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Being listed on the website only means the doctor probably was in-network at some point in time. These online lists are notoriously rarely updated. A doctor in my practice left in 2007 to move across the country. He is still listed as working here on multiple insurance company websites. I dropped United Healthcare last year and I am still listed on their website. They do this on purpose to make it look like they have more doctors. Then patients have the nerve to be mad at US when we tell them this.
Good luck with your surgery.
Did you or he notify them of the change? There is paperwork to fill out.
Qwerty, you just reminded me of something else the insurance broker/navigator said: If a doctor signs a contract to be in a certain network with an insurance carrier, he/she has to accept all the plans inside of it (I hope I'm explaining it correctly). They can't exclude a plan just because it's purchased through the exchange. Querty, this is very similar to what you said much earlier in this thread.
The broker suggested simply presenting the insurance card to the doctor and never mentioning where it was purchased. In addition, he gave the me plan he and his family are using in the Austin area, which is purchased on the exchange.
These official "navigators" are paid because in helping us to fill out the application their names become attached.
The insurance companies list as many doctors as possible to make their networks look as large as possible. This is their marketing scheme. A doctor in my office moved across the country in 2007, and I took his place. We still get people calling for him because some insurance companies still have him listed as a doctor in our practice. Some patients actually have the nerve to be mad at US instead of the insurance company. They think WE created that list of doctors.
Many doctors are not taking the ACA exchange plans because they don't want to add yet more financial risk to their practices. Especially when most of the payment comes from patients (via deductibles) that cannot afford their own deductible they signed up for. Even the non-ACA exchange plans have shifted towards very high deductibles. Therefore I collect the entire remaining deductible prior to surgery but am finding many cannot afford it so they don't get surgery.
BINGO!!! You are SPOT on in your informing people of the truth, as painful as it is to accept. Yeah, you can PAY YOUR Obamacare premium, but you better PRAY you have nothing in the way of "special medical needs" cause you will be paying through the nose in deductibles if you do. My poor sister learned this the hard was before she lost her battle with cancer 2 months ago...NOTHING affordable about expensive medication/chemo needs when you are unable to work because of the health issue/problem you are seeking care for....especially if you are on your own (she was widowed).
I think there is a HUGE sense of "false security" until that moment of actual need arises. Her employer, like may, decided as of 1 Jan to start paying folks a "Medical Insurance Stipend" and having them enroll in Obamacare for their coverage...lots of employers have or are headed in that direction for cost cutting.
Qwerty, you just reminded me of something else the insurance broker/navigator said: If a doctor signs a contract to be in a certain network with an insurance carrier, he/she has to accept all the plans inside of it (I hope I'm explaining it correctly). They can't exclude a plan just because it's purchased through the exchange. Querty, this is very similar to what you said much earlier in this thread.
The broker suggested simply presenting the insurance card to the doctor and never mentioning where it was purchased. In addition, he gave the me plan he and his family are using in the Austin area, which is purchased on the exchange.
These official "navigators" are paid because in helping us to fill out the application their names become attached.
Yes, if they sign up for a network, they have to take all plans in that network, however, most insurance companies have several networks and they don't have to accept all networks from an insurance company, which is why you never ask "Do you take XYZ Insurance", you ask if they accept whatever network from that insurance company. United Health, for example, has something like 45 different networks, so a doctor could be in one of those networks and if you ask "Do you take United Health" they will say yes.
BCBS is the biggest problem in my practice but I am not dropping them yet because they have more patients in my area than any other plan. I wouldn't be surprised if they drop me soon since I have become a pain in their butt by reporting them to the state insurance commissioner 3 times in the past year. Most patients would be amazed at the games they play with denials. I will drop them eventually but I am trying to decide when. I am one of only 4 surgeons in the state of Texas with the training to do what I do, so patients will still come to me even if I am out-of-network.
As for medical lobbies fighting this, there are 2 problems. One is that doctors are forbidden by law to create unions or similar tools of collective bargaining. So we are left to rely on separate groups like the AMA who has turned out to be a gutless self-serving entity of no use to doctors or patients. The 2nd problem is that this insurance fight is not the doctors' fight to begin with....it's the patients' fight because they are the ones who are the customers of the insurance companies and they are the ones paying/hiring the insurance companies. I don't care if insurance companies stop paying me because I'll just drop the insurance companies and go cash, make more money, and retire sooner. I didn't create the problem and I sure don't have the capacity to fix it.
So many people do not recognize or understand the risk to all in the Medical field to have to back out of certain plans, because of the cost of overhead, not to mention the cost of liability insurance. As a retired nurse, my hat is off to you trying to be there for the patients that need you as long as possible before you have to drop BCBS.
