Don’t assume that you can continue to see your doctor…
A City Journal article noted that “… having health insurance is not the same thing as getting good health care, or any health care. In fact, it doesn’t matter how many Americans obtain insurance under the ACA. Most will have difficulty finding a physician.”
“Those who do get coverage through the exchanges and pay their premiums will also struggle to get medical care. The ACA requires insurers to accept every patient regardless of risk, provide expansive benefits packages, and eliminate caps on lifetime benefits. Looking to control costs, most insurers are offering exchange plans that severely limit the number of doctors and hospitals patients can visit. Some state exchanges—including New York’s—don’t offer a single plan that covers visits to out-of-network doctors or hospitals.”
“If this scenario sounds familiar, it’s because we’ve seen it before, during the failed managed-care experiment of the 1990s. Patients and physicians quickly became disenchanted with the restrictions and bureaucratic complexity of Health Maintenance Organizations (HMOs). At least patients had options then. They could avoid HMO restrictions by buying broader, more expensive insurance plans. Many plans available now on the state exchanges are highly restrictive, HMO-like networks.”
“Patient choice has been further compromised by the haphazard implementation of the exchanges. Patients have reported trouble determining which physicians will participate in which plans. Doctors, too, are often unaware whether they’re listed in particular insurance networks and what the reimbursement rates are. Many find themselves arbitrarily excluded from plans in which they had previously participated; others are getting listed on plans without their knowledge.”
Click here to read the full City Journal article “The Doctor Won’t See You Now” by Joel Zinberg.
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Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.