Consumers losing doctors with new insurance plans

MIAMI — Some consumers who bought insurance under the Affordable Care Act are experiencing buyer’s remorse after realizing that their longtime doctors aren’t accepting the new plans.

Before the law took effect, some analysts warned that narrow networks could affect patients’ access to care, especially in cheaper plans. But with insurance cards now in hand, consumers are finding their access limited across all price ranges — sometimes even after they were told their plan would include their current doctor.

Michelle Pool is one of those customers. Before enrolling in a new health plan on California’s exchange, she said, she checked whether her longtime primary care doctor was covered. Pool, a 60-year-old with diabetes who has had back surgery and a hip replacement, purchased the plan only to find that the insurer was mistaken.


Her $352 a month gold plan was cheaper than what she’d paid under her husband’s insurance and seemed like a good deal because of her numerous preexisting conditions. But after her insurance card came in the mail, the Vista, Calif., resident learned her doctor wasn’t taking her new insurance.

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‘‘It’s not fun when you’ve had a doctor for years and years that you can confide in and he knows you,’’ Pool said. ‘‘I’m extremely discouraged. I’m stuck.’’

The dilemma undercuts President Obama’s 2009 pledge that: ‘‘If you like your doctor, you will be able to keep your doctor, period.’’ Consumer frustration over losing doctors comes as the Obama administration is still celebrating a victory with more than 8 million enrollees in its first year.

Narrow networks are part of the economic trade-off for keeping premiums under control and preventing insurers from turning away those with preexisting conditions. Even before the Affordable Care Act, doctors and hospitals would choose to leave a network — or be pushed out — over reimbursement issues as insurers tried to contain costs.

An insurance trade group, America’s Health Insurance Plans, says studies show the biggest factor influencing consumer choice is price. Insurers say that if consumers want low premiums, their choices may be limited.


Health and Human Services spokesman Fabien Levy says the law requires insurance companies to post their directories so consumers can see whether their doctor is covered before they sign up. Officials say insurance companies ultimately decide what doctors and hospitals to include in networks, just as they did before the law. The federal government is closely monitoring plans to see whether more guidelines are needed to ensure consumers have access to quality health care.

Insurance companies say doctors are equally responsible for letting consumers know what plans they accept. But finding that information can be tricky, because does not have a centralized directory of doctors and what plans they accept. Instead it offers links to directories of individual plans, which are sometimes inaccurate.

Insurance agents Craig Gussin in San Diego and Kelly Fristoe in Texas helped dozens of clients switch plans just before the enrollment deadline when clients realized their doctors weren’t covered. Now they’re struggling to help clients who realized they were in that position after the March 31 enrollment deadline, when consumers are locked into plans for one year.