Consumers losing doctors with Obamacare plans

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The first thing Michelle Pool did before picking a plan under President Barack Obama's health insurance law was check whether her longtime primary care doctor was covered. Pool, a 60-year-old diabetic who has had back surgery and a hip replacement, purchased the plan only to find that the insurer was mistaken.

Pool's $352-a-month gold plan through Covered California's exchange was cheaper than what she'd paid under her husband's insurance and seemed like a good deal because of her numerous pre-existing conditions. But after her insurance card came in the mail, the Vista, California resident learned her doctor wasn't taking her new insurance.

"It's not fun when you've had a doctor for years and years that you can confide in and he knows you," Pool said. "I'm extremely discouraged. I'm stuck."

Stories like Pool's are emerging as more consumers realize they bought plans with limited doctor and hospital networks, some after websites that mistakenly said their doctors were included.

Before the law took effect, experts warned that narrow networks could impact patient's access to care, especially in cheaper plans. But with insurance cards now in hand, consumers are finding their access limited across all price ranges.

The dilemma undercuts President Obama's 2009 pledge that: "If you like your doctor, you will be able to keep your doctor, period." Consumer frustration over losing doctors comes as the Obama administration is still celebrating a victory by landing as many as 8 million enrollees in its first year.

Narrow networks are part of the economic trade-off for keeping premiums under control and preventing insurers from turning away those with pre-existing conditions. Even before the Affordable Care Act, doctors and hospitals would choose to leave a network — or be pushed out — over reimbursement issues as insurers tried to contain costs.

Insurance trade group America's Health Insurance Plans says studies show the biggest factor influencing consumer choice is price. Insurers say that if consumers want low premiums, their choices may be limited.

Insurance companies also argue there's wide variation in what doctors and hospitals charge, with some increasing prices every year. Insurers say there's little evidence that higher-priced hospitals or doctors are actually delivering better care.

Further complicating matters, the trade group says that doctors and health plans often renegotiate throughout the year, meaning a doctor listed in a network at the time of enrollment may not be there a few months later.

Insurance agents Craig Gussin in San Diego and Kelly Fristoe in Texas helped dozens of clients switch plans just before the enrollment deadline when clients realized their doctors weren't covered. Now, they're struggling to help clients who realized they were in that position after the March 31 enrollment deadline, when consumers are locked into plans for one year.

Gussin says that even after his mad-dash to make switches before the deadline, he still has a half-dozen clients who are stuck — and he expects the number to grow as more try to schedule with doctors. He and other agents fear it will be one of their most serious issues in 2014.

"Everybody I talk to is having the same issue. It's probably the number one item that we're seeing right now," said Gussin, who is petitioning Covered California for special enrollment status to help clients change plans.

Health counselor Nathalie Milias, who helped enroll nearly 300 Miami-area residents in ACA plans, says most of them chose a plan with $0 monthly premiums and deductibles — but with much more limited choices. She says tax credits could have allowed them more robust plans if they were willing to spend more, but many are working poor who didn't want to pay another bill.

Marie Bien-Aime, a 59-year-old cook at a Miami restaurant, enrolled in that plan to avoid a monthly payment, but she realized her longtime health clinic didn't take the plan. Shortly before the enrollment deadline, Bien-Aime upgraded to a plan that costs $37 per month.

"Paying $37 isn't good for me, but I had to do it because I wanted to keep my doctor because he's so good," said Bien-Aime, who was previously uninsured.

Many consumers are still learning. They hear "Obamacare" and think it's free like Medicaid or Medicare, said John Foley, an attorney and navigator.

"They don't expect to pay anything," said Foley. "For a couple more dollars a month you can get a really good plan and they're like, 'This is free. I don't want to pay for this.'"

Even with pricier plans, some consumers have access problems.

James Potts' $647-per-month silver plan was issued by the same company that had insured him with a different plan cancelled under the Affordable Care Act. The 64-year-old property insurance agent assumed his doctors would remain the same under the insurer's new plan, but didn't double check.

When Potts got a nasty cold, he called three facilities near his home in Wichita Falls, Texas, and was shocked to find none took the insurance, including his primary care doctor.

"It was a waste of money for me," he said. "I couldn't find doctors that would talk to me."


