In an attempt to cut down on administrative paperwork and back office hours, the new plans under the Affordable Care Act will go up for Auto Renewal when they reach their expiration date for each consumer. The renewal is not as straight forward as you might think. Read this document to get in the know on what to expect when your plan comes up for its next cycle.

1. COVERAGE INACCURACIES MRS © 2014
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Coverage Inaccuracies
Frustrate Consumers

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No one wants to leave the
comfortable neighborhood
feel of what they know to be
familiar. With the new
healthcare law, however,
many people have been
forced to leave their long-
time doctors and insurance
plans because either it
became too costly to stay or
because the plan was no
longer available.
"
Once change has occurred, the least consumers expect is to get accurate
information when looking for a new provider so they can choose a new one based
on factors such as location and ratings.
"
Unfortunately, the lists of in-network providers offered by the insurers haven’t
proven to be totally clear or reliable. Rather than receiving timely care and
coverage, many patients are receiving the runaround and costly bills.
"
Nearly 2,000 complaints were filed regarding inaccurate or difficult enrollment
procedures in California. Consumers say they are not receiving paperwork and
insurance cards, and they are having difficulty finding a provider that will even take
their coverage due to dwindling networks.
"
Insurance companies say they narrowed networks in an effort to keep premiums at
a minimum; however, the resulting confusion has caused uproar, unexpected bills,
and lawsuits.
"
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California Consumers

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Mark Morgan, Anthem Blue
Cross president, said, "These
narrow networks are making a
huge difference in terms of
affordability. We found in
convincing numbers that people
value price above all else."
"
Some say their new provider
won’t accept their insurance
plan, however, because they
claim they weren’t supposed to
be listed as a provider in that
network in the first place.
"
One California woman battling breast cancer thought she had done her due
diligence. She was informed the day before a scheduled lumpectomy that it
wouldn’t be covered at the facility after all.
"
The patient found it too risky to wait, so she proceeded with having the lump
removed so she could be on the road to recovery.
"
The insurance company, because she had notice (even if it was just one day), will
not cover the $8,000 bill she received.
"
This is just one story of many in
California where patients have
been blindsided even after taking
extra steps to ensure they would
be covered.
"
The California Department of
Managed Healthcare launched an
investigation with both Anthem
Blue Cross and Blue Shield of
California to ensure that they are
in fact upholding the law
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4. COVERAGE INACCURACIES MRS © 2014
regarding provider lists as well as making way for patients to receive treatment in a
reasonable timeframe.
"
Steve Shivinsky, Blue Shield of California Spokesman said, "People need to be very
diligent in deciding where to go. We are trying to do our part to educate people, but
it's a big task when the market has been totally turned upside down."
"
Even though it seemed like a lot of complaints were being received, a
representative said that the number was small compared to the number of
enrollees.
"
California isn’t the only state struggling to figure out who their providers are. These
issues are widespread throughout the country.
"
Even though Connecticut has had a relatively smooth transition into the world of
Obamacare, locating providers has proven to be a noticeable struggle.
"
Kevin Counihan, Access Health’s CEO, said, “There remains confusion, I think, about
the networks. Everybody’s sensitive to it. It’s clearly a big member issue.”
"
Some patients have verified coverage and made appointments ahead of time and
were still turned away once they arrived at the doctor’s office.
Page 4
The fact that we have such a high volume of
people searching for providers is kind of shining
a spotlight on an issue that we need to remedy.
- Victoria Veltri
Connecticut Consumers
“

