I’m guessing that there aren’t too many people in Georgia who aren’t aware of the technical problems that have plagued the recent launch of the Patient Protection and Affordable Care Act’s state-level, web-based, “Health Insurance Marketplace,” where the uninsured will compare and obtain health insurance policies.
I also suspect that most Georgians don’t know about a related development that could have far greater ramifications when it comes to their well-being and peace of mind: an effort by health insurers participating in the aforementioned exchange to limit the number of physicians included in their “networks” as a way to reduce costs.
These companies are restricting the number of physicians residents of this state have access to as a way of manipulating the marketplace, which limits patient choice and undermines the patient-physician relationship.
The insurers have seized on the new health insurance exchange as an opportunity to create smaller networks. They will use an administrative exercise to pay the same physicians who see the same patients something less under the guise of a new commercial product, simply because these physicians will be part of smaller networks that will have less clout.
The health insurance plans in the ACA-driven exchange have enabled health insurance companies to obtain new members (that is, patients) with little consideration for what’s best for the community or the individual patient. This is especially true in markets in the state where there’s just one insurance company providing coverage.
Patients may also see higher out-of-pocket costs if they need to see a physician who is outside one of these narrower networks — especially if they require more complex care.
The health insurers in question have created networks of physicians (and hospitals) that are easier to control and manipulate than the ones traditionally seen in the commercial health insurance arena, for no other reason than being able to pay those physicians and other health care providers less. I know this is taking place, because I work daily with physicians in every specialty and practice in the state in my role as president of the Medical Association of Georgia.
Every Georgian should be concerned that the process and criteria that these companies use to determine which physicians are or aren’t in a given network lacks both clarity and transparency. It is also troubling to know that health insurers in the state are making these kinds of determinations without the physician’s knowledge or permission.
So what can we do as individual patients? Whether you obtain your coverage through the new state-level exchange or a private plan, I encourage you to contact your health insurance provider to ensure that you will continue to have access to the physician of your choice — one that’s in your community. It’s simply not right for an insurance company or the government to make that decision on your behalf. After all, we were told that we could keep our physician from the beginning.
Dr. William E. Silver is president of the Medical Association of Georgia, which has more than 7,400 physician members.
