Another very strange Affordable Care Act rule

Regarding doctors refusing to treat patients with particular medical coverages: I worked, in 2004, as a doctor's receptionist. This was well before Obamacare. He routinely refused patients if he thought their insurance wasn't good enough. He maintained the absolute minimum number of Medicare patients necessary to retain his licence - he was very frank about that. He said he hated Medicare patients because they took up valuable time that could be used to bill somebody profitable. If a patient had, say, Aetna, but their level of insurance wasn't good enough for him, he'd also refuse to see them. One of my duties was to phone the insurers to verify the prospective patient's details, then he'd decide whether or not to see them. We had a cheat sheet listing plans that he would not accept to save the cost of phone calls.

I particularly remember one patient: a young woman who had been seeing this doctor since she was a little girl. She was just out of school, just come off her parents' insurance, working a job with too few hours to qualify for benefits. She came in with strep throat. He refused to even examine her despite still having her parents on his books. He told her to go to the General Hospital and then get a real job. All this in the waiting room, in front of everybody. The girl left in tears.

My employer told me that, under the terms of his contracts with insurance companies, he was obliged to charge private patients a much higher rate than insured patients, saying openly that it was a tactic to get patients into the arms of the insurers.

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Originally Posted by Suzanne

Regarding doctors refusing to treat patients with particular medical coverages: I worked, in 2004, as a doctor's receptionist. This was well before Obamacare. He routinely refused patients if he thought their insurance wasn't good enough. He maintained the absolute minimum number of Medicare patients necessary to retain his licence - he was very frank about that. He said he hated Medicare patients because they took up valuable time that could be used to bill somebody profitable. If a patient had, say, Aetna, but their level of insurance wasn't good enough for him, he'd also refuse to see them. One of my duties was to phone the insurers to verify the prospective patient's details, then he'd decide whether or not to see them. We had a cheat sheet listing plans that he would not accept to save the cost of phone calls.

I particularly remember one patient: a young woman who had been seeing this doctor since she was a little girl. She was just out of school, just come off her parents' insurance, working a job with too few hours to qualify for benefits. She came in with strep throat. He refused to even examine her despite still having her parents on his books. He told her to go to the General Hospital and then get a real job. All this in the waiting room, in front of everybody. The girl left in tears.

My employer told me that, under the terms of his contracts with insurance companies, he was obliged to charge private patients a much higher rate than insured patients, saying openly that it was a tactic to get patients into the arms of the insurers.

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I read your post and all I can say is I'm very very very grateful to live close to Mexico....Did I say how grateful I was? Now please let me state here I understand there is economic pressure on this doctor to behave this way - but I have a way around it by crossing a border and empowering myself. I have a feeling in the future more will be joining me, this is just getting unacceptable for all parties - including medical professionals - involved. Rob

One huge glaring problem I see with this good doctors' comments - this is not 2004 and we are not in that economy. There are very few "real jobs" out there - certainly not enough to go around. And fewer employers are even insuring their employees these days - the costs are just too outrageous.

Catherine - I also had to purchase pediatric dental care when I bought a new health insurance plan when mine was cancelled in Jan. even though I don't have kids. I could not buy a plan off the exchange because I am too low taxable income and also able to use the VA so could only qualify for medicaid - which I didn't want. So bought directly thru a private insurance provider and they tacked on the kids dental coverage. No way around that.

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Originally Posted by iris lilies

Why would you expect the purveyors of Obamacare to admit that all may not be rosy with it?

From our President of the United States:
Let me be exactly clear about what health care reform means to you…if you’ve got health insurance, you like your doctors, you like your plan, you can keep your doctor, you can keep your plan. Nobody is talking about taking that away from you.”

In the spirit of fairness, this quote may be slightly out of context in that the Prez was talking about plans (if you've got it you can keep it) but unfortunately, that wasn't true, either.

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I agree with your point 100% here. Couldn't agree more. And I'm adding my own point - if you can't get a doctor to see you, what use is it that pre-existing conditions are covered? Rob

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Originally Posted by gimmethesimplelife

One huge glaring problem I see with this good doctors' comments - this is not 2004 and we are not in that economy. There are very few "real jobs" out there - certainly not enough to go around. And fewer employers are even insuring their employees these days - the costs are just too outrageous.

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Outrageous costs: yes. A young friend of mine is having her first baby in a couple of months. She has insurance that pays 90% of the cost of the delivery. She was quoted $30,000 for a normal delivery, out of the hospital next day. Obviously, she's very thankful for the insurance, but she still has to pay $3,000 upfront when she's admitted. I just don't see how a normal delivery can cost so much. Under the terms of her insurance, she can't opt for a home birth with midwife!

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Originally Posted by Spartana

Catherine - I also had to purchase pediatric dental care when I bought a new health insurance plan when mine was cancelled in Jan. even though I don't have kids. I could not buy a plan off the exchange because I am too low taxable income and also able to use the VA so could only qualify for medicaid - which I didn't want. So bought directly thru a private insurance provider and they tacked on the kids dental coverage. No way around that.

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Thanks for sharing, Spartana--misery loves company! :/
It's so stupid it's almost laughable. It's not the $24 that makes me the most angry--it's just the way they packaged it.

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Originally Posted by iris lilies

that is a lot of, ummm, information.

But Rob asked if is is true that "doctors are starting not to accept people who have purchased insurance through the exchanges" due to not enough reimbursement, saying nothing about timeliness of reimbursement.

And the answer to that is yes. Yes, that is happeneing. Physicians have chosen not to accept exchange based insurance coverage.