  • Same Problem
    Many have already nailed the problem, which is nothing new. What about employer plans which change carriers? My company has changed insurers three times in seven years, with some change of "in-network" providers. If we are going to keep for-profit insurance companies in the loop, this long standing non-ACA event will continue.
  • Discrepancy in Expectations
    The issue here is that many people took President Obamba at his word, that if you liked your physician, you would keep him. Unfortunately, for whatever reason, and while I don't doubt that President Obama had good intentions, the reality of ACA was that it could not guarantee that one could keep their physician. As they said in the movie, Cool Hand Luke, "what we have here is a failure to communicate", or more realistically, a failure to understand up and down the administration what was being promulgated.
  • From the Trenches!
    1st problem with the exchanges this year was the distribution model. There were navigators, enrollers,and so that had zero experience with health insurance advising people. The 2nd problem was people were going direct through the FFM and enrolling. Some did not know what they were doing and did not do research to make an informed decision. If the current administration would embrace the agent distribution model then we would have more informed consumers. Narrow Networks were created to control costs. Here in Indiana there was a 16% decrease in facility charges for one the exchange networks. That is a big number. The networks we see today on the exchange are going to get even smaller. Here is the best part of our current health care system, if you don't like the exchange plan you can buy off of the exchange. You will not get tax credits but you have that option. I do think future network negotiations should be done before the calender year to coincide with open enrollment. In Indiana, we have had some big issues with participating doctors refusing to treat exchange patients. It's about Money!
  • Beat the Obamacare
    Obamacare Law is playing with the health of every American. Our president Mr. Obama stated that if you love your insurance you can keep it. But they even not bothered about his statement. They just know how to impose this useless law with irregular mandate on citizens of America. Serious patients like Pool have left with no option jus because their doctor not covered under this Obamacare Law. Well, if I started discussing about this topic I think I will never end. However, I got the way to tackle with this Obamacare Law effectively after watching this video on http://freedomcarebenefits.com featuring the best ways to deal with this worst situation.
  • The Downfall
    These comments are so typical of our entitlement society. The producers of economic goods and service are criticized while the takers believe they are entitled to these goods and services with no obligations. We are not better off when the government takes over 1/6 of the economy. Study after study has been completed showing government inefficiency relative to private industry yet "the people" keep trusting this solution. Mikey spits out dogma with no real understanding of the issues. The fact of the matter is health insurance companies employ hundreds of thousands of people and make a relatively small margin compared to other businesses such as clothing stores, oil and gas, manufacturers, etc. But because the press has ostracized insurance executives and insurance companies you believe they are bad. They provide insurance and protect the assets of the private sector, what is bad about this? There economic benefit is far greater than you could ever provide Mikey. Not to mention the benefit they provide for a healthier society is far better than government will ever provide. ACA is a boondoggle to gain further economic control of the masses. Costs aren't lower, they are just shifted to the middle class.
  • A little more research
    Instead of relying on the insurance company to tell you which doctors are covered, how about checking with your longtime doctor to find out which plans he/she works with? Seems the problem mentioned in the first couple paragraphs could have been easily avoided. The issue this person encountered could happen anytime one switches insurance companies, and is not exclusive to Obamacare.
    • limiting medical access
      The entire plan is to bring down the salaries of Doctors and have them work for the government through government medical plans. As with the downfall of the Middle Class, only Doctors, Lawyers are in upper middle class and almost wealthy category. Now the powerful and wealthy, government are doing what they see as necessary to control all wealth groups in the U.S. other than the ultrawealthy, breaking the backs of Doctors and making the medical system a limited access to only with those with deep pockets, all others are confined to pre-world war 2 hospital and doctor access. In other words, rationed healthcare and determination of who gets treatment and who doesn't.
    • Misplaced Complaints
      Some critics of Obamacare complain about lack of market forces and cost control. It appears that we have evidence of the former pushing the latter. The last time we had cost moderation it was from narrow networks in the 1990s. But the cost moderation was accompanied by insurance firms dropping consumers and experience rating those still on the books. Now we have increasing enrollment with no discrimination. Is everyone totally happy? Of course not, but if there are more people better off than worse off then we have the definition of good policy. We don't have enough evidence to get to that conclusion, but increasing enrollment is a hopeful change in direction especially as some of those new enrollees were unable to purchase insurance of any kind in the past.
