Physicians brace for insurance-induced headaches

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New customers to the health insurance marketplace in southwestern Pennsylvania will have more than 35 different plans to choose from. And physicians who treat those patients may have no choice but to keep track of all 35 plans -- each with its own coverages, co-payments and deductibles.

That's just one of the administrative headaches that physician practices may face when the marketplace coverage under the Affordable Care Act starts Jan. 1.

"It's going to be very confusing to the patient and to the physicians," said C. Richard Schott, a Philadelphia-area cardiologist and president of the Pennsylvania Medical Society in a phone-in media briefing Wednesday.

There are also questions about how many patients will seek care once they have insurance, he said, what level of care they will need and what happens if patients with high-deductible plans can't pay their bills.

Although millions tried to log on to the healthcare.gov website for the first day of open enrollment Tuesday, no one knows how many intend to enroll because the Web traffic crashed the site.

"We are getting a lot of questions [from physicians] about how to deal with the volume of patients," said Dr. Schott, as well as how patients are going to be enrolled in the different plans. "We have gotten very little or no information from most of the insurance companies."

The answers should become clearer as the six-month open enrollment period unfolds, but that doesn't make planning any easier.

Dennis Olmstead, vice president of practice economics and payer relations for the state medical society, said there may be "a pent-up demand" for care among those who have gone years without seeing a doctor. They may come with an array of complex and chronic illnesses that will require extensive care at first.

Donna Kell, CEO of Kell Group on South Side that handles billing for about a dozen local independent physician groups, said she prefers not to speculate on what problems could happen. "I don't tend to like to speculate. I like to see what the facts are and figure out what my best course of action is."

She acknowledged, though, that with the multitude of different plans there "absolutely" will be a greater administrative burden on physician practices to determine a patient's eligibility and benefits ahead of time.

And, even if the physician practices get their part right, it doesn't mean the claim will be handled correctly, she added.

"I don't have a high level of confidence that the insurance plans are going to adjudicate it properly," she said. "They may not have the number of people to handle it, or they may not have the number of people who are educated" on the different plans.

"There's going to be a lot of variation."

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Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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