Small problem

With the first enrollment period over, Obamacare has received more than 10 million applications through public and private exchanges for qualified health plans. People who were unable to afford insurance before PPACA finally got a chance to purchase better health insurance through subsidies and expanded Medicaid coverage. However, there are some unprecedented challenges surfacing after such a good run of enrollments – some of the insured do not have the same wide network of hospitals and doctors to support them and several  are unable to find the right combination of doctors and hospitals in their covered network.

As per the norms of the ACA, the law requires insurers to accept enrollments without prejudicing enrollees on medical history and preexisting medical conditions. Taxes, fees, and other aspects of the law have prompted major insurers to look for ways to reduce costs and retain profitability. One such measure is reducing the reimbursements to doctors and hospitals , nearly 30 percent lower than what they received before ACA. Naturally, some doctors and hospitals have responded by rejecting the proposal and deciding not to associate with these insurers. By the time this tussle gets sorted out, the patients covered by these insurance carriers have fewer doctors and fewer hospitals to provide services.

For instance, Blue Shield of California now has 40 percent fewer doctors in its network than pre-ACA time. Similarly, the number of hospitals in its network is 25 percent fewer than pre-ACA era. On the other side of the scale, it has nearly 300,000 newly covered individuals under its umbrella. With these narrow networks, a bigger problem has surfaced – people are unable to find a working combination of a covered doctor and a covered hospital in their network, forcing them to pay out of pocket for one of these services. For instance, a woman suffering from a herniated disk in California reached out to surgeons in her network, and found out that those surgeons were operating out of hospitals which were out of her covered network. In some cases, the problem was the opposite; the hospitals in her network did not have doctors covered by her insurance. In total, after reaching out to 20 surgeons and 5 hospitals, she could not find a single combination that worked, finally prompting her to pay her doctor out of pocket.

According to available studies and facts, the story is same around the nation. Nearly 70 percent of Obamacare plans offer fewer hospitals and doctors than pre-ACA individual insurance. For people who were uninsured before ACA, this does not matter much, but for people who have enjoyed better coverage, this is a major issue. Naturally, the administration is trying to fix things. Here are some measures that are already implemented, or are in pipeline, for making sure that these wrinkles are ironed out as soon as possible.

  The administration has released strict, new standards for insurers to address customer complaints regarding ACA coverage.

  For people with low incomes and subsidized insurance, coverage network takes a backseat. For them, top priority is lower insurance premiums, and that’s where the attenuation can be made for balancing the physician availability for people who have had insurance before ACA implementation.

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