Whats Wrong With Idaho The Reddest and Whitest of All States is all in for Obamacare (visa, prison)
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How will this doctor even know if the patient is on a plan purchased through the exchanges? There no such thing as an "Obamacare Plan". This patient purchased a plan through BCBS. That is the only thing the doctor will know.
Even if government rates influence private insurer rates, nothing in direct government action nor implicit in the rates set by HHS forces insurers to pay less for exchange plans than for other commercial insurance. Insurers can pay the same, less, or more as they wish relative to their commercial rates.
There are however some structural differences between employer and pre-ACA individual plans on the one hand and post-ACA exchange plans on the other that create an incentive for insurers to pay doctors less and have a smaller network (as not all doctors will accept the lower reimbursements, should the insurers choose to do that).
These differences in large part have to do with who is buying the insurance, what those people want, and the interplay between cost, selection, and network size.
In employer plans, you are contracting with a larger business rather than an individual, and for individuals pre-ACA you had medical underwriting. With an exchange plan, you are dealing with an individuals, and no medical underwriting. Corporate benefit managers don't want to deal with complaints about out of network doctors/hospitals/etc. and the generally-better-off people buying pre-ACA individual plans also wanted to see whatever doctor they wanted to see and were willing to pay for that option even if they were healthy. Post-ACA, sicker people will want to see their doctor/specialists, but healthier people will want to save money -- and since most people buying on the exchanges are getting subsidies, you have a group that is more price sensitive and sees larger marginal price swings than for the policy as a whole since a flat chunk of it depending on their income is being picked up by the feds - not to mention pricing has gotten more transparent due to the exchanges.
So basically you've gone from a world where people are relatively less price sensitive and you get a smaller (or for sufficiently large groups, effectively no) favorable selection effect from a narrower network to a world with more price sensitive buyers and a stronger selection effect from having a narrower network than competing insurers. This makes the benefit in terms of sales for paying doctors less and passing the savings on to policyholders higher, at the same time making the cost in terms of alienating people from having a narrower network as a result of those compensation cuts lower because the volume lost will disproportionately be people who are going to lose the insurer money anyway.
Hence you see a pattern - although by no means a universal one, and not one that is required by HHS - of insurance companies paying doctors less money for exchange plans and as a consequence of that offering a narrower provider network.
As for whether that is the case of not for your specific plan Arjay, I have no clue.
Thanks so much, ALackOf Creativity. That is most illuminating.
I have been concerned from the outset that doctors might be the odd man out under the new law. Hopefully any necessary adjustments in that regard can be made.
-- Does an insurance policy purchased through the exchange pay the doctor less than it would if the policy is purchased directly from the insurance company (or an independent agent)?
-- If so, why? The premium I'm paying for my Humana policy (purchased through the exchange) is the same premium quoted on the Humana website.
-- Do my doctors know whether I purchased my policy directly or via the exchange or independent agent?
-- If so, how do they know? Is there some kind of code or number on the policy stating where it was purchased?
This is from last year, but it's from the Kaiser Health News, not an anti-Ocare site ---
"Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces. Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors".
Also, I saw somewhere, No Link, that it's easier for doctors to get stuck for bills owed by subsidized patients in exchange plans who don't pay their premiums.
The fact that one doctor doing this is news ought to tell you that it is not a major problem in the implementation of the ACA. I know several people who have private plans purchased through the ACA as well as a couple of new Medicaid enrollees and everyone, it seems, is getting the care they desire.
This very thing is happening in the town I live in. Its a wealthy retirement community. A few cardiologists/internal medicine doctors I work with have started what they call Concierge practices. One in particular has 200 patients that she charges $4000 each per year. She accepts no insurances. The annual fee covers all physician visit costs and anything done in the office. It also covers physician services in the hospital. Of course hospital admissions etc would be the responsibility of the patients insurance.
We have quite a few doctors here doing the same thing. Prices run from around $3000 to $7000 per year. Some of them are on 24 hour call and will text, email, etc for immediate access to the doctor.
