A View of ACA from a Physician Perspective

[Yagents]

I'll bet $2 that these patients didn't use an agent. How many of you are dealing with "I don't take obamacare patients"? Anyone seen this Amex card they speak of?

South Florida Doctors Explain Co-Insurance, As Well As Cholesterol Counts | Kaiser Health News

“Most people hand you that card like they are giving you an American Express Platinum without a limit,

The ACA does not penalize doctors for refusing to take Obamacare patients, but those who do may be in violation of their their contractual agreements with insurance companies.

Martinez said his office staff spends up to 30 minutes on the phone with insurance companies to establish if ACA patients are still paying their monthly premiums. Even after insurance companies say the person is on the plan, they often add the caveat of “no guarantee for payment,” Martinez said.

 

[kgmom219]

With the caveat that 95% of my clients are on the largest PPO in North Texas (whether they are on or off exchange), I'm dealing with this about once a week. Last year, it was about once a day.

I have to call, explain that their contractual obligations to the PPO and my clients get seen. Every once in a while, I have to speak to the "office manager". I only had one case where I had to get the provider relations rep on the phone. (But in all instances, I forward to the info to provider relations, so they can follow up with the office).

 

[AllenChicago]

Open-minded physicians are flexible!

Patient: "I have a Grandfathered Plan!"
Doctor: "No Colonoscopy for you, but I'll be happy to do exploratory surgery! All you have to pay is the first $500."


Patient: "I have an ObamaCare Plan!"
Doctor: "I'll gladly give you a free Colonoscopy, but if we find something, I won't go further until you pay the $6,000 deductible up-front. Understood?"

 

[insuranceconceptscindy]

Let's let the doctors educate the patients on their insurance. Of course that will work! Most doctors that I know can't even spell insurance!
The long and short of it is education- how do we educate to the masses about how this works? My clients leave with a halfway decent understanding of the policy they bought. The public that went online has no clue, they just know it will be $100 month and they won't go to jail for not having it.

Should we be teaching this stuff in school? It boggles my mind how ignorant the general public is about basic stuff that you need to know as an adult.

 

[sman]

With the caveat that 95% of my clients are on the largest PPO in North Texas (whether they are on or off exchange), I'm dealing with this about once a week. Last year, it was about once a day.

I have to call, explain that their contractual obligations to the PPO and my clients get seen. Every once in a while, I have to speak to the "office manager". I only had one case where I had to get the provider relations rep on the phone. (But in all instances, I forward to the info to provider relations, so they can follow up with the office).

I had a doctors office that was adamant last year that they weren't taking a clients plan (it's an off-exchange plan). They showed as being in-network. They even stated they were in Humana's National POS network (that's the network of the plan), but said they weren't taking any NEW plans (ACA compliant plans). I laughed and said I guess that means the doctor is retiring soon since ALL plans moving forward will be ACA compliant.

I spoke with the office manager and she was adamant as well. Knowing that this doctor's office had more than one location I asked if I could speak with the person over her. She gave me the phone number to that person. I called and left a message. The next day I received a call from her apologizing that her staff was uninformed and that she was going to be sending out a memo that day educating her staff.

It's a tough enough battle getting the clients and earning their trust. I don't need the doctors offices to make it even harder. And unfortunately people think the staff at the doctors office know what they're talking about.