According to the Wall Street Journal, many insurance companies are reducing reimbursements to doctors for services they provide to patients covered by policies sold on the Obamacare exchanges. The justification for the cuts is to reduce costs and thereby to keep premiums for health plans lower than they otherwise would have to be. The Journal also says that many doctors are opting to leave the network rather than accepting reimbursements at such low levels.
Let's use an example. Suppose a woman needs the services of an OB/GYN. She goes to the office and under the new rules the doctor is paid something between 40 and 50 dollars for the visit. You might think that this is adequate compensation since the doctor will only be with the patient for 5 or 10 minutes, but that would be wrong. Remember, the doctor has costs that he has to cover in order to stay in business. For an OB/GYN, one of the largest costs is malpractice insurance. Very often, when a pregnancy or delivery ends badly, there is a claim made of malpractice against the doctor. As a result, many doctors in this field pay something like $200,000 per year for their insurance even if there has never been a claim made against them. In many practices, the cost of insurance alone is 40 to 50 dollars per patient visit. In other words, the reimbursement under the Obamacare policy will cover only malpractice insurance but will not even help pay the salaries of the nurses or the clerical staff who are necessary just to deal with the insurance companies.
The most likely outcome to this mess is that the doctors who can fill their waiting rooms without taking Obamacare insurance policies will opt out of the networks. Folks who buy their insurance on the exchanges will be stuck with only second rate doctors in the network. And, since the Obamacare policies in many states do not cover out of network services, the people with these policies will effectively be cut off from first rate medical care. An Obamacare policy will be better than nothing, but the millions whose plans are cancelled will see a marked decline in the nature of their healthcare.
Let's use an example. Suppose a woman needs the services of an OB/GYN. She goes to the office and under the new rules the doctor is paid something between 40 and 50 dollars for the visit. You might think that this is adequate compensation since the doctor will only be with the patient for 5 or 10 minutes, but that would be wrong. Remember, the doctor has costs that he has to cover in order to stay in business. For an OB/GYN, one of the largest costs is malpractice insurance. Very often, when a pregnancy or delivery ends badly, there is a claim made of malpractice against the doctor. As a result, many doctors in this field pay something like $200,000 per year for their insurance even if there has never been a claim made against them. In many practices, the cost of insurance alone is 40 to 50 dollars per patient visit. In other words, the reimbursement under the Obamacare policy will cover only malpractice insurance but will not even help pay the salaries of the nurses or the clerical staff who are necessary just to deal with the insurance companies.
The most likely outcome to this mess is that the doctors who can fill their waiting rooms without taking Obamacare insurance policies will opt out of the networks. Folks who buy their insurance on the exchanges will be stuck with only second rate doctors in the network. And, since the Obamacare policies in many states do not cover out of network services, the people with these policies will effectively be cut off from first rate medical care. An Obamacare policy will be better than nothing, but the millions whose plans are cancelled will see a marked decline in the nature of their healthcare.
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