There are many medical professionals that are looking at retirement/changes in careers or the cash only options because of the very reasons you describe.
Ask the families that watched their child suffer irreversible brain damage after a slip at the family swimming pool and incurring a severe head injury that could not find a pediatric neurosurgeon with in 4 state are how that impacted their lives. When a regular neurosurgeon REFUSED to take the call for surgery for brain swelling (because he KNEW he was going to be questions WHAT he felt his qualifications were since he was not Pediatric certified) the child suffered for it. Certain surgeons (you included) are VERY specialized, and until/unless you or a loved one needs those services, you have NO idea how invaluable they can be to save life or limb.
Did you or he notify them of the change? There is paperwork to fill out.
Of course. A written notification has to be sent and they usually take 90 days to "process" it. My point is that the insurance company has no incentive to remove names from their list. But they do have incentives to pad their lists with more names.
Being listed on the website only means the doctor probably was in-network at some point in time. These online lists are notoriously rarely updated. A doctor in my practice left in 2007 to move across the country. He is still listed as working here on multiple insurance company websites. I dropped United Healthcare last year and I am still listed on their website. They do this on purpose to make it look like they have more doctors. Then patients have the nerve to be mad at US when we tell them this.
Good luck with your surgery.
I am sure that happens. However, i have had clients that have had all kinds of experiences. Let me list a couple:
1. Patient is critically injured in an auto pedestrian accident and requires three surgeries and two weeks hospitalization. At the end of that time, the orthopedic surgeon orders her discharged to rehabilitation hospital for another three weeks. The rehab hospital representative actually come to her bed at the first hospital and answer her questions. They tell her that her services are "in network" with her private health insurance plan and there will be no co-payment required. She believes them and on discharge is handed a bill for about $12,000. At this point the billing office denies having ever told her that. Silly her, she didn't get anything in writing, but hey what do you expect out of someone who just spent two weeks in a hospital and was practically killed?
2. Patient reads her most recent health insurance booklet which says "Dr. J" is an in-network physician with the health plan. Patient schedules an appointment and visits "Dr. J's" office. Patient again asks the receptionist if Dr. J is truly an in-network physician with PEHP's plan. She is given an affirmative answer. Six weeks later, a bill arrives asking her to pay far in excess of her deductible for the visit. When the doctor's office is phoned, they tell the patient that "Dr. J hasn't been part of PEHP's network for the last three months". Is that the patient's fault in any way?
The bottom line is that the system we have for paying for health care in the United States is ridiculous. Most of it is primarily driven by cost. If medical costs weren't so high, all these issues about "being in network" wouldn't be the problem that they are.
The bottom line is that the system we have for paying for health care in the United States is ridiculous. Most of it is primarily driven by cost. If medical costs weren't so high, all these issues about "being in network" wouldn't be the problem that they are.
I agree. There are multiple reasons why the costs are so high. Insurance is one of them, entitlement mentality is another, there are many more. As I have started dropping insurance plans, I am finding that costs are much less for both me and my patients.
The broker suggested simply presenting the insurance card to the doctor and never mentioning where it was purchased.
No worries. You won't have to mention anything - they will know immediately because the identifier is on your insurance card.
TEXAS just this year passed a law requiring identification on ACA cards:
Quote:
Exchange enrollees will be identified on ID cards
At the end of May, the Texas state senate passed House Bill 1514, and Governor Abbott signed it into law on June 17. The law will become effective September 1, and will require insurance carriers to label policy ID cards with “QHP” (qualified health plan) if the plan was purchased through the exchange.
This has been common for a while. Another example 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.
We've had a lot of discussion in the past on this issue because people presenting ACA cards were immediately identified as such by medical office personnel and often told "we don't accept that insurance" - Texas being commonly mentioned.
Hopefully, as your insurance broker said, these medical practices have now got over themselves and acceptance is not as much of a problem.
I wonder if the broker knows this! I'm as confused as ever but at least I know of a good group in my area that accepts most ACA plans. I may just have to spin the wheel and pray. I'm going to squeeze as much out of my CA plan as they will allow in relation to my upcoming surgery and aftercare. So far, they have been remarkably accommodating. We'll see what the near future brings when I try to get PT and maybe OT covered. If moving back to CA was an option (it is not) I would do so in a heartbeat just so I know my health needs would be taken care of and I wouldn't go bankrupt in the process. When you are healthy all your life as I have been, you don't realize how life-changing this all is until something happens. I have a lot more compassion now for people with serious injuries and conditions.
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My point is that the insurance company has no incentive to remove names from their list. But they do have incentives to pad their lists with more names.
