When buying health insurance under the Affordable Care Act, Michelle Pool made sure to ask her agent to ensure her longtime primary care doctor was a member of the plan. But when her insurance card arrived, Pool, who is diabetic and has had a hip replacement, learned her doctor did not accept her new insurance.

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When buying health insurance under the Affordable Care Act, Michelle Pool made sure to ask her agent to ensure her longtime primary care doctor was a member of the plan. But when her insurance card arrived, Pool, who is diabetic and has had a hip replacement, learned her doctor did not accept her new insurance.

Consumers lose doctors with new policies

By Kelli Kennedy
The Associated Press

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MIAMI – Some consumers who bought insurance under President Barack Obama’s health care law are experiencing buyer’s remorse after realizing that their longtime doctors aren’t accepting the new plans.

Before the law took effect, experts warned that narrow networks could affect patients’ access to care, especially in cheaper plans. But with insurance cards now in hand, consumers are finding their access limited across all price ranges – sometimes even after they were told their plan would include their current doctor.

Michelle Pool is one of those customers. Before enrolling in a new health plan on California’s exchange, she checked whether her longtime primary care doctor was covered. Pool, a 60-year-old diabetic who has had back surgery and a hip replacement, purchased the plan only to find that the insurer was mistaken.

Her $352 a month gold plan was cheaper than what she’d paid under her husband’s insurance and seemed like a good deal because of her pre-existing conditions. But after her insurance card came in the mail, the Vista, Calif., resident learned her doctor doesn’t take her new insurance.

“It’s not fun when you’ve had a doctor for years and years that you can confide in and he knows you,” Pool said. “I’m extremely discouraged. I’m stuck.”

The dilemma undercuts a 2009 pledge by the president: “If you like your doctor, you will be able to keep your doctor, period.”

Consumer frustration over losing doctors comes as the Obama administration still is celebrating a victory with more than 8 million enrollees in its first year.

Narrow networks are part of the economic trade-off for keeping premiums low and preventing insurers from turning away those with pre-existing conditions. Even before the Affordable Care Act, doctors and hospitals would choose to leave a network – or be pushed out – over reimbursement issues as insurers tried to contain costs.

America’s Health Insurance Plans, an industry trade group, said studies show the biggest factor influencing consumer choice is price. Insurers said if consumers want low premiums, their choices might be limited.

Insurance companies also argue there’s wide variation in what doctors and hospitals charge, with some increasing prices every year. Insurers said there’s little evidence that higher-priced hospitals or doctors actually deliver better care.

The act requires insurance companies to post their directories so consumers can see if their doctor is covered before they sign up, said Fabien Levy, a spokesman for the U.S. Department of Health and Human Services. Officials said insurance companies ultimately decide what doctors and hospitals to include in networks, just as they did before the law. The federal government closely monitors plans to see if more guidelines are needed to ensure consumers have access to quality health care.

Insurance companies said doctors equally are responsible for letting consumers know what plans they accept. But finding that information can be tricky because healthcare.gov does not have a centralized directory of doctors and what plans they accept. Instead it offers links to directories of individual plans, which sometimes are inaccurate.

Insurance agents Craig Gussin in San Diego and Kelly Fristoe in Texas helped dozens of clients switch plans just before the enrollment deadline when clients realized their doctors weren’t covered. Now, they’re struggling to help clients who realized they were in that position after the March 31 enrollment deadline, when consumers are locked into plans for one year.

Gussin said even after his mad dash to make switches before the deadline, he still has a half-dozen clients who are stuck and he expects the number to grow as more try to schedule appointments with doctors. He and other agents fear it will be one of their most serious issues in 2014.

“Everybody I talk to is having the same issue. It’s probably the No. 1 item that we’re seeing right now,” said Gussin, who is petitioning Covered California for special enrollment status to help clients change plans.

Health counselor Nathalie Milias, who helped enroll almost 300 Miami-area residents in ACA plans, said most of them chose a plan with no monthly premiums and deductibles – but with much more limited choices. Tax credits could have allowed them more robust plans if they were willing to spend more, she said, but many are working poor who didn’t want to pay another bill.

Many consumers still are learning. They hear “Obamacare” and think it’s free like Medicaid or Medicare, said John Foley, a lawyer and navigator.

Comments

Are You Serious?

Where has the AP been for the last four years? Are they now just a historical society? How about reporting on all the other "mis-speaks" about this terrible legislation. It would have been nice if they had reported this before an election that this could be fixed. At least report on all the bad things that are yet to come before November. And, yes, I mean 2014, not November 2020.

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