The familiar names and faces behind Obamacare

Submitted by gsbaird on December 27, 2013 - 12:23pm

Some health care providers are discouraging patients from signing up for insurance under the Affordable Care Act, saying they "won't be accepting Obamacare." The suggestion is that the marketplace of doctors has shrunk substantially.

This information had a fishy smell so I decided to test the truth of this assertion.

It is important to know that the policies offered in the ACA Health Insurance Marketplace are not government policies but are products sold by the same private insurers that are familiar names to us.

On the website, there are 61 plans offered for Bexar County from 5 insurers, including Blue Cross/Blue Shield, Aetna, Humana, Ambetter (Superior) and Community First. Of the 61 plans, 19 are PPOs and the rest are HMOs.

The PPO policies, while somewhat more expensive than HMO versions, offer 2 attractive features:

1) A policyholder can see a specialist without having to first visit his or her primary care provider.

2) There are more doctors, hospitals and clinics in PPO networks versus HMOs. Blue Cross/Blue Shield offers a website to enable people to explore the available doctors and hospitals included in its PPO and HMO networks.

Blue Cross Blue Shield of Texas offers a Provider Finder here on their website. When I selected San Antonio and searched for providers in the Blue Choice PPO network within a 20 mile radius, the search engine returned 8,142 names of doctors, hospitals, clinics and pharmacies.

I narrowed my search to primary care (family) physicians and received 1,083 names. Not bad. I checked for specialists with the following results:

• Cardiologists: 247 • Dermatologists: 81 • Gastroenterologists: 137 • Neurologists: 104 • Obstetrics/Gynecologists: 356 • Orthopedic Surgeons: 171

I decided to check on how many hospitals were in the same network. The search came up with 39 names. I’m feeling pretty comfortable with these results.

The assertion that Obamacare networks contain very few providers appears to be wrong.

If I select a plan that is an HMO, what will be the outcome? The Blue Cross/Blue Shield Blue Advantage HMO network has 2,064 providers, 246 primary care physicians, 75 cardiologists, 38 dermatologists, 33 gastroenterologists, 35 neurologists, 155 Obstetricians/Gynecologists, 49 orthopedic surgeons and 12 hospitals.

Yes, the number of doctors and hospitals in the Blue Cross/Blue Shield HMO network was smaller yet more than adequate.

I now can throw the commentary on a lack of doctors and hospitals available through Obamacare into the ‘bogus’ pile. Is the distribution of this sort of nonsense intentional? I think it is.

Those who oppose the Affordable Care Act will say anything to mislead others about the health care reform law. Does the law need some changes to improve it? Of course.

In the meantime, the good outweighs the bad and many more Texans are going to be able to see a doctor when they are sick.

For those who are interested in the networks of other providers, the following links are useful:

Aetna: DocFind

Ambetter by Superior: FindaDoc App

Community First: Find a Physician