse than last year, but it's still possible if you stay on it.

Personally, I have come to the conclusion that ACA is a conspiracy to kill poor people. I don't know what other explanation there could be. Also, some of the major insurance companies (here's to you Anthem BC/BS, the modern Mengele) are now systematically denying ordinary and routine medical care to NON-ACA policy holders. This started in February of this year.

[pnwmom]

29. I"m not indifferent. I said people should be reporting this to their states.

In my state, my son has an ACA policy, and he hasn't had trouble getting providers. We did check to make sure that his main ones were on the list, and they were.

Also, how can you blame the ACA for major insurance companies denying routine care to NON-ACA holders?

[liberalhistorian]

38. It's not the ACA that's the problem, it's the insurance

companies that are doing this. They are doing what they do best, fucking up people's care or denying it altogether while they pay themselves exorbitant salaries and perks; the ACA is just another way for them to do it. And they're working the ACA especially hard on this because they want people to be against it and make it look bad so it will ultimately fail.

[BrotherIvan]

47. Why do you think they wrote it?

They love it! They don't want it to fail. They have MANDATED customers to screw over. What's not to like?

[vi5]

53. I've heard this from a bunch of people

I know you're getting criticized for daring to point out the flaws in this wonderful system (sarcasm), but I have several doctor, both my doctors and friends and family members who are doctors who are saying this same thing. They aren't refusing to treat ACA patients but they are saying in many ways for them it's worse than uninsured patients because not only are they not getting paid, the paperwork and red tape involved is costing them additional money.

These are not wingnuts by any stretch of the imagination and many are and were in favor of healthcare reform.

[Sgent]

41. How do you know if I have an ACA policy?

There are two bcbs networks in my state -- ppo and HMO. The ACA policies have the same payment amounts and coverage of any policy in the respective network.

[MADem]

50. I'm not wrong--I said I didn't know a single solitary person with those issues,

and that is true, correct, and accurate.

The purpose of your volunteer work is to provide care to uninsured people, not insured people. It makes sense that they wouldn't be leaping to take people with insurance, as the people without would be displaced in the queue.

If your clinic is not accepting any ACA patients, how can they know if they're getting denials? They don't have any patients against which to judge.

No one denies there were a few rough spots at roll-out, but if you aren't accepting the patients, you can't really judge the program and how it's working today.

[kelliekat44]

54. So the next update to the ACA should really be universal healthcare since the corporate insurers don

want to serve the people.

[MADem]

58. If providers are crying about "reduced profit" now, they'll really have

something to whine about if we ever take that step.

Many NHS doctors in UK also work "private" to pad their incomes. It's very common.

[taught_me_patience]

33. Blue Cross is reimbursing 30% less for ACA plans

sorry... nobody works for 30% less pay and is happy about it. For that reason, many doctors are choosing not to accept ACA exchange patients. My wife is a private practice GP who accepts ACA plans, but once her patient panel is filled, they will get pushed to the back of the line. A small percentage of her patients have changed over, and it has made an impact on profit this year.

[liberalhistorian]

39. So, profit is more important

than people who desperately need care but may not be able to afford it on their own? And they get dicked around and sent to the back of the bus because of it? Nice, real nice.

[elias7]

49. So you would happily take a 30% paycut if your job was noble enough?

[justamama83]

55. Doctors have bills too

As horrible as you seem to think of it- running a medical practice is a business. They have rent, payroll, supplies, equipment, malpractice insurance anything that an office would need- and that's just for the practice- they also have families, student loans, mortgages, car payments so for someone to take a 30% cut in a payment it's pretty easy to see why they either do not accept the ACA insurance or limit the number of patients with ACA or adjust how they schedule. The days of the local doc taking chickens in trade for his/her services has gone the way of the dinosaur thanks to insurance companies and for profit hospitals.

Here is an example - a bit of apples to oranges but you'll see my point. I had the crappiest DMO dental insurance- it was great for me- cheap- covered a nice % of the procedures - but it was crappy because hardly any dentists took it because their reimbursement was very low. One day I call for an appointment and they asked me what kind of insurance I had- I told them and they told me it would be 6 weeks before they could see me. This was just for a check up. So I was not too happy with that and had my husband call back and when they asked about insurance he said he would be paying cash. Guess what- they had an appointment within 4 days. I called the insurance company to complain but was told it was at the discretion of the dental practice how they did their scheduling.

