I met with a doctor three weeks ago who told me that most carriers with whom he works simply sent him a letter telling him that they had added him to their Covered California plans and that his new reimbursement in those plans would be Medicaid (or Medi-CAL in California) plus 5%, 10% or something similar. In most cases, it was incumbent on him to opt out. Of course, he did.
His lobby had signs near the front desk stating that he would no longer take new Medicaid enrollees or any Covered California plan except for one particular carrier. He was still taking Medicare. In California Medicaid pays considerably less than Medicare. That is true in most but not all states.
I asked him about the one carrier he decided he would accept from Covered California. He explained that he was not accepting that plan until one day earlier. What changed? This carrier sent him a second letter (after he'd opted out) telling him that they would honor their existing contracted pricing with him on their Covered California plans until the end of his contract term which was four months away.
What is going on here? Nationwide, PPACA Exchange plans, including Covered California, are beginning to take political heat for only having 25% to 50% of the normal doctor networks available in them. This debacle is only going to exacerbate as patients get signed up and actually want care. This carrier had taken enough heat from Covered California that it decided to bite the bullet and just pay its full contracted pricing through the Obamacare enrollment period. After that period of time, they will go back to slashing doctor reimbursements and this doctor will opt back out.
Just because we have provided an insurance card to 5 million people does not mean they will get care.
The below is from Allison Bell at Benefits Pro discussing the same topic:
His lobby had signs near the front desk stating that he would no longer take new Medicaid enrollees or any Covered California plan except for one particular carrier. He was still taking Medicare. In California Medicaid pays considerably less than Medicare. That is true in most but not all states.
I asked him about the one carrier he decided he would accept from Covered California. He explained that he was not accepting that plan until one day earlier. What changed? This carrier sent him a second letter (after he'd opted out) telling him that they would honor their existing contracted pricing with him on their Covered California plans until the end of his contract term which was four months away.
What is going on here? Nationwide, PPACA Exchange plans, including Covered California, are beginning to take political heat for only having 25% to 50% of the normal doctor networks available in them. This debacle is only going to exacerbate as patients get signed up and actually want care. This carrier had taken enough heat from Covered California that it decided to bite the bullet and just pay its full contracted pricing through the Obamacare enrollment period. After that period of time, they will go back to slashing doctor reimbursements and this doctor will opt back out.
Just because we have provided an insurance card to 5 million people does not mean they will get care.
The below is from Allison Bell at Benefits Pro discussing the same topic:
... Doctors say plan reimbursement rates are 20 percent to 40 percent lower than traditional plan rates.
“Our physicians describe these payment reductions as unaffordable to their practices,” Dressner [an industry representative] says.
In some cases, Dressner says, carriers seem to think they can change contract terms by simply sending letters to the physicians.
Physicians have trouble finding out what the plan contract terms are, or even finding out whether they’re really in a plan provider network, Dressner says.
Dressner says his group is telling physicians they have to negotiate terms with the plan issuers just as they would with any other private payers....
