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If a Doctor does not want to accept what an insurance company or patient is willing to pay for elective surgery he can refuse the business. If he refuses enough business he can sell used cars. If he is a trauma surgeon in an emergency room he treats what ever comes through the door and worries about payment later.
I wonder how many people against "Obamacare" are annoyed because they believe having expensive health insurance is a privilege and a status symbol. As Affordable Health Insurance is now available to everyone they have lost one of their most important and exclusive privileges. I have no sympathy for these elite (fill in the blanks).
I think if doctors are going to discriminate against patients because they have ideological objections to how the patient came by his insurance, that doctor out to do the right thing, and leave the profession.
Why should he leave the profession? He can treat cash only patients. His choice.
Julie Miller has Blue Cross Blue Shield, which she purchased through the healthcare marketplace. Her plan lists this doctor as a covered provider. . . . Blue Cross Blue Shield says his reimbursement rate would be the same regardless of where the plan is purchased so Julie thinks this is a political statement.
So this doctor AGREED to take patients with her policy, then changed his mind?
I hear some double speak in that statement there. If she purchased an individual plan from either the exchange or BCBS itself, the reimbursement rate would be the same. However, the implication in that statement seems to be they are implying employer (e.g. group) insurance reimbursement rates and individual plan reimbursement rates are the same - they are not.
I do concur that if he agreed to take BCBS individual plans, he is contractually obliged to take them all, regardless of where the patient bought the plan.
I hear some double speak in that statement there. If she purchased an individual plan from either the exchange or BCBS itself, the reimbursement rate would be the same. However, the implication in that statement seems to be they are implying employer (e.g. group) insurance reimbursement rates and individual plan reimbursement rates are the same - they are not.
I do concur that if he agreed to take BCBS individual plans, he is contractually obliged to take them all, regardless of where the patient bought the plan.
I will give the doctor the benefit of the doubt. Although in Tucson I dont see where doctors can be that picky. Most people here are covered by Medicare and private plans. After that its a whole lot of people on Medicaid. Governor Brewer a Republican expanded Medicaid after Banner Hospitals and Carondelet reported big losses. When people dont have insurance it doesnt mean they dont show up in the hospital. The exchanges have cut out hospitals and of course different exchanges use their own doctors. I find it hard to believe that BCBS would have different Medicare and aca levels with different doctors. I would bet by Tuesday next week we find out a little more information. By the way BCBS probably doesnt have that tight a network in Tucson. Their rates are higher than Healthnet which is very reasonable.
I hear some double speak in that statement there. If she purchased an individual plan from either the exchange or BCBS itself, the reimbursement rate would be the same. However, the implication in that statement seems to be they are implying employer (e.g. group) insurance reimbursement rates and individual plan reimbursement rates are the same - they are not.
I do concur that if he agreed to take BCBS individual plans, he is contractually obliged to take them all, regardless of where the patient bought the plan.
I don't see any double speak, I don't see anything about an employer. And they're quoting Blue Cross itself. Now I know in these big companies the right hand doesn't always know what the left hand is doing, but really!
I don't see any double speak, I don't see anything about an employer. And they're quoting Blue Cross itself. Now I know in these big companies the right hand doesn't always know what the left hand is doing, but really!
I know, I'm saying it was a bit of double speak on the part of BCBS. It's in their interest to make this seem it's all on the doctor, I get that. But the truth is that group/employer plans pay a higher reimbursement rate than individual plans.
A Tucson, Arizona orthopedic surgeon is refusing to operate on patients who purchased insurance through the health care exchanges. He doesnt like Obamacare.
NO doctor has to be in any insurance companies networks if they do not want to.
And he can be a non assignment Medicare physician as well.
A patient is also not required to stay in network, if they agree to pay for the
out of network service. It's really quite simple.
It has been that way since the beginning of our rotten for profit insurance company driven health care system.
It's not the insurers' fault. Those low reimbursement rates were set by HHS as a component of Obamacare. The insurers actually are being told by the gov't what they will pay for an appt, procedure, etc. The high cost of those plans is due to the increased risk (e.g. sicker people that use more medical care) and to pay for all of those subsidies that low income participants are getting. After, there's no such thing as free - someone's gotta pay.
No, the ACA does not set physician reimbursement rates:
"The benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.
So, yes, these plans are paying less, and the insurance companies are the ones setting the docs' fees.
It's interesting that Sara Rosenbaum, "a professor of health law and policy", thinks the low fees are acceptable because "physicians are very well-compensated people, no matter what.". In other words, it's fine that they will have to do more work to make the same amount of money.
Why should doctors accept patients for whom the reimbursement is lower than Medicare? I suspect the orthopedist in question has plenty of Medicare patients he could see instead of people on policies bought through the exchanges that are low balling fees. I do not blame him.
Last edited by Ibginnie; 04-26-2014 at 04:46 PM..
Reason: copyright violation
"The benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.
Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. 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.
Some experts minimized the impact of lower pay rates on enrollees.
People 'may experience wait times to get in, but that is not unique to people in exchange plans,' said Sara Rosenbaum, a professor of health law and policy at George Washington University,
Rosenbaum said she was not overly concerned about physicians’ compensation. 'I don’t mean to suggest that physicians don’t deserve to do well,' she said. 'But physicians are very well-compensated people, no matter what.'
Confusion About Rates, Provider Lists
Many doctors say they have not decided if they will participate in the new plans –in some cases, even when an insurer is including them in their provider list.
A survey by The Medical Society of the State of New York found that 40 percent of more than 400 physicians who had responded so far said they chose not to participate in a health insurer’s exchange plan, and one-third said they did not know whether they were participating or not.
Two-thirds indicated they had received no information about reimbursements; of those who did get that information, 'a significant majority indicated that the reimbursement generally was well below what the insurer pays in other contracts,' according to a statement from the society’s president Dr. Sam Unterricht."
So, yes, these plans are paying less, and the insurance companies are the ones setting the docs' fees.
It's interesting that Sara Rosenbaum, "a professor of health law and policy", thinks the low fees are acceptable because "physicians are very well-compensated people, no matter what.". In other words, it's fine that they will have to do more work to make the same amount of money.
Why should doctors accept patients for whom the reimbursement is lower than Medicare? I suspect the orthopedist in question has plenty of Medicare patients he could see instead of people on policies bought through the exchanges that are low balling fees. I do not blame him.
I stand corrected but I was under the impression HHS set reimbursement rates (or a range depending on market). I would have to find that information to be sure but if I'm wrong, I have no problem admitting my error.
I 100% agree with you that saying doctors are well-compensated people, no matter what is a horrible statement. From what I can see, the premise is that they are comfortable with very low reimbursements but the answer is see more patients. Already, doctors do not have enough face time with their patients and they think it is acceptable to ramp that up even more? Personally, I think the idea of increasing volume will necessarily decrease quality.
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