[taught_me_patience]

59. When one is a doctor, profit=income

Would you take a 30% cut in income? Also, a 30% reduction in gross income can easily translate into a loss of all profit. For example, take a small practice that grosses 600k, with a 30% net profit margin... the doctor is making 200k. Let's say every patient reimbursement is dropped 30%, and patient volume stayed the same. Now, the practice grosses 400k, but all the fixed and variable costs are the same (400k), so there is ZERO profit. Would you be willing to work for free?

[MADem]

51. This poster, though, is telling us what the insurance company will not do,

while not having any ACA patients to prove the thesis.

The insurance companies are being forced to play ball and plow most of their money into the patients they are covering rather than CEO bonuses. There is a lot of shake-out happening, but the ship is righting itself. Doctors are going to have to adjust, too and find economies. The sickness for profit days are coming to an end.

[Kilgore]

11. Not Uncommon

We compared the provider list of an ACA policy purchased through the exchange and the same policy purchased directly There were many more providers available for the direct purchase policy and the ones accepting ACA policies were 30 to 50 miles away from where we live, the non ACA providers were in our town.

Of course there were no subsidies for directly purchased policies.

Kilgore

[elehhhhna]

13. m hmmm. anecdata. thanks.

[taught_me_patience]

34. When the ACA plans reimburse 30% less than comparable direct plans

there is good reason why doctors are not participating.

[Lex]

12. Even before ACA, there were doctors that didn't take my insurance.

I had to find a doctor who did. Just did a little research and called a couple of offices.

This isn't a new thing.

[bettyellen]

15. or they'd "take it" but not follow the policy rules and not reimburse when promised! Now they are

taking that BS more seriously. You have had to do your homework though, for at least the last 20 years.

[Yo_Mama]

17. There are special financial problems with ACA policies.

The first is that more doctors are not getting paid, because of the federal rule that the ins co can't actually cancel your insurance for three months even if you don't pay the premium. However, the ins co does not have to reimburse claims after the first month. So, with a standard policy, when one does a benefit check it will tell you whether the person has active insurance. With an ACA policy, that's not true.

The second issue is that some of these policies are simply paying the providers very little. Doctors can't afford to take too many low-reimbursement patients, or they won't be able to make payroll. With the aging of the population, most doctors are limiting low-reimbursement patients. So it's a choice. Do you take care of the Medicare/Medicaid patients? Do you take charity patients? Do you take some of all, but limit the total percentage?

It depends partly on the state and the insurance company, but the "insured but claim won't be paid" is a much bigger problem for surgeons and the like.

[Ms. Toad]

22. Documentation, please, as to your first paragraph. n/t

[Yo_Mama]

27. Here's a non-regulation link

I realize the regs are hard to read. Here's a very clear explanation:
http://www.aafp.org/dam/AAFP/documents/practice_management/payment/90DayFAQ.pdf

Note that most physicians would continue care, and in some cases you would be required to continue care (for an emergency, for example).

Unfortunately, one of my brothers probably has early-stage prostrate cancer. I wanted to get him in at U-Penn (Abramson Cancer Center). I did that through the clinic where I volunteer, because I trust the doctor and want his continuous advice and review of treatment. They verified FOUR times that his policy wasn't ACA. I don't think I could have gotten him in if he had an ACA policy unless he could pay a big hunk of cash up front. Maybe not at all. The doctor was stunned at the problem, but when I pointed out to him the ACA grace period, he understood.

In my own experience, it is impossible to treat ACA patients. Everything you try to do is denied, or you jump through endless hoops. There is a Haitian immigrant (legal - she came in about seven months ago to join her husband) we have been treating. She has diabetes, heart disease, and a few other problems.

But here's the kicker. At the beginning of May she got insurance. Up until then we had been treating her for free, giving her free diabetes meds, going through the Walmart route for testing, etc.

Once she had insurance, they would allow us to run lab tests on her. But they would not pay for the diabetes medication, they would not pay for her to test her blood sugar more than once a day, they didn't want to approve the other procedures (even though we had documented that she had severe CV). The upshot? In late June we had to send her to the ER with blood sugars of 438. We can't deal with the paperwork any more to get this poor lady ANY sort of reasonable medical care, so we referred her to an endocrinologist and a cardiologist. She's going to die, because they can't afford their copays. But the insurance company won't let us treat her. I think her condition degenerated so much because of the heart condition. But she needs high-level treatment now, and it became apparent that we weren't going to be able to get it for her.

