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Independent Docs Can’t Afford To Accept O-Care

From CBS’s San Francisco affiliate, KPIX:

Some Doctors Surprised To Be On Covered California Provider List

By Julie Watts | February 10, 2014

SAN FRANCISCO (KPIX 5) — After KPIX 5 ConsumerWatch revealed confusion over which physicians are accepting patients under Covered California, some doctors who did not want to accept patients on the exchange said they were surprised to find out they were on the exchange’s list of providers.

Last week, KPIX 5 reported on Covered California enrollees who found many doctors on the insurance exchange’s list wouldn’t accept them as patients. As a result of our report, Covered California removed the list of doctors from their website.

Independent physicians across California say they can’t afford to participate in Covered California’s insurance plans because the reimbursement rates are too low, and they say they don’t have the clout doctors with larger medical groups have to negotiate higher rates. They also warn that could mean a shortage of doctors in areas largely served by independent physicians.

‘Independent physicians’ would seem to be just about any doctor who doesn’t work out of a hospital or medical center. (Which is probably the majority, at least among general practitioners.)

Dr. Marie President is one of those doctors unhappy with reimbursement rates. The Redwood City internist said she was surprised to even find herself on a provider list published on the Covered California site. “We were astonished because we hadn’t signed anything yet,” President told KPIX 5.

Additionally, she says the reimbursement rates offered under the state’s plan aren’t realistic. Taking patients under those circumstances isn’t practical, President said. “We can’t, or we’ll be out of business.” …

For example, President said, if a doctor bills $134 for a standard office visit, a standard insurance policy will reimburse the physician $87. But under one of the new Covered California policies, the same insurer will reimburse the physician just $59. By comparison, even Medicare pays more, at $84.

She added insurers do pay more to doctors who are part of large medical groups that negotiate with insurers on their behalf. “What’s needed is a standard reimbursement rate for physicians so there are incentives to accept those patients…"

Which means the Obama-Care premiums and deductibles will also have to go up.

The insurance industry admits it’s a difficult situation, with no quick solution. The California Association of Health Plans told KPIX 5: “The Affordable Care Act promises good medical care at an affordable price…And that means everyone must be cost conscious.”

And this is happening in California, which the administration is currently touting as an Obama-Care success story, then it must be happening all over the country.

This article was posted by Steve Gilbert on Tuesday, February 11th, 2014. Comments are currently closed.

3 Responses to “Independent Docs Can’t Afford To Accept O-Care”

  1. Yet, you will be forced .. die alone or forced to (dun dun dun duuuun) Collectivize

    That wouldn’t be the point, would it?

  2. canary

    Hopefully people will get their premiums they paid refunded.
    I still want to know why the media won’t list the names of the market places.

    • canary

      ooh. I see now “Covered California” was the insurer at the market place that made the error.

      The ACA law is written taxpayers will pay them for their losses.




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