Can Doctors Refuse Obamacare?

This is a complicated question for a number of reasons, namely that Obamacare is not a specific type of insurance. What the Affordable Care Act (ACA) has done is provide discounts on government-sponsored health insurance policies to some qualified individuals as well as set a standard for what all insurance policies must cover. Those eligible for Medicare, Medicaid, and related programs will not have failed to notice that their policies now fall under the ACA. There are independent insurance providers and policies, and many people still get coverage through benefits packages provided by their employers. Still, plenty of people have complained about doctors that refuse to take certain types of insurance. Can they refuse “Obamacare”? The answer is, ostensibly, yes.

In truth, this is nothing new. If you had insurance before Obamacare, you are well aware of the fact that doctors can be choosy about the types of insurance they accept. This is due to the fact that they have to learn the rules for billing for every type of insurance they contract with. Both billing and coverage vary from one insurance provider to the next, from policy to policy, and so on. Doctors running private practices cannot be expected to take every type of insurance. Even before Obamacare, they had to choose which insurance providers to work with and providers had the option to decide whether or not they wanted to include certain doctors in their networks.

Obamacare has only really exacerbated an existing problem. Here’s how it works. Policies offered through state healthcare exchanges are generally more affordable for patients because federal and state governments are footing a portion of the bill (in most cases) and subsidizing some policies for qualified individuals. However, the plans offered through Obamacare often don’t have the same reimbursement rate for doctors that private insurance provides. In other words, consumers pay less for their policies, but doctors also get paid less for their services. In addition, patients could be on the hook to cover more out-of-pocket expenses depending on the level of policy they choose. Whereas a high-cost, platinum plan will cover up to 90% of medical costs, a low-cost, bronze plan will only cover 60%, leaving patients to pay the rest – a cost they may not be able to cover.

For this reason, some doctors are limiting the number of new patients they’ll accept with policies obtained through the ACA healthcare insurance marketplace. In most cases, they can simply make more money from patients that have private insurance through their work or independent policies. On the other hand, some doctors have decided that they’re only going to accept ACA policies such as Medicare, Medicaid, CHIP, and others.

The big question for many people is whether or not they can continue to see their current physicians once they switch to Obamacare. The answer will depend on the policy you choose and the preferences of your doctors. There is no rule stating that hospitals or doctors must accept policies obtained through the healthcare marketplace established under Obamacare. Your best bet if you want to continue seeing your doctors is to find out exactly which providers and/or policies they are willing to accept and then purchasing insurance to match. Otherwise you could find yourself searching for new doctors within the network approved by your policy.

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