    • Really???
      Mikey, So, successful people and insurance executives are bad because they don't want to give you something you feel you are entitled to for free? I suspect if you were lucky (or smart) enough to be one of those insurance executives, you'd be singing a different song. You just don't like them because they are successful. Let's see you find somebody who can lead and grow a company for $50K per year. Without investors, those companies wouldn't be in business, then what good would they be? Investors expect a return on their money, and the insurance companies must make sure that happens. How about you loan me $100K with no expected return?
    • Wait a second
      So, let me get this straight. Insurance providers mistakenly listed doctors in their network that weren't in the network. And, some people chose plans without researching which doctors were in the network on that specific plan. OK, are these new things exclusively tied to Obamacare that did not exist prior? No, crap like this has been happening since the dawn of doctor networks. So it's not something new, well is it somehow the fault of Obamacare in this case? Nope. Sounds like some people should have done better research and chosen a plan with the doctor they wanted. And it also sounds like some insurance providers should be taken to task for selling a plan with false promises. What a joke. Its as if all problems with the health insurance industry that existed before are now somehow the fault of the ACA.
    • Supply and Demand.
      I'll preface this by saying I am pro-ACA. This is essentially what has been happening for years with HMOs, etc. What I think is important to note however is that while the lower reimbursements may mostly apply to people in the exchanges now…its won't be long before the insurance companies start to push the reimbursement rate lower for their other customers. At this point, doctors are going to have to decide if their current supply of high reimbursement folks is enough to sustain their lifestyle. I am NOT saying that all doctors are living high on the hog as they roll around in their Rolls Royces all day…as a matter a fact, I hate that GP docs are getting squeezed, but I do think there's a happy medium between quality of care and cost. Certainly some Drs. have higher risk/higher stress specialties and should be compensated accordingly, but looking at the Indy Star's list of top paid Drs. locally does make one wonder how much is too much.
    • Approved Provider
      I switched insurance coverage( not ACA) and my Doctor was not on the "approved" list. Can we move on to the Bengasi story.
    • No I Didn't
      Steve, speak for yourself. It is not who I voted for.
    • destroyed what?
      what did Obama destroy? the system was broken LONG before he came into office! when you turn healthcare into a for profit entity to please a few millionaires it destroys it. blaming Obama is just what your typical Republican will always do....blame blame blame. it was broken long ago!
    • Lies
      Obamacare is a good thing. the real problem with our system is the greedy for-profit insurance companies that care only about the bottom line to pad their bonus/stock instead of doing what they are suppose to...that is to make sure you're taken care of health wise. these greedy scumbags are why our system is broken, not because of Obamacare. you can make whatever excuse you want but getting millions access to insurance is a good thing bc insurance companies are VERY BAD!!! there are many things that need to be non-profit, and insurance is one of them. this is a huge reason why our country is not great anymore, bc companies no longer work for the consumers or care about their service/products, the only thing that matters is making sure the billionaires and elitists are taken care of and padding their already thick wallets at the expense of the middle class and lower income brackets. don't be fooled by the lies Republicans and all the other haters want to spread, they are just greedy a-holes who in the end don't care about others and only themselves. we once had a great country, but the greed is what will destroy it. Obamacare in no way affected me, but it helped LOTS I know!
      • On the other hand ...
        Millions of people are now covered who weren't covered before and the for-profit insurers have created the narrow networks to maintain their healthy profits and executive bonuses. That was not a government mandate. I am delighted with my new silver plan. Yes, I had to change one of my specialists but the replacement is equally good. This Hoosier is very, very happy with my new Obamacare silver policy.
      • If the Tables were Turned...
        "If you like your doctor, you will be able to keep your doctor, period." Remember the backlash on "Read my lips, No new taxes"? There is no way Pres. O' will get anything close to the Scorn that Bush-41 received...even though every unbiased expert said O'Care was never going to operate as it was Sold to the masses. You got what you voted for Ms. Pool !!
      • Nothing new...
        Narrow netoworks were a cost containment strategy being proposed / utilized by insurance companies well before the ACA passed. BTW, nice recycle job by IBJ. Way to take a story off the AP wire to push your partisan agenda.
      • Boo Hoo
        Obama destroyed what was left of America's healthcare system by pandering to the "Gimme Gimme" crowd. Live with it, America. It's what you voted for.
        • Dont blame me
          I voted for Romney.

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