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I just tried to schedule an appointment with a dermatologist. I was told that they did not accept marketplace insurance. Does anyone know why some providers won't accept marketplace insurance?
Personal Politics is the main reason many providers decide not to accept these plans.
However, "not accept" could also be the plan is an HMO and they are not a network provider of that HMO. Others do "not accept" because the plan limits the total number of provider in a specialty and they have to wait until an opening comes up. Some do "not accept" because they just never got around to contracting with that health insurance company. And, some would rather only accept plans that pay them the most so they don't accept ANY plan (marketplace or open market) that doesn't reimburse a certain amount.
Without them explaining what they mean and why, you really have no idea of knowing what they actually meant by it.
I just tried to schedule an appointment with a dermatologist. I was told that they did not accept marketplace insurance. Does anyone know why some providers won't accept marketplace insurance?
Thank you.
This is far too generic to even address Dee...But whenever any Doctor deny's new patient's it mean's they don't need new clients..or require a referral first..which mean's they will only take on new patient's when referred..then of course it's always possible "Conscientious Obstruction"...Assuming ACA connected
Marketplace Insurance is how ALL Public Insurance has always been below 49th...Private Insurance Policies..versus Medicaid/Medicare (Govt)...So have no specific idea why that particular Dermatologist refused you..
The wait for a dermatologist appt in my city is 6 months or more so it is a specialty much in demand (or short in supply, take your pick). They may limit insurance that they take because they can - fewer insurances they accept, the less work for the back billing office and the more money they save.
Doctors choose to accept or not-accept insurance plans (ACA plans or otherwise) based on reimbursement and the hassle required to get the reimbursement (frequency of denials, paperwork required). But mostly reimbursement. Who else here will willingly accept a job that pays 20 percent of your normal fees?
Something similar just happened to me. Except I was rejected by a DR (Rheumatology specialist) who I am already a patient of for 5 years.
A brief timeline.
2012 and before - I had private employer provided health insurance
2013 exchange health insurance from Anthem blue cross
2014 exchange health insurance from Connecticare - Rejected by DR's office. They do accept Connecticare insurance just not if its an "exchange policy"
In my experience Connecticare pays claims quickly, so I'm not sure why the office would reject them if it was bought thru the exchange.
I thought DR's were not able to determine if a policy was an exchange policy or not. In my experience with 3 DR's so far all of them and their office staff have known the policies were "exchange policies" without me telling them. Last year a DR actually told me "you're the first exchange policy patient I've seen" he was very curious about my experience with the exchange and was actually quite happy that I was covered again though.
Something similar just happened to me. Except I was rejected by a DR (Rheumatology specialist) who I am already a patient of for 5 years.
A brief timeline.
2012 and before - I had private employer provided health insurance
2013 exchange health insurance from Anthem blue cross
2014 exchange health insurance from Connecticare - Rejected by DR's office. They do accept Connecticare insurance just not if its an "exchange policy"
In my experience Connecticare pays claims quickly, so I'm not sure why the office would reject them if it was bought thru the exchange.
I thought DR's were not able to determine if a policy was an exchange policy or not. In my experience with 3 DR's so far all of them and their office staff have known the policies were "exchange policies" without me telling them. Last year a DR actually told me "you're the first exchange policy patient I've seen" he was very curious about my experience with the exchange and was actually quite happy that I was covered again though.
Most every insurance company has several networks, some 30+ networks, in which doctors can participate. They don't always participate in all the networks. The exchange plan network is one they have opted not to use, probably because it's likely an HMO and they don't want to have to deal with the low reimbursements or whatever reason.
In my experience Connecticare pays claims quickly, so I'm not sure why the office would reject them if it was bought thru the exchange.
Higher deductibles - which may mean collection issues - combined with the reimbursement issue. Many subsidized plans offer much lower reimbursements. Non-exchange Connecticare may pay that doctor better.
An old article, but still true. Some exchange plans pay far below Medicare rates - more in the area of Medicaid rates:
Quote:
But information cobbled together from interviews suggests that if the
Medicare pays $90 for an office visit of a complex nature, and
a commercial plan pays $100 or more,
some exchange plans are offering $60 to $70.
Doctors say the insurers have not always clearly spelled out the proposed rate reductions.
I thought DR's were not able to determine if a policy was an exchange policy or not. In my experience with 3 DR's so far all of them and their office staff have known the policies were "exchange policies" without me telling them.
This is true. There is an identifier on your medical card from what many others on this board reported last year.
Per this from Aetna:
Quote:
How will I be able to identify an exchange member?
ID cards for members in these plans will have “QHP” on them. The product name is on the right side of the card, and the plan name is on the left side. There are also other fields unique to exchange plans that may not be apparent to the provider, such as a dedicated member services toll-free numbers, state-specific control numbers, and the plan name.
I just tried to schedule an appointment with a dermatologist. I was told that they did not accept marketplace insurance. Does anyone know why some providers won't accept marketplace insurance?
Thank you.
There are a great many dermatologists who will not accept any insurance at all. They are strictly cash only.
As far as not taking a particular type of insurance, if a practitioner receives little, if any, reimbursement from a particular payor, or in the case of Medicaid and Medicare actually loses money in some cases, why would they accept that payor? Providing a service where you lose money is a quick way to go out of business. And make no mistake about it, a physician is a small business owner. It doesn't matter if they are in private practice, an academic/faculty plan, or hospital employed, they will have to cover their costs in some capacity.
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