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Affordable Care Act – Do You Know Who Your Provider Is?

Dec 6, 2013 | Healthy Living | 0 comments

I’ve avoided talking about the Affordable Care Act until now, because I like to keep this blog relatively free of politics.  Of course, with all the changes occurring in health care, it’s virtually impossible to avoid discussing it altogether.

I am going to avoid sharing my opinion, and that in part is because I’m not entirely sure what my opinion is.  Like everything in life, the ACA has both good and bad parts.  But today I want to bring up one facet of the Health Care Exchange that you might not be aware of- whether your provider is in-network.  Please be advised, my knowledge of this is only based on 1) my personal experience with the health care exchange (e.g. and 2) what is going on here in Cleveland.

With that in mind, here is my word of warning to you, the consumer.  If you sign up for coverage through the Healthcare Marketplace, and you already have a physician or hospital system that you like, check to see if that provider is on your new insurance plan.  I would recommend looking at included providers through the website.  I myself searched for some plans out of curiosity, and to see how well the site was working.  When the website gives you a list of plans, there is a link on each plan so you can search for providers or hospital systems.  The process is a bit tedious, as it links to the external insurance company website, and you have to search each plan individually.  But you absolutely need to do this.
Why can’t you just call your doctor’s office and ask if they take your insurance?  Well let me give you an example.  Here in Cleveland, CareSource is a fairly popular insurance plan.  Many physicians and hospitals in the city take CareSource, including my office.  But if you purchase CareSource through the health care Marketplace, the providers who are in network are very limited.  As in, you have a choice of exactly one hospital.  If you purchase CareSource through the Marketplace, you are only covered at MetroHealth.  CareSource, purchased through the Marketplace, elected not to negotiate contracts with any other hospital systems (e.g. the Cleveland Clinic, University Hospitals, or Lake Health).   Thus my office, who participates with insurance companies that negotiate contracts through our PHO (physician hospital organization), cannot take that type of insurance.  But we do take regular CareSource.  So if you call our office and ask if we take CareSource, the answer is yes.  But we may not take your CareSource.

So my closing recommendation?  If you purchase insurance through the Marketplace, check through the Marketplace to see if your provider is in-network.  Do not just call your provider to see if they take your insurance plan, because they may not realize plans are different if you purchase insurance through the exchange.


What has your experience been with the Affordable Care Act? 


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