The Physician's Risk in HCR

[kgmom219]

With a 90 day grace period on premiums and the carriers only have to pay for medical care in the first 30 days of the grace period, one can see the docs/ facilities concern.

That's On Exchange (correct me if I'm wrong). I'm talking Off Ex Indy PPO plans.

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Here in AZ, an awful lot of doctors have been telling their patients they won't accept plans purchased on the exchanges. I have had a large number of phone calls about that. In many cases, the doctors' offices will cave if it's a current patient, and/or if enough ruckus is raised. The doctors have figured out which plans/networks are the worst, and I heard from a carrier that they are beginning to leave those networks when the contracts come up for renewal.

Which brings us back to that the Exchange will be all HMO by 2017....

 

[taterpeeler]

Which brings us back to that the Exchange will be all HMO by 2017....

cough.... cough..... glad some are getting on board with that......

the poor... HMO
the middle class at 300-400% HMO
the middle class above 400%, no plan due to excessive premiums for ppo so now in an HMO if they want coverage but probably no coverage
the upper middle class just see above but they will purchase something probably HMO.
and lastly... the loaded rich like yagents... PPO plans because they are rich

bottom line, you will be in an HMO or nothing

 

[somarco]

If you sign a contract without looking at reimbursement, I have zero sympathy for you. You signed it, now honor it. They are not in their rights.

I agree, to a point.

Many of the carriers did not send out contracts until AFTER Jan 1, 2014.

Providers get so many different contracts from multiple carriers it is hard to keep up.

But yes, they are within their right to establish waiting times for new patients.

A lot of them did not know about the 90 day premium drag and their responsibility. SOME of the trade groups talked about it but it wasn't widely publicized.

At least not as much as "If you like your doctor you can keep your doctor. Period."

 

[kgmom219]

I agree, to a point.

Many of the carriers did not send out contracts until AFTER Jan 1, 2014.

Providers get so many different contracts from multiple carriers it is hard to keep up.

But yes, they are within their right to establish waiting times for new patients.

A lot of them did not know about the 90 day premium drag and their responsibility. SOME of the trade groups talked about it but it wasn't widely publicized.

At least not as much as "If you like your doctor you can keep your doctor. Period."

Then the AMA needs to step up. If their members aren't informed, that's their fault. Not the carriers. Or my clients.

The docs aren't getting any sympathy from me.

I'm not hearing waiting times (I have very few HMO), I am hearing "refusal to see Obamacare patients"

 

[houcoogster]

cough.... cough..... glad some are getting on board with that......

the poor... HMO
the middle class at 300-400% HMO
the middle class above 400%, no plan due to excessive premiums for ppo so now in an HMO if they want coverage but probably no coverage
the upper middle class just see above but they will purchase something probably HMO.
and lastly... the loaded rich like yagents... PPO plans because they are rich

bottom line, you will be in an HMO or nothing

I agree...it's the only half @ss chance we have in order to get a handle on escalating costs.

Agents bitch about this law not bending the cost curve but still want to sling PPO's.......go figure.

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Then the AMA needs to step up.

BRAVO! (APPLAUSE)............

 

[Ann H]

... Agents bitch about this law not bending the cost curve but still want to sling PPO's....

Houcoogster, why would we stop "slinging" PPOs off-exchange when the clients want that and will pay the premium to get it? If you can afford hamburger should you start eating dogfood now, just in case things get so bad that you are forced to eat dogfood later? And, remember, KGMom219 said "THE EXCHANGE will be all HMO by 2017", she didn't say the whole nation will be on HMOs.

Which brings us back to that the Exchange will be all HMO by 2017....

I understand selling HMO's if you are ratting & rolling the EXCHANGE crowd predominantly. But try selling that to the off-exchange crowd and you will see sales plummet! They won't eat dogfood now, just because there's a threat they may have to later! And, before they eat dogfood later, they will cause political ruckus (along with the medical profession and businesses) who won't take it lying down. If we go to HMO-style benefits for the entire nation, it's single payer, not Exchange!

 

[houcoogster]

Houcoogster, why would we stop "slinging" PPOs off-exchange when the clients want that and will pay the premium to get it? If you can afford hamburger should you start eating dogfood now, just in case things get so bad that you are forced to eat dogfood later? And, remember, KGMom219 said "THE EXCHANGE will be all HMO by 2017", she didn't say the whole nation will be on HMOs.

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I understand selling HMO's if you are ratting & rolling the EXCHANGE crowd predominantly. But try selling that to the off-exchange crowd and you will see sales plummet! They won't eat dogfood now, just because there's a threat they may have to later! And, before they eat dogfood later, they will cause political ruckus (along with the medical profession and businesses) who won't take it lying down. If we go to HMO-style benefits for the entire nation, it's single payer, not Exchange!

The current PPO model is a tiger off the leash....unsustainable long term....it must change if its to survive. When the price of the group plan PPO is 2,3,4 times the HMO plan you'll know its over.

 

[somarco]

Ann, I agree with your comments regarding the future of PPO plans and the market for those types of plans (vs HMO). PPO plans have changed over the years, as have HMO's.

30 years ago when managed care was introduced people said they would never catch on. Now they are the norm rather than the exception.

As much as people complain about PPO plans there is even more uproar about HMO plans.

The people in the cheap seats hooked on Obamacrack subsidies will just have to play by the rules.

But then, the ones that have no $$$ of their own will still continue to stiff the providers.

 

[AllenChicago]

May 15, 2015

Physicians opting to not accept what they call "Obamacare" plans is gaining higher media visibility.

Ref: Doctors 'reluctant' to take Obamacare patients: Hospital CEO

This hospital CEO is forgetting about the Obamacare mandate that directs physicians to accept insurance that is up to 30 days behind in premium. I guess there are too many snares, even for him to comprehend.

 

[Ann H]

Is there such a mandate in the ACA? I know that the ACA requires INSURERS to pay claims for the first 30 days of a lapse for subsidized policies in the 90 day grace period. However, I don't remember any mandate for physicians to accept the patient. Of course, network contracts are a different story.