Exchanges in the News: Exchange Enrollees Can’t Find Doctors?

Recent press coverage reports that some patients with health coverage from the state exchanges are facing a new and unexpected problem in securing the care they need: they can’t find a doctor who will take them on as a patient.

According to USA Today, because the “exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies.”

Shawn Smith of Seymour, Indiana, for example, “spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.” She was finally successful in recent weeks.

Or take Jon Fougner, a “recent Yale Law School graduate” who “sued Empire Blue Cross this month because he couldn't find a primary care doctor in his new ACA exchange plan.”

The USA Today article includes a very important take-away: these people’s “experience underscores how important it is for consumers to check out doctor and hospital networks for plans before they purchase them—and to call doctors to make sure they are accepting new patients with their policies.”

In addition, insurers “are also moving to smaller networks of doctors and hospitals in their exchange plans. These ‘narrow networks’ help them reduce costs, but they can also lead to problems when consumers look for doctors who will take them.”

Unfortunately, as Community for a Healthy Exchange members already know all too well, this is just one example of how the exchanges’ lack of transparency and tools to help patients and their families understand exactly what their health plan covers is creating challenges when it comes to actually using the health insurance they’ve purchased.

The exchanges can work well, but we need to work together to ensure they treat everyone fairly and really meet the needs of patients and caregivers, particularly those struggling with chronic and serious health conditions. Only then will the exchanges be able to truly fulfill their purpose of providing quality care at a low cost—for everyone.

Read more about narrow networks here.

Read the full USA Today article.

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