I hate all insurance companies, but ACA has made them much, much worse. They're in the driver's seat now. It can take us three weeks to even get an offiicial denial so we can begin the appeal, and that's only with someone sitting on the phone for an hour to get through to a live person and telling them that you are recording the call.

I finally threatened BC/BS that if they didn't start at least responding to our pre-authorization requests (which they are legally required to do) that I would print up a letter and distribute it to all our BC/BS patients explaining what they were doing and having each one call the company, and then I would have them sign statements and send them to our local Congressional Rep. Then they at least started responding to them. From our clinic.

It's not just ACA policies - this year it is much worse across the board. It's not just this clinic. The pharmacists are freaking out. One of the local ones called me screaming in rage twice the week before last, and last week notified us that he was retiring.

We had one old dude (Medicare) that came into our office because the insurance company sent him a letter saying they wouldn't cover his Levamir (long-acting insulin). Obviously he's a diabetic. He has significant cardiovascular problems, and another doctor switched him to Levamir from Lantus because the insulin in Levamir is mostly protein-bound, so it can be less irritating to the CV system. Well, we wrote him a prescription for Lantus. Then we got a denial on the Lantus. So I filed an urgent request for an override for at least the Lantus, because this guy was gonna be dead within a week.

We have had to drop 25% of our patients in order to have time to treat the rest of them, because it takes hours longer due to the fact that all we do is deal with (expletive deleted) MU and chasing insurance companies down. The only reason we are still open at all is that we have more volunteers doing this.

The worst of it is that I had to sit down the doc and explain to him the legal jeopardy he was in. Unless we document all this, it's on our heads. But the insurance companies make it impossible to document it, because they are JUST NOT RESPONDING TO OUR REQUESTS. So I figure I personally killed ten people in the last six months in order to keep thirty more alive. I hate myself. I hate the world. We now have to not see people we could treat before.

Most of all, I hate all the people who don't care about what is happening to these people because they just want to live in a fantasy world.

[Ms. Toad]

31. That's not exactly what you said.

If the insured person is not paying their share, insurance must still pay the providers for 30 days after they stop paying. The policy won't be canceled for two additional months - and the link you provided specifically recommended that the doctors verify, at the time of the visit, that the claim is eligible for coverage. The very thing you say can't be done.

That means that the provider is guaranteed to be paid the insurance company's portion for 30 days beyond when a policy would normally be cancelled (i.e. more payment, not less). For an additional 2 months, it may be covered - but is not guaranteed and in this period doctors should verify before treating if they do not believe the patient can cover the full cost. Incidentally, with our non-ACA insurance - which could be dropped at any moment - leaving the provider holding the bag (or chasing me for the bill), the providers don't check beyond asking if the insurance is the same - and once a year asking for the new card. If my policy is cancelled because I leave my job, there is no 30 day period during which claims will still be paid. And if I answered "yes" my insurance is still the same, no one would question it. So the ACA gives them MORE protection rather than less - and the document you linked to suggested how to decide in the 60 day period (which doesn't exist at all in the private market) whether to provide coverage without getting payment up front.

As for paperwork - my experience is that far too many providers don't know their head from a hole in the ground. I have had to walk more providers through how to get coverage for step therapy meds, obtaining approval or denial for care, or even how to find out if they are in the provider network or not. Basic things that are part of their contract with the insurance company. It would be nice if they settled on a standard practice, but I know how to do each of these things (and a lot more) because the information is available. I had one provider insist for weeks that they had been denied the step therapy medicine - despite the fact that my spouse had taken multiple of the first step meds, and that they had appealed and been denied multiple times. Turns out they just kept shipping the prescription in over and over again, even after I gave them the phone number and form for step therapy meds. I finally had the insurance company initiate the process by calling them. My most recent battle was with a provider which insisted it was not in network - despite the fact that they had never called the insurance company and provided it with their billing EIN. It took me about 3 weeks, and multiple phone calls before I could get the provider to call.

