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Networks Of Doctors And Hospitals Change with Healthcare Reform

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Doctors across the nation have been voicing that they will not participate in the new Obamacare plan. Right from the start, it shows that many of the doctors are not educated on the new law. This ‘Obamacare Plan’ does not exist with the new Affordable Care Act.

The Affordable Care Act (ACA), commonly known as ‘Obamacare’, only changed how policies are sold and bought in the marketplace going forward. There is no government health plan that was attached to the law. When someone purchases a plan, on or off the Health Insurance Marketplace/Exchange, they are purchasing the plan from the insurance company that is offering the coverage. All the customer service, claims, and the invoices come from the actual health insurance company picked by the policyholder, not the government or anything called ‘Obamacare’.

With new restrictions for the health insurance companies, they had to do two things: Increase costs to cover the required expenses and anticipated claims experience; and control costs on the backend. In order to control costs on the backend, they had to reduce their network or completely change it.

In many states, in order to control the cost, the insurance companies had to change their network of doctors and hospitals. This forces some policyholders with a new ACA compliant plan to pick a new doctor. But why can’t you go the same doctor? It’s just dollars and cents.

In order for a doctor to be inside of a network with an insurance company, the doctor or hospital have to agree to the terms of the contract. Parts of those terms are the reimbursement schedule for seeing patients. Many doctors have seen a gradual decrease in the reimbursement schedule as time goes on. With the new law, many doctors decided it wasn’t worth the reimbursement schedule and did not sign the new contract. Therefore no longer being part of that insurance company’s network of doctors and hospitals.

This had nothing to do with where someone buys his or her new health insurance policy. It does not matter if someone purchased a plan on the Health Insurance Marketplace/Exchanges or outside of the Marketplace and directly with the insurance company or through an insurance broker. The networks are identical, generally speaking. There maybe some differences in certain counties or cities across the nation, but for the most part, this makes no difference.

Could doctors say they are not accepting the ‘Obamacare Plan’? Sure. However, it is very misleading to the patients, policyholders and the general public. It actually means that they do not agree to the new terms of the contract for the reimbursement schedule for seeing patients that have those plans.

Plus, there is no such thing as an ‘Obamacare Plan’. Each policy is still stamped by the insurance company, not the government. The role of the Health Insurance Marketplace/Exchanges is to control the tax credit. Those who apply and qualify for a tax credit can still finish the application with majority of the insurance companies on their website. This is done with a special connection between the Marketplace and the insurance company. It is still controlled by the Health Insurance Marketplace/Exchanges because that was where the tax credit qualification comes from.

This is no different from you buying a product from a store. You cannot make changes to that product or ask for a refund unless you go back to the store you purchased it from. This is no different.

You must be sure to look at the network of doctors and hospitals with any insurance company. Several major insurance companies have multiple networks to choose from. They will charge more to be part of a larger network of doctors and hospitals, or you can simply save money on premium dollars by choosing a smaller network and find a doctor within the network. It would be wise to seek professional help and guidance from a licensed professional, such as an insurance broker, to find the best option for you.

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