Thinking about getting new insurance or about ready for an event like turning 65 years of age that changes your eligibility to have insurance?

Question about your health insurance?

Our country is going through an unprecedented change in the way health insurance is purchased, promoted, and carried out.  Here are some important things you should know and should find out prior to signing up for a new health insurance plan.

Are there limits on what doctors you can see?

In the past, health plans were basically divided into plans which were managed care type plans with a set group of doctors and clinics you could go to, or private open access plans where you go essentially anywhere or to any doctor you would want to see.
There are very narrow limits on which doctors you can see in the new health exchanges and Medicare Advantage plans – even if you have been in the Medicare Advantage plan in the past. In order to control cost and make these health plans less expensive these types of insurance plans have very limited groups of doctors you can see.  In fact, one very large national insurance carrier just dropped many of its doctors.  This particular company will not drop the doctors until February of 2014 so that many doctors will show up as participating doctors on the published lists for the Medicare Advantage Plans it offers when in fact they will not be available to you shortly after the insurance takes affect.

What should you do?

Contact your doctors or doctors you may want to see for treatment to see if they are either currently in or plan to be in a given health plan especially for any Medicare Advantage or new health care exchange.
Standard Medicare, while more expensive does allow you to see what ever participating doctor you may want to see.

Why do these plans exclude some doctors?

Answer – to save money. They offer to pay some doctors less but promise to send more people to them if they will be in their small panel of doctors. Also they may not want doctors who correct problems other doctors do not fix – like corneal transplants, complex reconstructions of the eye like we do at Price Vision Group.  If they have no one who does those surgeries, well you just don’t get it done and it save them money (also the saves the Government money with the exchanges).
If you think you may want DMEK or some specialized eye surgery that Price Vision Group provides – call our office and see if we and our surgery center are actually in the group of doctors and facilities covered by the plan you are in or looking at.  It has come to our attention that a number of companies have listed our names in their lists when in fact we are not in them.
Some companies also do not want to pay for the corneal tissue in ambulatory surgery centers.  They claim no one ever asks them to pay for the corneal tissue.  This is an absurd comment on their part as the corneal tissue is often as expensive as the physician fee and surgery center placed together.  Moreover they may be paying large medical centers multiple times the cost of the cornea tissue for the same surgeries that we and other doctors do in less expensive, and what we believe are safer, independent ambulatory surgery centers.