Diagnosis: Headaches For Obamacare Enrollees At The Doctor's Office

Jun 18, 2014 | Updated Jun 18, 2014
Mauren Mandel

Obamacare's enrollment glitches might have been fixed long ago, but they're still causing headaches at doctors' offices and clinics around the country.

Patients and health care providers, in a series of interviews with The Huffington Post, complained that they are having trouble confirming that patients are insured, working out what their plans cover and figuring out which plans doctors will accept.

These complaints are signs that the Affordable Care Act, President Barack Obama's signature health care reform law, is suffering growing pains more than six months since its insurance policies took effect.

The law has provided low-cost, subsidized health insurance to millions of working families and no-cost Medicaid coverage to millions more. It has opened the market to people with pre-existing conditions who were shut out before. And these new plans come with a slew of guaranteed benefits and consumer protections.

But the technical and bureaucratic failures of the six-month open enrollment period that officially ended March 31, the millions of new customers on insurance rolls and a poor understanding among the previously uninsured about how insurance works are combining to create extra burdens for some doctors and their patients.

Such problems serve to highlight the fragmented, complex nature of the existing health care system and the shortcomings the law failed to fix: the hassle of negotiating with insurance companies, the struggle to understand how benefits work, and the difficulty of finding doctors.

Maureen Mandel of North Bellmore, New York, has endured a gauntlet of troubles to get and use her new insurance since October, when she first tried to sign up through New York State of Health, her state's insurance exchange. Mandel, 47, spent countless hours on the phone with the exchange and her insurer, until her plan was finally confirmed in April.

Mandel thought she had it sorted out.

Then she went to the doctor. The front-desk attendant said some other physician was listed in the insurer's system as her primary care provider -- a doctor in Waco, Texas. According to Mandel, an insurance company representative told the attendant their internal records listed this physician, but when Mandel signed into the account herself, it listed her real primary care provider's name. The attendant was still arguing with the insurer about the discrepancy when Mandel's visit with the doctor was over, she said.

"I sympathized with the doctor's office," Mandel said. "I honestly would've understood if they'd said, 'Maureen, I'm sorry. We just can't take you.'"

These experiences soured Mandel, who described herself as politically liberal, on Obamacare, despite her appreciation for the coverage it provides and the tax credits that cut her insurance costs. "I haven't seen any improvement," she said, "and that's what scares me."

Physicians' offices are feeling the pain, too. Seeing patients whose insurance coverage is in doubt risks leaving doctors with unpaid bills. Staff has to spend precious time helping patients resolve issues with insurers, said David Taylor, the vice president of regional services for CoxHealth, a chain of clinics and hospitals based in Springfield, Missouri.

In an April survey by the Medical Group Management Association, which represents large physician practices, 63 percent of doctors' offices said verifying a patient's insurance was more difficult with plans bought through Obamacare exchanges. The same percentage reported greater difficulty getting information from insurers about how much patients had to pay for services, and 59 percent said it was harder to get accurate information about what specialty physicians were in patients' insurance networks.

"The front desk is probably our toughest position," Taylor said. "In some instances, they may be able to help, but in others they may be too busy," he said. When there's uncertainty, the office may demand payment upfront, he said. "We're not turning people away, but we are asking for money," he said.

When Paige Bayer of San Jose, California, took her 9-year-old son to his pediatrician for an ear infection, she ended up paying $125 in cash after learning the doctor wasn't in her new plan's network, contrary to information listed on her insurer's website, she said. "I wanted to get my son seen quickly," she said.

"I didn't get the idea that you don't get to go out of network anymore. If you go out of network, you are paying every red cent," said Bayer, 40. "That was kind of shocking to me."

Bayer is more optimistic than Mandel that such problems will smooth out over time, and her family is benefitting from the law's guaranteed coverage for people with pre-existing conditions. Her 40-year-old husband's chronic back problems made it impossible for him to get private insurance before Obamacare, she said. "That kept me up at night. I started thinking, 'My God, what if he ended up getting cancer or something?'" Bayer said. "We'd lose everything -- and we have a lot of money. But we live in Silicon Valley, and a lot of money doesn't go very far if you end up with cancer."

At her small practice in Wilmington, Delaware, physician Rebecca Jaffe has experienced her share of administrative issues with Obamacare plans. Jaffee worries she won't get paid if a patient's insurance isn't in effect, but tries to accommodate them as much as possible, she said.

Jaffe's staff also spends a lot of time helping patients answer tricky questions about how their benefits work, like whether a service is "preventive" -- and therefore has no out-of-pocket charges -- or a treatment, for which they must pay.

"Patients really, really don't understand that," she said. "We're seeing confusion, because people don't know what's covered and what's not covered." Patients who were previously uninsured and don't understand complex insurance plans need the most help, she said.

Still, Jaffe said, these kinds of problems aren't so different from what happens when insurance plans change every year, and they represent the early struggles of reforming the health care system.

"The ACA was a huge step. I mean, it took 50 years for some sort of substantive change," she said. "We need to fix what we find doesn't work well."