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“The fact that we have such a
h i g h v o l u m e o f p e o p l e
searching for providers is kind
of shining a spotlight on an
issue that we need to remedy,”
Victoria Veltri, a healthcare
advocate, said.
"
One of the worst areas of
confusion is thought to be due
to irregularities of the biggest
companies offering plans on
C o n n e c t i c u t ’s exc h a n g e .
ConnectiCare and Anthem Blue Cross and Blue shield do not use the same
networks for plans on the exchange as they do off the exchange.
"
This, in addition to the fact that one of the insurers had ambiguously labeled
provider information on their website, only served to add confusion to consumers
during their search.
"
Veltri did say that patients that received care from an out-of-network provider
because the insurer listed them as in-network were advocated for and the
companies are requested to cover the visit. She did say that the carriers usually
acquiesce to such requests.
"
She also said, “My immediate concern is to make sure the lists are accurate and to
the degree people have purchased based on inaccuracies in lists, we need to make
sure those people, if they complain, are informed of their options, including
changing plans.”
"
Veltri also mentioned that just because some doctors are accepting a plan at a
practice does not mean all doctors at that practice do. Three doctors may accept a
plan while one does not, so she said it is important to be certain that each doctor is
separately researched to see if they accept the insurance plan.
"
"
"
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Annette Frey, a New Yorker who
beat lung cancer, had her policy
cancelled when the Affordable
Care Act rolled out, and she had
to purchase a plan on New
York’s healthcare exchange, NY
State of Health.
"
Frey claims her insurance “was
almost unusable” even though it
was the most expensive one on
the exchange and listed her
doctor as being “in-network.”
Not only was the in-network list
of providers incorrect, some of the locations were even inaccurate.
"
She needed to see the doctor. She also needed specialist referrals and checkup
approvals to keep an eye on her progress. Instead, Frey waited weeks to hear
whether or not her doctor would even be available for her to see.
"
During the ordeal, she was given conflicting information from the insurance
company and the doctor’s office and says she made nearly 200 phone calls to
secure the services she signed up for in the first place.
"
“I signed up for United Healthcare specifically because of the doctors I needed that
were ‘in network’ – something I went to great lengths to verify before signing up,”
Frey said.
"
When Frey finally got confirmation to see her doctor, United Healthcare denied the
claim, stating that her doctor was not in-network (even though the doctor’s name
was on her insurance card).
"
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A Cancer Survivor’s Struggle

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United Healthcare said Frey’s situation is rare and that it is in no way a reflection of
how the company operates as a whole.
"
“Ms. Frey’s doctor has opted not to participate in individual exchange networks. We
apologize to Ms. Frey for any inconveniences she experienced as this does not
reflect how we like to support our members.”
"
Notwithstanding her self-proclaimed identity as “...a tough New Yorker,” Frey has
become exasperated trying to get the care that she needs. “I don’t think people
understand the stress. My insurance is making me sick. I can’t do this every time I
need to see a doctor.”
"
It isn’t just the patients dealing with the confusion. Those who purchased their plan
on the exchange are told to specifically ask if they accept that particular plan if
purchased from the exchange.
"
They are also told that the doctor’s office may not have the answer. It’s not enough
to know they accept Anthem Blue Cross (or any other plan); they have to know
whether or not they accept the Anthem Blue Cross that was purchased from the
exchange.
"
Furthermore, patients can call a doctor’s office and many times the staff can’t tell
whether or not they accept that patient’s particular plan, because many providers
don’t deal directly with the insurance companies. Instead, they are part of larger
organizations and third parties who deal with contracts.
"
Lisa Folberg, vice president of medical and regulatory policy at CMA, said that
“many physicians have been ‘opted in’” to plans unknowingly. Some “all-products
clauses” in contracts signed between physicians and insurance companies exist.
"
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Confusion Among Providers

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Once signed, the agreement is that the doctors who accept one plan from the
insurance company also agree to accept all of their other plans. A good number of
physicians overlook that part, and as a result they become part of networks and
plans of which they are completely unaware.
Tim Tracy, a Connecticut insurance broker at Farifield, said, “Your doctor may think
they take Anthem and ConnectiCare, which they do, but these exchange networks
are completely new and different, and they are smaller than networks already
established.”
"
Patients can’t say whether or not a provider list is accurate; however they can take
steps to cover themselves. By making phone calls, taking names, and getting
approvals in writing, the patients who must get care can at least have some type of
proof that they were told by the insurance company that they would be covered.
"
We can only hope that, during this second year of Obamacare plans, these
detrimental kinks will be worked out and that the information will become more
reliable.
Page 8
Call 855-203-7058 or Click the Button to Visit MedicalRecoveryServices.org
Looking to Dispute Medical Bills?
Your doctor may think they take Anthem and
ConnectiCare, which they do, but these
exchange networks are completely new and
different, and they are smaller than networks
already established.
- Tim Tracy
“