- Posted by admin_canopyinc
- On February 24, 2014
- 0 Comments
Author: Justin Fallein, Vice President of Operations – Canopy
I recently read a story about a man in California that was experiencing difficulties getting approved for a surgery with his new ACA (Obamacare) compliant health insurance plan (Read story here). The story paints a picture of providers denying him the surgery because he had an ACA plan and went on to paint a misguided picture of how provider networks work on health insurance plans. It is very much a victim based story that took jabs at everyone – the insurance company, the providers and the ACA law in general. The ACA has become an easy target for criticism and a punching bag for its flaws, but in this situation, the law isn’t the problem.
What I took away from this story is a problem that’s been in place since healthcare.gov opened for use on October 1st and that is people navigating the site and purchasing health insurance coverage on their own. Part of it can be attributed to the government marketing campaign that actually urges people to sign up on their own while making it sound “oh so simple”. At one point, President Obama even compared buying health insurance to buying airplane tickets. The problem with this analogy is that a health insurance policy is much more complicated and much more expensive than a plane ticket and too often, people end up buying health insurance plans they don’t understand.
Under the new ACA law, many carriers do offer plans with limited networks as a way of trying to keep options in place for consumers, with lower premiums. Unfortunately, the Marketplace plan summaries and even the carrier websites, often don’t explicitly state this fact and unless someone takes the time to search the provider directories, they won’t know and they’ll likely think they’re just buying the plan with the lowest premium. In the story it mentions the doctor the gentleman had selected to do his surgery was in the BCBS network but wouldn’t accept the gentleman’s plan….that’s because the doctor wasn’t in the specific BCBS network that gentleman’s plan utilized.
The situation referenced in the story seems like a fairly obvious situation. The gentleman unknowingly purchased a plan with a smaller, limited network of providers. While the plan might be through Blue Cross Blue Shield, the plan he purchased doesn’t utilize the larger Blue Cross network. However, when he bought the plan, he obviously didn’t realize this was the case, and how would he know if no one advised him or told him? Fact is, unless you are very well-versed in health insurance and more specifically, in ACA compliant health plans, you should really think twice about buying health insurance on your own without consulting a broker or an agent that can advise you properly on which plan is most appropriate.
A vast majority of health insurance agents and brokers don’t charge a fee to sign someone up for a health plan – it’s free consultation. So why wouldn’t you use an expert in the field to help you select and enroll in a plan? Our agency’s brokers have signed up over 3000 individuals since October 1st and have helped many more finalize their plan on the Marketplace because people got to the point where they needed to pick a plan and were unsure which plan was the best option for them. They best thing they did was make a call to one of our brokers to help them finish the process. Otherwise they may have found themselves in the same situation as the gentleman from California still searching for a provider in his network to do his surgery. While the ACA law is far from perfect, it’s what we have to work with right now. If you do need to sign up for a Marketplace plan or a plan off the Marketplace (direct through a carrier), do yourself a favor and get help! Even if it’s just to ask a few questions and verify you are making the right plan choice.