Concerns Linger About Lower Doctor Pay Through Health Exchanges

As millions of Americans are expected to purchase coverage through the new healthcare marketplace, several doctors are becoming increasingly concerned about their pay. With more patients opting for affordable coverage through the online exchanges, many physicians fear that they will be paid much less to provide care.

Some physicians have even voiced their concerns to various medical associations. These doctors explained that the discounted rates could cause a two-tiered system to develop, where fewer doctors would be willing to participate. As a result, consumers could have a harder time obtaining necessary care.

Nevertheless, insurers have been under plenty of pressure to make premiums more affordable for consumers. As a result, insurance officials have reduced the rates for some plans. Additionally, because plans usually are comprised of smaller networks, insurers believe that doctors will be compensated for pay decreases as more patients come to them for care. However, when it comes to providing care for current patients, many primary care physicians admit that they are already pressed for time.

A major reason for this conflict is that doctors aren’t always sure which plans they are listed under, or even how much payment they should expect to receive from patients covered under a certain plan. Additionally, some physicians are just starting to find out about the decreasing pay rates among particular plans sold through Obamacare’s online exchanges.

According to a senior executive at Blue Cross Blue Shield Association, a few of its 37 member organizations are already providing lower rates to doctors that belong to smaller exchange plan networks. However, the executive also said that an adequate amount of doctors are being enlisted within their plans, and that insurers are well aware that a good network of providers is necessary to retain patients.

Regardless, some doctors have a different opinion. Contracts established between insurers and physicians can vary, and some even permit insurers alone to alter rates of payment issued to doctors. Furthermore, insurers may enlist doctors into several different plans. As a result, several physicians are undecided as to whether or not they will participate in the new plans.

In a survey conducted by The Medical Society of the State of New York, more than 400 doctors were asked if they would participate in an insurer’s exchange plan. Among the respondents, 40 percent said that they would not participate, and one-third said they were unsure. Lastly, two-thirds admitted that they never received any type of reimbursement information.