What if you went shopping for health insurance, bought yourself a plan, and then found out that you couldn't get a doctor to take the health insurance? Would you blame the system? Would you blame the insurer? Or would you accept part of the blame: that your shopping process didn't take into account the availability of doctors in your area. Would you change your answer if the insurer was the U.S. Government and the insurance program was Medicare?
I was reminded of this particular peril of health insurance today when reading "The Primary Care Crisis is Here" by Dr. Bob Wachter. He discussed the difficulty that people have in getting a primary care physician at a number of hospitals, and referenced a few broadcasts on NPR on the subject. Some examples of people who had purchased health insurance only to find that they could not get a primary care doctor to take their insurance plan were given in the article.
The reasons that a particular doctor might discontinue using a certain insurer are varied, but generally come down to the level of payment to a provider. If the insurer doesn't pay enough, the doctor will either drop that insurer or adjust business practices in order to continue to see patients. If the provider has more than enough patients, the easiest solution is to drop those insurers, and by association those patients, that are not helping the bottom line. And according to Dr. Wachter, this can even include non-profit institutions, who still must pay their bills and manage their money.
So how do you avoid getting stuck like this? The most important thing is to be flexible and review the numbers. While some doctors are dropping Medicare as an insurer, others are filling in the gaps. If you are not eligible for Medicare and buy or select your health insurance, look beyond the financial numbers to the breadth and depth of the doctors available to you.
In his article, Dr. Wachter is writing specifically about primary care physicians, so make sure you understand the number of available doctors and the number of available practices composed of the doctors available under the plan. Frequently a practice will move in or out of a network together, so having many doctors in one practice would be putting all of your eggs in one basket. Having 10 practices available is a safer bet. The biggest "out" for having a network is when you can go outside the network. This is usually accompanied by higher rates, which make a financial difference, but having access to care is paramount.
The best cure to this problem is prevention. When shopping for a health insurance plan, ensure that there are many members, many providers, and provisions to go outside the network. If you'd like to know even more, I've written about this in more detail in my book Get a Good Deal on Your Health Insurance Without Getting Ripped-Off. You can also access free and helpful health insurance resources online at http://www.besthealthinsurancebook.com/resources/.
