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Insurers Slashing Doctors’ Payments in the Healthcare Marketplace

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By Phil Cohen

With the introduction of the new healthcare marketplace, insurers are cutting payments issued to doctors through many of their plans sold through online exchanges. As a result, Americans enrolling in these coverage plans may have fewer doctors to choose from if the reduced fees cause physicians to opt-out of the plans.

Recently, UnitedHealth Group Inc. sent out contract amendments to some physicians based in New York City. These changes reflected rates that were set significantly lower than what doctors normally expected to receive from private insurers. These reduced rates ranged from $40 for a routine office visit and around $20 for a mammogram reading.

Additionally, certain rates imposed by United come close to matching fees determined by the state under the Medicaid program. Consequently, many low-income individuals end up paying almost the same amount for receiving these services. Many doctors in the city report that some of these fees associated with office visits amount to less than half of what they receive for treating individuals with employer-based insurance.

By the year 2016, more than 20 million people are expected to be covered under the online exchange plans. Nevertheless, doctors have continuously been opposed to declining or static rates set by Medicare, Medicaid and other government-run programs. Instead, physicians relied on the exchanges to bring in more patients covered by private insurance plans.

According to doctors and experts, an increasing number of physicians may opt-out of these plans once they learn about the new rates. In a survey conducted in September by the Medical Group Management Association, many doctors admitted that they had no knowledge of the payments they would receive for providing care to patients covered through the exchanges. Among the physicians who were actually aware of the new fees, 37 percent revealed that the rates they were provided were lower than Medicare. Furthermore, 18 percent said their rates were lower than those offered through Medicaid.

Designed to rein in costs, the recent move by United Health Care would affect plans revolving around larger, more expansive physician networks. Some doctors admitted that they were informed of reductions in their pay even as some consumers started choosing their coverage plans. Therefore, consumers could actually pick physicians who hadn’t yet decided to participate in these plans. In order to help alleviate this problem, United is providing doctors with 30 days to opt-out of the plans if they are unhappy with the rates.

Regardless, some contracts don’t even give doctors a chance to accept the new rates. As a result, physicians are automatically included in the new networks. Meanwhile, other contracts provide doctors up to 90 days to opt-out of plans. Some plans still provide medical practices with the same rates as before.

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Phil Cohen

About the author

Philip Cohen is the founder and President of PRN Funding, LLC. PRN Funding is an extraordinarily focused niche player in healthcare funding. With years of…... Read More

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