Some people who bought Affordable Care Act plans might have a hard time finding doctors willing to accept them as patients, USA Today reported. Doctors cite payment concerns, already-full practices or administrative hassles related to exchange products as reasons for turning new patients away.
One silver-plan enrollee sued his insurance company when he couldn't find an in-network primary care physician after contacting 30 offices, the newspaper noted.
"The exchanges have become very much like Medicaid," Andrew Kleinman, M.D., president of the medical society of the state of New York, told USA Today. "Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they're not going to be in business very long."
Kleinman's colleagues complain that ACA plan rates can be half of what commercial plans pay for the same services. But insurers contacted by USA Today refuted this point.
Doctors also have administrative concerns about exchange plans. The 90-day grace period patients have before plan cancelation for non-payment of premiums, for example, may force some practices to chase patients for money. Then there's a lack of health insurance literacy among the newly-insured. Many new enrollees don't understand their cost sharing obligations despite payer efforts to educate the public during ACA implementation. So doctors' employees must spend time teaching people how their coverage works.
Another factor making it harder for patients to find providers is the movement to narrow networks in exchange plans to curb costs. To this point, federal officials are developing new standards to determine whether ACA plans have enough doctors and hospitals in their networks. Under the new standards, insurers must have contracts with at least 30 percent of essential community providers that treat low-income people, as well as networks with sufficient numbers and types of providers, as FierceHealthPayer reported.
- here's the USA Today article