At the time of your insurance purchase you ask the agent, or whomever is helping you, if your specialist is in this company's network. You check the insurance company's website and are told that yes, your doctor is part of the network.
Now you make an appointment with the doctor's office and they verify your insurance over the phone but your can't see a doctor for month or so. Finally, the day arrives, you go to your physician and are told, sorry, but this doctor isn't taking your insurance because it was purchased on the healthcare exchange.
"What? I was told you took my insurance!" you exclaim.
This is happening everyday in doctor's offices around this country. Doctors are turning away patients because the policies that are sold on the exchange have lower reimbursement rates. So even though everyone is required to have insurance and the government is subsidizing part of the premium, your policy isn't the same as the others.
What can be done to fix this? Easy. The Affordable Care Act should be amended to require payments to doctors to be the same on or off the exchange. Or, require insurance carriers to note on their websites which doctors won't be accepting those policies so the patient doesn't waste their time or money. And while they are fixing it, take the coding out of the policy number that indicates if coverage is sold on the exchange or not.
In essence, medical practices are using the "we won't get reimbursed as much" reason for keeping away patients that need services. Unfortunately, congress won't take any action on fixing the problem because too many are focused on repealing the law altogether. That's a story for a later blog.
