Consumers losing doctors with new insurance plans

By Kelli Kennedy

Associated Press

Published: Wednesday, May 14 2014 6:47 p.m. MDT

In this May 6, 2014 photo, Michelle Pool, who is diabetic and has had a hip replacement, sits with her dog, Ryker, at her home in Vista, Calif. The first thing Pool did before picking a health insurance plan under President Barack Obama’s health care law was asking her agent to make sure that her longtime primary care doctor was covered. But after her insurance card came in the mail, she learned her doctor wasn’t taking her new insurance.

Lenny Ignelzi, Associated Press

Enlarge photo»

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 impact 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 numerous pre-existing conditions. But after her insurance card came in the mail, the Vista, California resident learned her doctor wasn't taking 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 President Obama's 2009 pledge that: "If you like your doctor, you will be able to keep your doctor, period." Consumer frustration over losing doctors comes as the Obama administration is still 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 under control 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.

Insurance trade group America's Health Insurance Plans says studies show the biggest factor influencing consumer choice is price. Insurers say that if consumers want low premiums, their choices may be limited.

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

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

Insurance companies say doctors are equally 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 are sometimes 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 says that 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 with doctors. He and other agents fear it will be one of their most serious issues in 2014.

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