Physicians Reluctant to Treat Patients Insured Under ACA

(HealthDay News) — Millions of Americans bought health insurance coverage through the Affordable Care Act in the past year and physicians may be reluctant to accept these patients.

“I think doctors have a couple of problems with the exchange policies,” Austin King, MD, an otolaryngologist and president of the Texas Medical Association, told HealthDay. People often don’t understand their insurance coverage, so staff members have to educate them, “and that adds to the hassle of seeing these patients,” King said. 

Another problem: Doctors are wary of the law’s provision giving people with subsidized coverage a 90-day grace period before their coverage is cancelled for failing to pay the premium. Doctors fear they could end up on the hook for care provided to people who lose their coverage, King explained.

Recent news reports also indicate that some doctors in states like New York and Florida are reluctant to accept these patients because reimbursement rates are well below those of traditional health insurance plans. 

“We are hearing from a lot of physicians that the fees that they’re being paid by the exchange plans are substantially below the fees that are paid by the same companies in the commercial plans. So that’s one of the reasons why a lot of physicians don’t want to participate in the exchange,” Andrew Kleinman, MD, a plastic surgeon and president of the Medical Society of the State of New York, told HealthDay. “I’ve heard fees as low as 50% of the Medicare rate.” 

For consumers buying health plans on the New York State of Health, the state exchange, trying to find a doctor “is rather difficult,” partly because provider fees are inadequate and also because provider directories are often inaccurate, Kleinman explained.

New York Attorney General Eric Schneiderman has urged consumers shopping for health insurance this open enrollment season “not to rely solely on provider lists offered by insurance companies.” He advises consumers to call both their providers and the health plan before signing up during the current enrollment period. 

Enrollment began Nov. 15 and will end Dec. 15 for current enrollees who want their health insurance plan changed on Jan. 1 and for newcomers who want a health insurance plan in place on Jan. 1. has tips for choosing a marketplace plan.