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MDs Unsure if They're Participating in Exchanges


Patients aren't the only people confused about the Affordable Care Act's insurance exchanges - some doctors aren't even sure if they're participating in their state's exchange.

Patients aren’t the only people confused about the Affordable Care Act’s insurance exchanges — some doctors aren’t even sure if they’re participating in their state’s exchange.

A survey by the Medical Society of the State of New York (MSSNY) revealed that 33.5% of respondents weren’t sure if they were participating in any health insurer exchange plans.

“…MSSNY’s physician survey preliminarily shows that there is a lot of confusion and concern among physicians regarding the information, or in some cases lack of information, being provided by health insurance companies offering coverage in New York’s health insurance exchange,” MSSNY President Sam Unterricht, MD, said in a statement.

Furthermore, 40% said they weren’t sure if they chose to be in the network of an exchange plan or if they were required by contract, and more than half weren’t sure if they had been given an opportunity to opt-out of participating.

The survey also found that 77% of respondents claim they weren’t given a proposed fee schedule from the insurance companies in whose exchange they were participating, and 63% weren’t sure how to categorize the payment levels offered to them to participate in the exchange plan.

According to Modern Healthcare, New York’s physicians aren’t the only ones confused. Similar reports are coming out of Texas where physicians are trying to determine their plan participation. The Texas Medical Association told Modern Healthcare that physicians are concerned about potential interruptions in care continuity and the adequacy of reimbursement.

“Some doctors report that exchange plans are offering reimbursement rates close to Medicaid rates, though there are no definitive data on what plans are paying doctors.”

A week after the launch of the insurance exchanges 40% of respondents to a Medical Group Management Association (MGMA) survey said that they were still considering whether or not to participate with new exchange insurance products.

“At least initially, physician practices are taking a cautious approach with ACA exchanges,” Susan L. Turney, MD, MS, FACMPE, FACP, MGMA president and chief executive officer, had said in a statement at the time. “Because it’s unclear how many patients will sign up for exchanges in their area, or if practices will even contract to provide care under new exchange insurance products, at this time they can only speculate about their future business needs in relation to the ACA.”

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