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No, it's not 'Obamacare" they aren't accepting. It's Blue Shield they aren't accepting, and frankly they probably refused it BEFORE Obamacare cause Blue Shield is crappy insurance. At least my experiences with it, before Obamacare showed me that.
Obamacare has nothing to do with how much INDIVIDUAL insurance companies pay. See, cause they are individual...from the government..not owned by the government, or Obama as it turns out.
So it isn't really the same as saying doc's aren't accepting exchange insurance. Cause they are. If you have the insurance your doctor accepts. As someone else pointed out, doctors have always had this option and they used it.
Here's a thought. People should call their favorite doctor and ask them which insurance they accept. I'll bet a lot of them don't accept Blue Shield.

This is kind of like people saying 'I lost my insurance." Well, no you didn't. Your policy changed, but you didn't lose it. Not really the same thing. And really, for anyone who wasn't paying attention, that happened before Obamacare too.:)

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Originally Posted by creaker

Anytime you change rules midstream someone is going to get the short end of the stick.

The one part I wonder about is that the kids on your plan until 26 thing does not cover maternity for them, even though they are at a prime age for that kind of thing happening. I wonder what happens in those situations?

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What happened to them before Obamacare, cause before that, when your kid hit 18 or 20 they were off your family plan. And even those who had medical, more often than not the insurance company 'required' you to give them 3 or 4 months notice before you became pregnant. How many young people, or couples, did that screw up? Think How many people say, 'Oh my kid wasn't planned." And that's not just the young unmarried.

" I was lucky as I was able to switch to another hospital and doctor that are actually within walking distance of where I live. But....not everyone seems to have that kind of luck under ObamaCare. It's like IL said, there are winners and losers here and for once in my life I'm one of the winners. This does not mean I care for other people not to be winners, though - it just means that I got lucky. I would rather others have the options I have been lucky to have so far. Rob"

No Rob, you weren't 'lucky'. You just did it, yourself, like thousands of other people. Taking charge of your health care and situation is not 'luck' any more than getting the right education, dressing right and showing up on time and sober to get the right job is luck. It's finding out what you have to do then doing it. That works for everything and not just jobs and healthcare.
It's work,sometimes hard work. Sometimes it means playing phone tag and comparing plans and such. Funny how people brag about how many cars they looked at or test drove, or how far they went to find just the right car, but complain about spending a few hours shopping for something so important as health insurance. Are we really so used to being screwed or confused that we refuse to take responsibility for this? And even if you are confused, there are people in place to help you make sense of it.


"Came back to add - here in Arizona there is an insurance provider on the exchanges (Health Net) that is one of the least expensive in the nation and that has extremely narrow networks, just like in the HuffPost article above. And a lot of consumer complaints and a very tarnished image. My mother has Health Net and she had problems finding a provider for her mammogram for the first time ever as the network even for Medicare has shrunk. She managed to find a provider eventually but even she said if it's that much of a hassle next time, you can go to Mexico with me and I'll have it done there. (She doesn't want to go alone which I believe is understandable). Rob"

OK Rob, what is the answer for this. Pretty obvious to me, although it doesn't seem apparent to most anti-ACA.
Don't buy from that company. Don't do it. Do the research and get your mom DIFFERENT health insurance, if she is unable to do it herself.
Again, just because insurance companies have screwed us in the past doesn't mean we have to keep letting them. Don't buy from a company that screws you over. Don't go to a sandwich shop that's clearly anti-gay, don't buy from a company that hides it's wealth to avoid paying taxes, and don't buy from an insurance company that most health care providers won't honor.

It' reminds me of a joke by husband tells about the complaining person in every group..."The food was horrible...and such small portions!"

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Originally Posted by rodeosweetheart

Yes, it is true that many doctors are refusing to see Medicare patients, at least in SC. My students who work at doctor's office complain about it, especially the effect on the elderly poor, who are now not being seen.

Up here in MI, we cannot find any primary care doctors taking new patients, and we have employer BC/BS.

On the other hand, my husband's three medical emergencies in May have been covered by insurance, and it has worked semi well, although it has taken a lot of phone time to get the insurance company to pay what it is supposed to pay.

On the other other hand, my asthma medication has gone up so much it is unaffordable, at 450 dollars a month, although the subsidized folk get it for virtually free.

It almost seems the point of OC is to kill off the chronically ill and elderly.

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So it works for your husband, just like it works for thousands across the country, but the INSURANCE COMPANY is dragging it's feet paying. So how exactly is this different from BEFORE Obamacare? Really, were insurance companies so quick and wonderful before?
No, they weren't. In fact they were worse. That was the point of Obamacare. Did you think all the nightmare stories before Obamacare were made up?
The government, and Obama do not own the insurance companies. They don't run them. This wasn't a government takeover of healthcare, or the insurance industry.
If the insurance company was slow to pay, it was the insurance company. This privately owned (and not by Obama) company. Their fault, their foot dragging. And to be honest, before Obamacare, they could have just as easily denied your husband his coverage, as they did to countless others. Even after years of paying for coverage.

As far as drug prices go, again, not Obama's fault. Drug prices have been going through the roof for years, and I think you know that. So what you are really complaining about is that other sick people, those who really need this drug as much as you and simply don't have the money, are getting it subsidized when they should just go without. They should just suck it up and die? That seems to be your plan, not the ACA.
Is the beyond greedy drug company not at fault here?

How exactly is making needed medicine available subsidized along with insurance for the previously uninsured killing them off?