Can You Keep Your HMO Doctor?

[AllenChicago]

May 27, 2014

REF: Family Opts Out Of Obamacare Plan After They Say Doctors Told Them They Didn’t Take Their Insurance « CBS Houston

The family in this article states that even though the doctors are listed in the BCBS-TX HMO Network, most of them are not accepting the new BCBS HMO plans.

BCBS-TX spokesperson says that the doctors listed in the HMO search results DO accept the plan.

Stories like this are occurring with greater frequency. What's behind most of these? Is the carrier including doctors in its network(s) just to prove network adequacy to keep HHS/CMS at bay? Or, are doctors (for some reason) placing themselves in a network with no intention of accepting the associated plan? Or, are clients searching the wrong network? Due to the cost-containment pressures of ObamaCare, we're now seeing 3 HMO networks per carrier in some cases.
ac

 

[timsip]

May 27, 2014

REF: Family Opts Out Of Obamacare Plan After They Say Doctors Told Them They Didn’t Take Their Insurance « CBS Houston

The family in this article states that even though the doctors are listed in the BCBS-TX HMO Network, most of them are not accepting the new BCBS HMO plans.

BCBS-TX spokesperson says that the doctors listed in the HMO search results DO accept the plan.

Stories like this are occurring with greater frequency. What's behind most of these? Is the carrier including doctors in its network(s) just to prove network adequacy to keep HHS/CMS at bay? Or, are doctors (for some reason) placing themselves in a network with no intention of accepting the associated plan? Or, are clients searching the wrong network? Due to the cost-containment pressures of ObamaCare, we're now seeing 3 HMO networks per carrier in some cases.
ac

Here is the page from the Coventry customer provider look up tool. If you are a consumer, which network do you click on? Heck, our CoOp isn't much better. I think this could be one of the problems.

 

[RayNY]

Tim,

Change "Coventry" to "UHC" in that link you posted to see United's networks. No exaggeration, it took 15 phone calls to get a definitive answer as to what network they were using for QHP's. The answer came from a broker ultimately, carrier and exchange couldn't figure it out. A lot of confusion happened there.

Allen,

In my experience, it's usually the provider not realizing they're in or out of a network because they were not notified or briefed on the changes. There are some errors, and some doctors not accepting patients for various reasons, but most appear to just be poorly informed.

 

[taterpeeler]

according to my research of the BCBS TX HMO plans the networks with a third or less of the number of PPO dr's that are in the HMO... example, Laredo where I am right now has about 60% of the same number of PPO docs... 1000 PPO dr's 600 HMO doctors(just an example) those plans seem to be holding up well... why does Laredo have such a high % of HMO docs? because of the heavy concertration of Medicaid recipents.... In Dallas where the % runs closer to 30% the HMO docs filled up quickly and are not taking any new patients... one client in South Dallas(heavy minority) she said she called 147 Doc and none would see her.... she finalialy found 2 that would treat her....

Also, the 90 day rule is scaring these docs to not take new patients.

 

[AllenChicago]

It looks like the root cause of all these medical provider problems is the Affordable Care Act. Thanks for everyone's thoughts, feedback and sharing of experiences.

Adding millions of new patients to a medical system where more doctors are leaving their careers than starting one, and you have a slow-motion train wreck in the making. Now where have I heard that before!?
ac

 

[timsip]

Tim,

Change "Coventry" to "UHC" in that link you posted to see United's networks. No exaggeration, it took 15 phone calls to get a definitive answer as to what network they were using for QHP's. The answer came from a broker ultimately, carrier and exchange couldn't figure it out. A lot of confusion happened there.

To add to the confusion, health benefits with our CoOp can be different if the provider is a tier 1 or tier 2 provider. This has gotten nearly impossible for the average consumer to navigate.

 

[houcoogster]

It looks like the root cause of all these medical provider problems is the Affordable Care Act. Thanks for everyone's thoughts, feedback and sharing of experiences.

Adding millions of new patients to a medical system where more doctors are leaving their careers than starting one, and you have a slow-motion train wreck in the making. Now where have I heard that before!?
ac

AC investigate the AMA Mafia that runs the show with an iron fist. They control the number of Docs because they control the number of degrees awarded!

 

[timsip]

AC investigate the AMA Mafia that runs the show with an iron fist. They control the number of Docs because they control the number of degrees awarded!

Finally someone points to the true root cause of why our healthcare system is so expensive!!!

 

[houcoogster]

Finally someone points to the true root cause of why our healthcare system is so expensive!!!

Check out the third paragraph from the last.

The Evil-Mongering Of The American Medical Association - Forbes

 

[AllenChicago]

February 19, 2015

""And Blue Cross & Blue Shield of Illinois, the state's dominant insurer, has notified physicians that they will be paid less if they send "certain" HMO patients to Rush University Medical Center. To avert the threat to its business, the Near West Side facility is cutting its reimbursement rate for those patients.""

Ref: http://www.chicagobusiness.com/arti...icine-and-rush-have-health-insurance-problems

Are HMO plans losing their reliability to the point where they aren't even worth the relatively low premium? It seems that Insurers are adjusting their HMO contracts with physicians and hospitals on a whim, and always in a direction that's less favorable to the patient / paying customer.
ac