In these first months of Affordable Care Act (ACA) implementation, there’s a lot of uncertainty around health plans sold through the insurance exchanges and how their lack of transparency will impact continuity of patient care.
We’re hearing reports that exchange enrollees don’t have access to accurate network directories for their health plan options. That means our patients might not know whether we’re part of their health plan network until well after they have secured their coverage for the year.
Similarly, many physicians have been left to guess which exchange plans may consider them as part of their networks. Does a managed care contract with an all-products clause mean a physician automatically is part of a new health plan on the exchange, or has the insurer decided to limit that network? Insurers simply aren’t giving us the information we need.
That ambiguity may give rise to more complicated problems. Will my longstanding patient with complex chronic care needs be able to continue seeing me in network? If not, her care could be disrupted, and her health could suffer as she searches for another doctor. What about my colleague to whom I have referred patients for years—is she still counted as part of the health plan’s network? If not, my patient could face a large bill he can ill afford.
As physicians, our chief goal is to make sure our patients get the care they need to get healthy and stay healthy. The primary aim of the ACA is to create an environment in which that can happen. Under the new law, millions of previously uninsured people will gain access to care, and millions more no longer will be at risk of losing their coverage when they need it most.
But that doesn’t mean that the law’s implementation will be without growing pains—particularly in this early stage. The AMA is working hard to address these challenges.
We believe that during this transition period, all patients should be able to keep the physicians they know and trust, and insurers should create plan networks that allow patients to continue receiving the care they need without disruption.
To help physicians through the transition in their practices, we are providing practical resources, including a six-step checklist we just released with the Medical Group Management Association and forthcoming resources related to managing care through a patient’s 90-day grace period.
In addition to our ongoing work with the federal government to troubleshoot roll-out issues as they arise, we also are advocating with state governments to make needed improvements in how they carry out the law. These efforts include a transparency campaign for which we have model bills on the following topics:
- Tiered and narrow networks. Several bills call for providing meaningful access to accurate physician directories, instituting due process and physician profiling protections, and honoring patients’ assignments of benefits.
- The coverage grace period. Another bill would require insurers to inform physicians if patients are in a 90-day grace period for not paying their premiums. Such notification would allow physicians to educate their patients about the importance of maintaining coverage.
- Fair contracting. This bill would prevent insurers from forcing physicians to participate in all of the insurers’ networks if they agree to be part of one of their plans.
While we are celebrating that patients are gaining access to the care they need under the ACA, the AMA also remains committed to improving how the law is carried out. Implementation no doubt will be less than perfect, but we continue to strive toward a stronger, better-performing health care system for physicians and patients.
