Finding an Orthopedic Surgeon who takes Obamacare in Austin (medical, plan, doctor)
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I fractured my left knee five days ago, and although living near Austin, TX am still covered through my employer's old police, which is a California HMO. I'm fighting with them every day to cover this emergency situation, (which they say is covered), but more importantly I'm looking for a long term solution. I am 61, too young for Medicare and partially retired. The ACA exchange is the only place I can get insurance. But even with the Silver Blue Cross/Shield PPO on the exchange I can't find an orthopedic surgeon who takes it. The website lies; says the doctor is a provider but when you ask the doctor they don't take it. The current orthopedic group I'm seeing in Round Rock, which is HUGE, takes NO ACA plans! None!
For now I'm praying that my CA insurance will cover the upcoming surgery, but what about the long term consequences?
Any suggestions on how to find an orthopedic surgeon who takes any type of exchange plan? What are other people doing when caught in the gap between retirement and Medicare?
I just did a quick search for plans in the Austin area, Aetna has over 100 orthopedic dr's in Texas, including many in Round Rock. BCBS of TX has 687 Orthopedic drs that accept their HMO marketplace plan. I'm not sure how you were searching but something got missed. Also, if it's been 5 days, it's not an emergency and that is why your HMO from CA is not covering you. Emergency care is life threatening issues like a heart attack and a fractured knee cap usually isn't an emergency, painful I am sure, but not an emergency. I really, REALLY dislike HMO's and this is one reason why.
The ACA exchange is the only place I can get insurance. But even with the Silver Blue Cross/Shield PPO on the exchange I can't find an orthopedic surgeon who takes it.
The website lies; says the doctor is a provider but when you ask the doctor they don't take it.
Your experience in TEXAS is very common. We have many reports on CD from people in TX stating providers are refusing to accept the hated Obamacare.
Don't discount the fact that you ARE in TEXAS - a completely different political environment than you experienced in California.
You are VERY WISE to check with the providers BEFORE enrolling in any ACA plan in Texas. The insurance company provider lists are VERY INACCURATE in certain states.
I recently viewed a health insurance symposium on C-Span verifying this. The issue of the disconnect between insurance company provider lists and the REALITY is a serious and relevant issue.
Quote:
Originally Posted by kat78613
The current orthopedic group I'm seeing in Round Rock, which is HUGE, takes NO ACA plans! None!
Any suggestions on how to find an orthopedic surgeon who takes any type of exchange plan? What are other people doing when caught in the gap between retirement and Medicare?
Try to find a good health insurance broker in TEXAS who is familiar with the issues ACA enrollees face in TX. TX is its own world - actually there are people in TX who talk of secession - still fighting the Civil War.
So, go forth knowing that ACA (subsidized) coverage is very unpopular as a concept in the Texas universe.
That said, there surely are reliable ACA plans with suitable providers who WILL accept ACA coverage. Just going to take a bit more work to find them.
Otherwise, your option would be to purchase unsubsidized coverage. Again, an insurance broker familiar with Texas peculiarities may have some good suggestions for you.
Maybe a problem with a California employer HMO because normally they have very limit network area. You need to call the insurance to check .Obamacare or ACA more correctly has nothing to do with private employer coverage . Its a pool consisting of employees not general pubic. Call and be sure to get pre -cleared for planned surgery since its not emergency. Exchange is unlikely to cover when you already have insurance. Call the insurance you have and explain situation. Some have travel or out of network coverage but it may only pay out of network price since unlikely to have a contract with Doctors in Austin. Good Luck.
Thank you ARIAD, for your thoughtful reply. You hit the nail on the exact head as to what I am experiencing. So far my CA HMO has approved the CT scan scheduled for Monday and the followup appt. with the surgeon. The next step would be seeking approval for surgery, which is most likely necessary.
The long term concern, however, is the switch over to the ACA plan and who exactly takes it. Yes, Qwerty, there are tons of docs listed on the insurance company's website who supposedly take the plans, but when you call them, they do not. Case in point is the orthopedic surgeon I'm currently seeing. The ACA website lists them; but at their front desk the other day I asked for a list of insurances accepted and in bold type they say they accept NO plans on the ACA exchange. None. This is a huge group of orthopedic surgeons. I was shocked.
Anyway, the suggestion to contact a health insurance broker is excellent, and not one I had thought of. I will work on that asap.
I know "Obamacare" is hated in many areas, but I didn't realize it would be to the exclusion of such a large segment of the population. At 61 and partially retired, this is my only option until I'm eligible for Medicare at 65. Four years is a long way off.
Thank you ARIAD, for your thoughtful reply. You hit the nail on the exact head as to what I am experiencing. So far my CA HMO has approved the CT scan scheduled for Monday and the followup appt. with the surgeon. The next step would be seeking approval for surgery, which is most likely necessary.
The long term concern, however, is the switch over to the ACA plan and who exactly takes it. Yes, Qwerty, there are tons of docs listed on the insurance company's website who supposedly take the plans, but when you call them, they do not. Case in point is the orthopedic surgeon I'm currently seeing. The ACA website lists them; but at their front desk the other day I asked for a list of insurances accepted and in bold type they say they accept NO plans on the ACA exchange. None. This is a huge group of orthopedic surgeons. I was shocked.
Anyway, the suggestion to contact a health insurance broker is excellent, and not one I had thought of. I will work on that asap.
I know "Obamacare" is hated in many areas, but I didn't realize it would be to the exclusion of such a large segment of the population. At 61 and partially retired, this is my only option until I'm eligible for Medicare at 65. Four years is a long way off.
I would suggest that they ask the health insurance companies to take their name off their provider list then. Also, you don't have to take a marketplace plan, you can go to any insurance provider in Texas and get an individual plan. A marketplace plan is not your only option.
If you're willing/able to drive, check Houston. They're the world's largest medical center, and I've found take more insurance plans than other places. Start with Fondron Orthopedic Group, also try Methodist, Hermann, just keep trying.....
Querty no insurer is going to give an individual policy to a 61 year old with a pre-existing condition. That was a big part of the Affordable Care Act in the first place, so that people with pre-existing conditions could still get coverage. Prior to that part of the law anyone with any kind of issue - and I mean basic stiff like asthma, or basal cell, - could not get coverage.
I may be having difficulty narrowing down which doctors will take which insurance, but at least I can GET insurance, and for that I am grateful.
Querty no insurer is going to give an individual policy to a 61 year old with a pre-existing condition. That was a big part of the Affordable Care Act in the first place, so that people with pre-existing conditions could still get coverage. Prior to that part of the law anyone with any kind of issue - and I mean basic stiff like asthma, or basal cell, - could not get coverage.
Good news for you, this is NO LONGER TRUE. Elimination of preexisting conditions under the ACA covers both exchange plans and nonexchange plans. No health insurance provider can deny you because of health issues, nor can they charge you more for coverage, nor can they cancel the policy because of too many claims. In addition, the ACA requires any insurance sold now to meet certain basic parameters.
The real problem with ACA policies, however, in many cases are the higher deductibles which can translate to collection issues for certain consumers leaving providers on the hook, much lower insurance reimbursements to providers, slow pays, etc., which is why many providers don't take them. Couple all of that with "subsidized" - which means the wealthier taxpayer is paying for the less wealthy, and you have providers who say "they don't believe" in the ACA aka Obamacare.
Let us know what you learn from the insurance broker, when you find one.
kat,
you just stated that you have insurance. I don't understand the post. You are covered.
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