Newsmax: Doctors Opting Out of Obamacare Exchange Plans As many as 214,500 doctors will not participate in any Affordable Care Act exchange plans in the coming year, according to a medical practice trade group. Physicians are opting out for two main reasons: concern over low reimbursement rates, and worries that in a significant number of cases they wont be paid for their services, a new survey by the Medical Group Management Association reveals. Exchange plans, or health insurance marketplaces, facilitate the purchase of health insurance in each state in accordance with the Affordable Care Act. The exchanges provide a set of government-regulated and standardized healthcare plans from which individuals may purchase health insurance policies eligible for federal subsidies. In March 2012, the Department of Health and Human Services set forth the procedures to be followed if patients with an exchange plan stop paying their premiums. In the private healthcare market, an individual loses coverage after failing to pay a premium. But exchange plans must provide their members with a 90-day grace period to pay their premiums, Brittany La Couture of the American Action Forum points out in a report on the survey. The insurer is required to continue coverage for 30 days. After that, any medical care given a patient will be covered by the insurer if the overdue premium is paid by the end of the 90-day period. If the patient does not pay up, the healthcare provider will have to recover any charges incurred between the 31st and 90th day of the grace period directly from the patient. If the patient doesnt pay, the provider wont be compensated. A patient could conceivably join an exchange plan, stop paying the premium, receive extensive medical care, and escape paying completely. This is the number one reason for providers deciding not to participate in exchange plans, said La Couture, who notes that nearly 1 million individuals enrolled in exchange plans have not paid their premiums to date. The other major reason for doctors opting out of the exchanges is their low reimbursement rates. Compared to each dollar a private plan pays providers for a service, it’s estimated that Medicare pays $0.80 and Obamacare exchanges pay about $0.60. The thought was that insurers would compete by lowering payments to providers, and the providers would make up the difference with an increased patient load. Primary care providers, however, are already overburdened and have too many patients as it is, so the increase in volume will do nothing to offset their losses, La Couture observes. She concludes: This reduction in payment rates has caused many physicians and hospitals to decline to accept insurance plans issued through the exchanges, thereby negating the intended effect of providing individuals with affordable care by virtue of eliminating their access to care. The stated goals of the law fly in the face of the actual results that it produces.
Posted on: Wed, 12 Nov 2014 16:33:40 +0000
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