Medical Billing Forum

General Category => General Questions => Topic started by: switcheroo on January 05, 2016, 08:25:29 PM

Title: Are doctor groups limiting # of new Obamacare subsidized exchange patients?
Post by: switcheroo on January 05, 2016, 08:25:29 PM
I've read that doctors, those who accept Medicaid, can choose to see only a few Medicaid patients. This, I assume, let's them do some good public service while limiting their exposure to the bad aspects of Medicaid (low reimbursement payments, government paperwork, etc).

Does this happen also with patients who bought insurance through a marketplace/exchange? Perhaps a doctor's contract with an insurance company requires the doctor to accept all plans, but the doctor simply accepts only a very few patients with exchange plans. That lets the doctor accept more patients with plans that pay more for the doctor's services.

I've read that people with subsidized exchange plans sometimes have trouble finding available doctors. Maybe this is especially a problem if they need a specialist?

Please tell me your real world observations and experiences with this. Thank you!
Title: Re: Are doctor groups limiting # of new Obamacare subsidized exchange patients?
Post by: Michele on January 06, 2016, 11:54:16 AM
I have not seen this.  None of our providers are doing this or having issues with too many patients with ACA plans.
Title: Re: Are doctor groups limiting # of new Obamacare subsidized exchange patients?
Post by: RichardP on January 07, 2016, 08:47:35 PM
Medicaid plans are a joint-venture between a particular state and the Federal government.  So the requirements placed upon a provider participating in their state's Medicaid program are likely to vary from one state to another.

At the moment, commercial insurance plans (including the ACA Exchange carriers) are also state-specific past the basic requirements imposed on all states by the ACA.  So the requirements placed upon a provider participating in an ACA Exhange are also likely to vary from one state to another.

Having said that, the reality is that a doctor can say at any time that he is not accepting new patients whenever he wants to.  Our clients are either completely non-participating or fully participating with Medicaid and/or ACA Exchange patients.  But, for those who are participating but who want to limit the number of these patients in their mix, I'm sure that "sorry, but doctor is not accepting new patients just now" has been spoken more than once.  The rules may state that the provider must accept all who ask to be seen if s/he is a participating provider.  But no rules can require the provider to take on more patients than s/he can handle - so that always leaves the provider an "out" that they can use to their benefit.
Title: Re: Are doctor groups limiting # of new Obamacare subsidized exchange patients?
Post by: PMRNC on January 08, 2016, 08:07:14 AM
Quote
The rules may state that the provider must accept all who ask to be seen if s/he is a participating provider.  But no rules can require the provider to take on more patients than s/he can handle - so that always leaves the provider an "out" that they can use to their benefit.

I agree with Richard, but I would MAKE sure you clearly understand the practice's compliance on this. In other words, Asking Mary smith what her insurance is and then telling her the doctor isn't seeing any new patients sure can open up a can of worms  :o  I'd be very careful and check with your state medical society as well.