Healthcare the Chicago Way
Obamacare enrollees hit snags at doctor's offices
Many consumers faced hurdles
signing up for Covered California health plans. Now they're having trouble
finding in-network doctors.
By Chad Terhune
February 4, 2014, 6:41 p.m
After overcoming website glitches
and long waits to get Obamacare,
some patients are now running into frustrating new roadblocks at the doctor's
office.
A month into the most sweeping
changes to healthcare in half a century, people are having trouble finding
doctors at all, getting faulty information on which ones are covered and
receiving little help from insurers swamped by new business.
Experts have warned for months
that the logjam was inevitable. But the extent of the problems is taking by
surprise many patients — and even doctors — as frustrations mount.
Aliso Viejo resident Danielle
Nelson said Anthem Blue Cross promised
half a dozen times that her oncologists would be covered under her new policy.
She was diagnosed last year with non-Hodgkin's lymphoma and discovered a
suspicious lump near her jaw in early January.
But when she went to her
oncologist's office, she promptly encountered a bright orange sign saying that
Covered California plans are not accepted.
"I'm a complete fan of the
Affordable Care Act, but now I can't sleep at night," Nelson said. "I
can't imagine this is how President Obama wanted it to happen."
To hold down premiums under the
healthcare law, major insurers have sharply cut the number of doctors and
hospitals available to patients in the state's new health insurance market.
Now those limited options are
becoming clearer, and California
officials say they are receiving more consumer complaints about access to
medical providers. State lawmakers are also moving swiftly to ease some of the
problems that have arisen.
"It's a little early for
anyone to know how widespread and deep this problem is," said California
Insurance Commissioner Dave Jones. "There are a lot of economic incentives
for health insurers to narrow their networks, but if they go too far, people
won't have access to care. Network adequacy will be a big issue in 2014."
The latest travails come at a
crucial time during the rollout of Obama's signature law. Government exchanges
and other supporters of the healthcare law are trying to boost enrollment,
particularly among young and healthy people, ahead of a March 31 deadline.
Of course, complaints about
outdated provider lists and delays in getting a doctor's appointment were
common long before the healthcare law was enacted. But some experts worry the
influx of newly insured patients and the cost-cutting strategies of health
plans may further strain the system.
Maria Berumen, a tax preparer in Downey, was uninsured for
years because of preexisting conditions. The 53-year-old was thrilled to find
coverage for herself and her husband for $148 a month after qualifying for a
big government subsidy.
She jumped at the chance in early
January to visit a primary-care doctor for long-running numbness in her arm and
shoulder as a result of bone spurs on her spine. The doctor referred her to a
specialist, and problems ensued. At least four doctors wouldn't accept her
health plan — even though the state exchange website and her insurer, Health
Net Inc., list them as part of her HMO network.
"It's a phantom
network," Berumen said.
It was no surprise to her family
doctor, Ragaa Iskarous. She has run into this problem repeatedly with other
patients in the last month, the doctor said. "This is really driving us
crazy."
Berumen said she was seen by a
neurosurgeon Thursday — after state regulators intervened on her behalf.
Insurers say they are working hard
to resolve customers' problems as they arise, and they continue to add
physicians to augment certain geographic areas and medical specialties.
"Any huge implementation like
this comes with a lot of moving parts," said Health Net spokesman Brad
Kieffer. "There is a learning curve for everyone, and we expect as time
goes on these issues should dissipate."
Looking to head off potential
problems, government regulators and patient advocates are pushing for tougher
rules to ensure health plans provide timely access to care.
Anthem Blue Cross
Anthem
Blue Cross and Blue Shield is a member of the Blue Cross Blue Shield Association.
Note: Alphonso
O'Neil-White is the chairman for the Blue
Cross Blue Shield Association, and a director at the Federal Reserve Bank of New York.
Lee
C. Bollinger was the chairman for the Federal
Reserve Bank of New York, and is a trustee at the Committee for Economic Development.
Foundation
to Promote Open Society was a funder for the Committee for Economic Development, and the Center for American Progress.
George Soros
was the chairman for the Foundation to Promote Open Society, and a
supporter for the Center for American
Progress.
Center
for American Progress was a funder for the Blue Cross Blue Shield Association.
Donna
S. Morea was a trustee at the Committee
for Economic Development, and the EVP for the CGI Group Inc.
CGI Group Inc.
was the Obamacare contractor that
developed Healthcare.gov web site.
Obamacare
is Barack Obama’s signature policy
initiative.
Barbara G. Fast
was a VP for the CGI Group Inc., and
a VP at the Boeing Company.
W. James
McNerney Jr. is the chairman & president & CEO for the Boeing Company,
and a member of the Commercial Club of
Chicago.
Kenneth M.
Duberstein is a director at the Boeing
Company, and was the VP for the Committee
for Economic Development.
George A. Ranney
Jr. was a trustee at the Committee
for Economic Development, is a trustee at WTTW, and a member of the Commercial
Club of Chicago.
Scott
P. Serota is a trustee at WTTW,
and the president & CEO for the Blue
Cross Blue Shield Association.
Newton
N. Minow is a trustee emeritus for WTTW,
a member of the Commercial Club of
Chicago, and a senior counsel at Sidley
Austin LLP.
Michelle
Obama was a lawyer at Sidley Austin
LLP.
Barack
Obama was an intern at Sidley Austin
LLP.
Obamacare
is Barack Obama’s signature policy
initiative.
R.
Eden Martin is counsel at Sidley
Austin LLP, and the president of the Commercial
Club of Chicago.
Kathleen
Brown is a member of the Commercial
Club of Chicago, Jerry Brown’s sister, and was the California state government treasurer.
Jerry
Brown is Kathleen Brown’s
brother, and the California state government governor.
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