Friday, December 20, 2013
Shopping for doctors isn't always easy. CoveredCa, California's health exchange seems to be making it tougher. Ask someone looking for a doctor.Many individuals are looking to use Covered California to get a policy that lets him keep a handful of doctors they like. But like many applying for coverage, the choices are not always to their liking. "My internist is not on the plan",individuals say. Neither is my orthopedist or any of the specialists recommended the individuals primary care doctor. As a result, many are having a difficult choice to make: Keep looking for an affordable plan with the doctors they like, pick a plan with new doctors, or sign up for a plan that allows care by out-of-network docs, typically at a higher cost. Many consumers who currently have insurance and are shopping for a new plan through Covered California are finding it difficult to locate policies that include the doctors and hospitals they're accustomed to seeing. Insurance brokers aren't finding the process any easier. Three words: It's a nightmare, says insurance agents. Most of the insurance companies on the exchange are offering provider networks that are far narrower than the other plans they're selling outside of the exchange. Just how much narrower, however, isn't clear. It is hard to determine. Covered California issued a report last week saying that more than 58,000 physicians were available through the exchange's plans, compared with the 63,000 to 72,000 physicians in the state's largest commercial networks. But how that plays out for consumers probably depends on the specific plan they choose. Blue Shield, the San Francisco-based nonprofit insurer, says it is offering a network through its exchange plans that represents roughly 50% of its full network. In many cases, even doctors themselves are unsure of their status in the new plans. Insurers have a long history of inaccurate and outdated provider listings, which the law does nothing to fix. And the provider lists found on Covered California have themselves been riddled with errors. There are quite a few inaccuracies. The changing and shrinking provider networks do pose a challenge for consumers, but then again that's nothing new. Even before the Affordable Care Act, networks changed because health plans and physician groups reached different agreements on costs. One of the benefits of the Affordable Care Act may make coverage more expensive. Plans must now provide standard benefits across all of their products. Annual limits on out-of-pocket costs apply, and, of course, they must now accept all comers and cannot charge people with preexisting medical conditions more than the healthy. To make insurance affordable, insurers are seeking to control costs in part by limiting the number of doctors and hospitals included in their networks. The question for consumers, is whether they can locate a plan that has good doctors and hospitals at an affordable price. And that's a question that many people are wrestling with for the last couple of months. Most individuals are concerned with how do I decide if I continue to see my primary care physician? Consumers shoudl be to go to any doctor they want. Unfortunately that's not the case. Experts offer some tips for consumers in the market for a plan that includes the doctors they wish to see. Do your homework. Check directly with both your health plan and your doctors and hospitals, particularly if your choice of policies is based on keeping the doctors you like. Unfortunately, you'll need to check each plan's network individually for your doctor. But, beware; Even if your doctors of choice are listed as participating with your plan, be sure to inquire as to whether the office is taking on new patients. Don't be afraid to switch plans. Open enrollment runs through the end of March. If you're unhappy with the plan you purchased early in the year, or learn that you don't have access to the doctors you thought you did, you can switch to another plan before March 31, 2014. Enlist the help of an insurance agent. Local insurance agents certified to sell you a health plan through Covered California can be invaluable. For some reason there is a misconception that if you use an agent you'll have to pay. It costs you nothing extra to have a certified insurance agent who can help you with the decision.Once you're signed up, an agent often works as your advocate when problems with your insurance plan arise. Finding the right plan has been frustrating for many, but keep a sense of humor. As one individual says "Right now I'm starting to look to see if there's a psychologist in the network, because I'm going nuts".