Recently a USA Today article http://www.usatoday.com * noted: “Nancy Pippenger and Marcia Perez live thousands of miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers. “They said, ‘We take the old plan, but not the new one,’ ” says Perez, an attorney in Palo Alto, Calif. In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.”
“Both women unwittingly enrolled in policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but with its expansion of insurance, they are covering more people — and some are shrinking enrollees’ options further than before. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect. “
Consumer groups argue many enrollees were misled. In California, consumers filed class-action lawsuits against some insurers, alleging they were given inaccurate information about their plans’ limitations and about which doctors and hospitals participate in them. Nationally, regulators and insurance agents are inundated with complaints, while lawmakers are considering rules to ensure consumers’ access to doctors. For plans being submitted for sale next year, the federal Department of Health and Human Services said it will more closely scrutinize whether networks are adequate.”
“Insurers say they are simply trying to provide low-cost plans in a challenging environment. The new federal health law doesn’t let them reject enrollees with health problems or charge them more just because they are sick. So they are using the few tools left to them — contracting with smaller groups of hospitals and doctors willing to accept lower reimbursements; requiring referrals for specialty care; and limiting coverage outside those networks.”
* to read the full USA Today article “New health plans’ limitations anger enrollees” by Julie Appleby, highlight and click on open hyperlink http://www.usatoday.com/story/news/nation/2014/07/26/obamacare-health-plan-limits-insurers/13172133/
Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.