A few consumers across the country are finally finding ways to get insurance through the national insurance exchange as part of the Patient Protection and Affordable Care Act (aka Obamacare). Many have expressed frustration regarding the federal website, healthcare.gov, as attempts have been made to enroll in some type of health insurance to no avail due to a faulty website that cost taxpayers hundreds of millions of dollars. That frustration is probably going to turn to anger in the coming days and here’s why.
In our particular area (south Georgia) there will be only one company that will offer health care plans through the exchange and that company is Blue Cross/Blue Shield (BCBS). It was believed that Humana would also be offering plans in our area, but it appears that this company will be opting out in our area. This creates a problem. Since there is no competition in our particular market Blue Cross/Blue Shield basically has a monopoly on the market.
Now here is the real rub. Providers across the area have been trying to negotiate a contract with Blue Cross/Blue Shield, which means that many health care providers (i.e. doctors, some hospitals, etc.) are currently not accepting the Blue Cross/Blue Shield exchange insurance. Therefore if a consumer purchases an exchange plan on the exchange website there is no guarantee that the plan will be accepted by a health care provider.
One health care insider reported to The News-Banner that the reimbursements offered by Blue Cross/Blue Shield would be less than Medicare reimbursements. The insider stated in most cases providers couldn’t afford to stay in business under the company’s proposed contract. There have been attempts by providers and organizations across the state to negotiate a better contract with Blue Cross/Blue Shield, but as it stands no agreement has been reached with the majority of providers.
The News-Banner also spoke with Appling HealthCare’s Ray Leadbetter about the issue and he reported, as it currently stands, Appling HealthCare has a contract through a preexisting agreement with Blue Cross/Blue Shield regarding the insurance plans offered through the exchange that should cover hospital services only for the exchange insurance. However, there continues to be questions surrounding local physician offices. Therefore people who do sign up for a Blue Cross/Blue Shield insurance plan through the exchange may have to drive great distances to find a provider that will accept the exchange insurance. Leadbetter did stress that people who have policies already in place with Blue Cross/Blue Shield (not part of the exchange) should have no problems with coverage at the hospital or at physician offices.
“There continues to be much confusion regarding the BCBS network for the exchanges, especially for physicians,” said Leadbetter. “Many providers around the state, including Appling, are not totally certain as to their network status nor rates to be paid with the BCBS product in the exchange. While the BCBS website shows this facility as participating, we have yet to receive correspondence directly from BCBS to indicate as such. We are disappointed that, given the beginning of services to enrollees is in three weeks, these issues are still unclear. Consumers that do get Pathways products (per the website) should be covered at the hospital. We are diligently working with BCBS to come up with an agreement.”
I have made it no secret that I have been opposed to parts of the Affordable Care Act (ACA) since day one. I still disagree with the individual mandate. However, in my personal opinion, considering the way implementation of the law has went thus far it will only be a matter of time before ACA possibly crashes. If you remember former Speaker of the House Nancy Pelosi stated that the so-called geniuses in Washington needed to pass the law to find out what was in it. We are all now learning what is in the law and many of us don’t like what we’ve found.
Obummercare...first of all if you cant afford it what good is it with a $6,000.00 deductible> Second young people are needed to balance out the insurance agencies....once again no money, no jobs so who can afford this insurance????? Somebody please explain to me.....