I just received a call from a long-standing patient because he learned that we are not in his network under his new insurance plan. However, we always accepted his plan and have no intentions of dropping it. After closer investigation, his specific plan requires him to use one of several hospital clinics. Everything else is out-of-network. He was not given this information when he signed up for this plan, a plan he is paying for himself. He is not allowed to change plans until October when his next enrollment period rolls out. Insurers are increasingly narrowing their doctor panels.
Last year, in NJ, many doctors were suddenly terminated from certain plans they accepted for many years. This was without prior notice or any discussion. I was not one of those physicians but in caused havoc for doctors and patients alike. It was a play by the insurance company to narrow down the panel to cut costs.
Unfortunately, this narrowing of doctor panels is becoming a frequent occurrence in the healthcare scene. And the doctors who are being excluded are not being given any choice or ample notification. Additionally, the doctors being deselected are not being chosen by quality criteria. The driving force is reducing costs which thereby increase insurance company profits. Patients should be allowed to have the highest care, not bargain basement fixes.
People are clamoring for patients to be empowered consumers, to advocate for themselves and take a greater role in their own medical decision-making. But how is that even possible when they are denied access to the doctors they want to treat them? And for many patients, they are forced to leave doctors who they feel comfortable with and who have treated them for years.
Why should patients be allowed to see the doctors they want?
– The doctor-patient relationship is essential for good outcomes. A patient is not going to follow the advice of a doctor they do not trust. Likewise, doctors need to trust that patients are telling them accurate information.
– Patients were promised that under the ACA they would be allowed to keep their doctors. Promises should be kept.
– Patients are now paying an increasing amount into their own health insurance coverage. They should be allowed to choose the doctor that provides them medical care. It is unjustifiable that they are forced to pay their own premiums and then deny them access to the care that they want.
– Only patients and the doctors should determine what is in the best medical interests for each individual patient. Third parties, such as insurance companies, need to stop intruding into this relationship and overturning health care decisions. This is harming patients.
As the ACA becomes more deeply entrenched, patients are footing more of their health care expenses. As the consumers of these products, they should have choices of where they receive their care. If a person wants to eat dinner out, they can spend their money at any restaurant of their choosing. When they purchase a car, there are no limits on where they can shop. Why is a patient’s health and well-being valued at less than these services? It will not change only if doctors demand to stay in network with insurance plans. Patients need to stand up and demand options.
Copyright secured by Digiprove © 2015 Linda Girgis, MD, FAAFP