So I'm not too sympathetic to providers who can't figure out how to comply with the rules of the system. My experiences have nothing to do with the ACA (and those are two examples of many). It is, unfortunately, the dysfunctional relationship between insurance companies and providers - and in my experience with a half dozen very different insurance companies over the past decade, the blame for the dysfunction is about equally split.

[Yo_Mama]

35. We can't verify

There is no procedure, other than calling the company, as far as we can find out.

Not that we care, but a surgeon would. The notice you would receive would come after the billing, which is too late to control a financial risk:
http://www.npr.org/blogs/health/2014/02/25/282115303/doctors-offices-get-put-on-hold-trying-to-find-out-whos-insured

Maybe you will believe NPR? No one on DU wants to deal with what's really going on, do they?

[Ms. Toad]

56. My point is - there is no way to verify other than calling the company

for anyone. It has nothing to do with the ACA - it has do do with the way insurance companies work.

If my insurance is cancelled and I don't have a marketplace policy, the doctor doesn't even have a 30 day grace period. The surgeon could operate on me on September 1, when my employer paid my last monthly premium on August 1 (meaning on September 1 I had no insurance). The surgeon would not be paid. Nothing on my card would indicate that my insurance had been expired. If the doctor did not call and verify, s/he would have no clue that my September 1 surgery was not covered. With a marketplace policy, on the other hand, the insurance company would still be paid, because it would be 1 day into the grace period - meaning the doctor has MORE protection under the ACA if they took the risk without verifying that I still had insurance.

The difference is that doctors are less willing to take the risk that people who are paying their own premiums will continue to pay them - employers are relatively reliable about paying them, and most people who have insurance through work continue to work (and have insurance). But doctors now feel, perhaps correctly, that policies are more likely to be canceled so they now feel a need to verify which just has not been part of their routine practice until now. I'm not disputing that doctors are getting put on hold - but it is because they are now calling to check when they never bothered to before because they assumed (aside from procedures large enough to require pre-approval) that they could take their client's word that they were still insured.

[uppityperson]

45. it is not just ACA policies but all insurance policies? Ins co's are jerks. I've a question, what do

you mean by "ACA policy"? What makes a policy an "ACA policy"? I am not sure of what you mean, if you'd clarify, thanks.

Medicaid? Any policy signed up for since ACA went into effect? I am confusd by your terminology and would like to understand as I thought all ins policies fell under the aca. Thank you.

[BrotherIvan]

48. Do you have a suggestion for those who are looking for insurance?

I have junk ACA insurance and I would love to find a better option. Well, besides moving to Europe which I may do.

[SheilaT]

18. So sorry to hear this.

I don't know a whole lot about insurance stuff, but I've long been aware that not all doctors take all insurances. I've also heard some horror stories about Medicare. I also have been aware of times and places where doctors have not been taking on new patients.

That said, I recently retired and went on Medicare. I got an Advantage plan and so far I'm quite happy with it because my out of pocket costs so far have gone down. I am actually paying slightly more for my Medicare and prescription drug coverage than I was when I was working, but that's not a big problem for me.

Hope things get better for you and your insurance.

[Paula Sims]

20. My heart goes out to those who are caught in the middle of this. . .

Luckily, I have the "universally accepted", employer purchased, insurance company. I was just thinking of the person who thought "great, now I can get that colonoscopy to check if I have the same colon cancer that killed my father", only to be turned away. I'm seeing this with more and more specialists. My heart breaks for them.

In my personal case, although I have the premier of premier plans through my employer (I pay $700/mo for two people and thank God we can afford it), I need specific genetic testing and both (and ONLY two) labs in the US don't take ANY insurance. They expect a $1,000 down-payment and if the insurance company doesn't cover it, I'll be on the hook for $10,500. AND they won't give me the financial requirements until I have my blood drawn. Yes, I'm double and triple checking with my insurance company. Either that or the docs can guess whether I have adult-onset muscular dystrophy and guess which treatment will help me walk without, let alone walk without being in horrific pain.

Our system sucks.

[Yo_Mama]

36. Our system does suck.

So sorry for your situation. Guessing is not a viable option.

[Motown_Johnny]

21. can't your regular doctor refer you to a GI doctor?

That is how it worked for me.