The fact that one doctor doing this is news ought to tell you that it is not a major problem in the implementation of the ACA. I know several people who have private plans purchased through the ACA as well as a couple of new Medicaid enrollees and everyone, it seems, is getting the care they desire.
We've both been to the doctor a few times since a Humana policy through the exchange. It has operated exactly as in the past with other insurers -- not a ripple. The co-pay, claims handling, reimbursement and premium are all very much in line with past policies.
Amazing how facts are clouded by politics and paranoia.
The main idea of the exchanges was to increase the number of insured, thereby helping to control costs of premiums.
I would be very surprised if doctors "check" on whether their patient is in a group or individual plan. That said, a doctor may not be in
the list of approved providers under a given plan. For example, a doctor may be a provider under a BCBS PPO, but not in a BCBS HMO in
the same geographic area.
For the fifteen millionth time, "ObamaCare" and the "Affordable Care Act" are not insurance plans. Insurance companies put their products out there
under the exchanges and administer their own plans, just as in the past. However, now they have to play by the rules, such as providing policies to those with pre-existing conditions.
If a doctor turns patients away because they are on an individual health plan, they must think the ACA is really Medicaid or they have some other
mistaken idea about their reimbursement.
A ton of these "scary" stories are merely political propaganda. All of us need to become educated about the facts before the next election.
So people who couldn't get insurance before and now can are not worthy of being treated? Because that's pretty much what this doctor is saying.
No, what the doctor is saying is the plans don't reimburse enough to cover his costs.
If you want something to disappear, be it a service, food, gasoline or whatever, all you have to do is put price controls on the commodity and it will disappear.
The stupids of Venezuela are discovering this little fact right now has had every other left wing nut job government from the dawn of time.
HeyJude, what is it you do for a living?
I have no idea, and really don't care, but let's assume you own a small business that sells and mounts tires at a local tire store. The government, wanting everyone to be safe on the road with new tires, institutes a policy where you can only mark up your tires $2.00 and charge a customer $1.00 to mount a tire. You pay the guy who does the actual work $14/hr and he can mount 4 tires an hour earning you $4.
Are you going to lose money on every sale or are you going to be a greedy, capitalist, running dog who wants to make money at the expense of saving the lives of innocent children because you are putting profits ahead of children riding in cars with safe tires?
A Tucson, Arizona orthopedic surgeon is refusing to operate on patients who purchased insurance through the health care exchanges. He doesnt like Obamacare. Apparently their are a number of conservative doctors who are refusing to see ACA patients. How about if someone is paying the full rate and in fact more than they were last year, should a doctor still refuse? The woman in this case is covered by BCBS. My guess is when doctors like this start selecting which BCBS patients they take BCBS will have something to say. Being that this is in Tucson, Arizona with a lot of seniors I dont see how an orthopedic surgeon can stay in business without a heavy load of Medicare patients, some on BCBS plans. The average salary of an orthopedic surgeon is $333,000
1. We, as physicians, can accept or refuse any insurance we want.
2. One is obligatged, when on call, to treat EVERYONE.
3. When in clinic we can accept or reject ANY PATIENT, for whatever reason we want.
4. Orthopods make MUCH MORE than $333K. Those figures are distorted by academic salaries.
5. We lose money on every medicare/medicaid patient we see. Not seeing any of them would help our bottom dollar, as we can easily fill our clinics/surgery schedule with regular insurance patients.
As much as liberals would love to dictate fees and who physicians can see, the fact remains that there is a SHORTAGE of physicians. Given this shortage, we can pick and choose who we want to see. CONGRESS dictates the number of medical school and residency slots- complain to them.
Just get a group of intelligent, highly educated, motivated people, who have sacrificed a decade of income and have $350K of debt to work for free, then you have the problem solved. Until then, the market (and congress with its limits on residency slots- which were REDUCED by Obamacare) determines salaries and the number of physicians.
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