Trouble Finding or Seeing A Doctor?

As the Affordable Care Act moves into operation and many of the problems with enrolling have been overcome, the main concern now is finding a doctor that will accept Obamacare in the insurance network you have chosen. Here are some requirements in the Affordable Care Act you may not have known:

• Health plans have to offer and adequate network of healthcare providers. By law, plans must provide policyholders access to a primary physician within 15 miles or 30 minutes of their homes. (Insurers have more flexibility in rural areas;
• You have to be able to get an appointment with a primary care doctor with 10 business days for non-urgent care and with 15 days if you need an appointment with a specialist. If you can’t find a doctor in your area to offer you an appointment within those timelines, you have cause to complain and demand your insurer to find someone who can see you.
• If your network does not include the type of specialist you need to treat a condition, your insurer is obligated to find one and cover those services as it would for an in-network provider.
• If your are in the middle of treatment, and your doctor drops out of the your plan’s network, you may have the right to continue care with that doctor for a period of time.For example women who are pregnant may be allowed to continue care with their obstetrician until and immediately following their baby’s delivery. Someone with a chronic condition such as diabetes may allowed to continue their doctor for up to 12 months.

The big hangup in this system is the low reimbursement rate under Obamacare (33% less than regular policies). If your doctor will not accept this rate you must go to your insurance plans and find a doctor who will. While you have the right to appeal with your insurance carrier to continue with your doctor you must be prepared for a fight and probably will have to go to the state agency responsible for overseeing healthcare plans (in California it is the Department of Managed Health Care. See the map on our sister site for national information ACAI Consultants to find the agency in your state that oversees the Affordable Care Act.