Obamacare – Narrowing the Network of Providers Accessible to Enrollees

by | Last updated Jul 4, 2023 | Published on Jan 31, 2014 | Healthcare News

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Most people, especially the sick and the elderly community opt for Obamacare owing to the cost advantages it offers. However, many people looking for coverage will find that they have access only to a lesser number of provider and hospital networks compared to their peers outside of state-based exchanges. On the part of the insurers, they are limiting their selection of doctors to cut down premium and other costs.

One of the noticeable measures insurers take is restricting enrollees’ access to healthcare providers through Health Maintenance Organization (HMO) plans that offer benefits only to those patients who access services from the network of providers specified in the plan.

Insurers contract with those doctors and hospitals that charge them the lowest fees for providing healthcare services to patients. They also exclude large academic medical centers that target the sickest patients and more complex cases as it is too expensive to access such services. According to the Department of Health and Human Services (HHS), the decision as regards which insurance plans cover which doctors or hospitals is made by the insurers and providers and it will continue in this way.

Though the insurers claim that most of the new participants are currently uninsured and therefore not likely to have strong relationships with doctors, the truth is that some people looking for coverage on the exchange do have concerns about the provider networks. Such people will have to find plans in which their doctors are participating and even pay higher premiums for that privilege. At the same time, those who are looking for lower premiums may have to visit a doctor other than their usual provider. Even though patients will have access only to a few physicians in areas with a heavy concentration of doctors, it is better than not having health insurance.

The lack of physicians will add to the responsibility and workload of the in-network physicians who will have to see more patients. Moreover, they have to streamline their medical billing process to receive good reimbursement.

As millions of people are getting enrolled into Obamacare, the in-network physicians will see a surge of patients each day. It is a cumbersome task to conduct insurance verification and authorization of each patient, carry out accurate medical billing and coding, and perform AR follow up. With the help of a professional medical billing and coding company, providers can effectively streamline their revenue cycle management.

  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
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    CPC: Senior Solutions Manager: Practice and RCM

    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

  • Amber Darst
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    Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.

  • Loralee Kapp
    Loralee Kapp
    Solutions Manager: Practice and RCM

    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.