[Ms. Toad]

23. The ACA plans have doctors who have agreed by contract to accept

what they designate as the usual, customary, and reasonable - just like every other insurance plan for the 3.5 decades I've had insurance. If you choose to go to a doctor who is not in the network (i.e. doesn't have a contract with that plan), your care will either not be covered - or will be covered at a different rate.

Every time we move to a different insurance plan, we have to check the network to make sure our key doctors are covered. Nearly every time we lose at least one of our minor doctors. That's just the way insurance works.

Our current insurance is a major brand insurance, but we have an expanded network with a different name that is less well recognized. I've had the same kind of discussions you just had with a major provider (the primary reason for the expanded network). It took them over a month to verify the insurance (even though the ONLY thing that changed between December and January was the name). Ultimately, I had to get their billing EIN and verify it myself and then bully them into sitting through the hold time because even though they told me they had spoken with the insurance company and had been told they were not in network, they had actually only gone to the insurance website which only listed a fraction of the provider's services which bill using the same EIN.

It isn't the ACA - it is just the nature of insurance networks.

[mucifer]

24. Here in Illinois many doctors won't take medicaid.

The state pays their bills VERY late. The late payments put lots and lots and lots of stress on non profit health companies (I mean REAL non profits not blue cross type non profits).

[WillowTree]

61. Blue Cross of Illinois does happen to be a not-for-profit company.

Just for the record.

[mucifer]

62. Yeah that's amazingly messed up but it's true.

[pnwmom]

26. Everyone with problems like this should report them to their state regulatory people.

There are actually a couple states that say insurance must cover every licensed MD and hospital in their state, so it is legally possible. We need to put pressure on all our states to do this.

[TheKentuckian]

32. A lot of the networks are very limited, there should be a provider directory online.

[Chimeradog]

40. my bf a cancer patient :(

my friend did. Because we have the misfortune of (temporarily thank God) being in a red state that refused Medicaid funding- red states ER's are now clogged. Stupid Sen Corker finally realized what a mistake it was....

Unreal

The oncology dr said "For profit medical care does NOT work" I wish the hacks in state legislature would take note. But their golf game is more important than peoples actual needs in their constituency, apparently.

The red states are not "handling it". Its a disaster ad they are doing this purposely, in some cases I believe.

so now he just has a crate of bills (chemo is 20k for one treatment) and will have to do a Chapter 7, yeah great system. It is enraging.

[uppityperson]

42. Docotrs, clinics, have always picked and chosen which insurances to accept. This is nothing new

I have had to switch doctors in the past years due to this and blaming this on the ACA is wrong.

Our local health care conglomerate 10 years ago missed reupping with a big insuance company and many people lost them for several months, having to travel to the next county. It was a big mess.

I have had 3 different endocrinologists over the years due to them switching what ins companies they have agreed to take. It is a pain in the butt and difficult to not have continuity of care, but is nothing new.

[flamingdem]

44. ACA at least in California is based on networks

so before you pick an insurance it's best to see who is in the network.

I had basically Blue Shield with Cedars or Anthem with UCLA, talking hospitals and their doctors. So far I'm okay with Anthem.

Each area is different though. Anthem etc. has gotten flak for narrow networks but they say this is how money is saved..

[jambo101]

52. Canadian missing a piece of the puzzle.

My thoughts on the ACA was to cover the 30-40 million uninsured by pooling many people to any given insurance company,presumably making the insurance company happy with all the new customers now paying for insurance.
Then millions of uninsured are now insured and paying for coverage they previously didnt qualify for so i presume they are now happy.
And then theres the hospitals and doctors offices who now have a major new customer base in addition to what they had before so i'd presume they are also happy.
So wheres the problem?

[flamingdem]

57. Narrow networks is a problem in some areas

Previously one could chose a doctor but now they have to be within a network meaning you're totally out of luck if a specialist you need is not in your network.

[ellenfl]

60. i have an employer-based group plan. my premiums go up every year and i

have had doctors drop out of my network. the rw decries the changes in access and cost, supposedly caused by the aca. how is this any different?

[Thinkingabout]

63. I have had fortune to have had health insurance all of my life and I have had

Difficulty getting some procedures covered and had to fight to get some treatments. This was also before Obama was born so I know there isn't any way ACA affected all of the decisions. I have used a network and have been limited on doctor selections and also to locate a doctor accepting new patients. It gets hard when on Medicare, not all doctors accept Medicare and when the slots are filled you have to look further.