Nation's Top Hospitals Reject Obamacare Plans

Friday, 01 Nov 2013 11:11 AM

By Sandy Fitzgerald

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Most of the nation's top hospitals plan to accept insurance from only a few companies participating in Obamacare, a new reports says.

Insurers participating though the Obamacare healthcare exchanges plan to offer doctors and hospitals less compensation for services so they can recoup their own losses coming from federal caps on premiums, reports U.S. News & World Report.

As a result, hospitals are rejecting many of the companies included on states' health-insurance exchanges, which typically include many low-cost options for consumers.

Urgent: ObamaCare Is About to Strike — Are You Prepared?

"This doesn't surprise me," Gail Wilensky, Medicare adviser for the second Bush Administration and senior fellow for Project HOPE, told U.S. News. "There has been an incredible amount of focus on the premium cost and subsidy, and precious little focus on what you get for your money."

U.S. News contacted its top 18 hospitals  for this year to determine their contracts, and learned that most are opting out of Obamacare insurance companies.

Individual plans purchased outside the Obamacare regulations still will be accepted in many cases, however. The Cleveland Clinic, ranked fourth on the U.S. News list of top hospitals, responded that it accepts several insurance plans and managed-care options that are purchased individually, but accepts only Medical Mutual of Ohio from among the dozens of insurers included on Ohio's healthcare exchange.

Some top hospitals, such as the publication's top-rated facility Johns Hopkins in Baltimore, must accept all insurance companies' coverage due to state law. But 11 of the 18 hospitals on the U.S. News listings allow just one or two carriers from their state's healthcare exchanges.

"Many companies have selectively entered the exchanges because they are concerned that (the exchanges) will be dominated by risky, high-using populations who wanted insurance (before Obamacare) and couldn't afford it," said Wilensky, a member of the board of directors of UnitedHealth.

Many insurance companies declined to comment on the trade-off between price and quality of service. Critics say consumers are getting into coverage they don't understand.

"In many cases, consumers are shopping blind when it comes to what doctors and hospitals are included in their Obamacare-exchange plans," said Josh Archambault, a senior fellow with the think tank Foundation for Government Accountability. "These patients will be in for a rude awakening once they need care and get stuck with a big bill for going out-of-network without realizing it."

But even if customers don't want or need to go to a top-rated hospital, they may find that their own community hospitals also are rejecting Obamacare plans, reports CNN.

For example, residents in Concord, N.H., are learning that the city's lone hospital accepts no policies offered through the state's marketplace.

As a result, Concord residents on Obamacare plans will have to pay out-of-pocket to see a doctor, specialist or primary-care provider affiliated with the hospital or they'll have to drive at least 25 miles to the next community, Manchester, to get medical care.

Concord Hospital CEO Michael Green said the hospital isn't opting out to make a "political statement" but blamed Anthem Blue Cross Blue Shield, the state exchange's only provider, saying the company is "unwilling to negotiate sustainable contract terms" and the hospital would be "paid less than what it costs us to provide care."

Still, many consumers care more about how much their policies cost than where they're getting their services, according to a PriceWaterhouse Cooper survey, which determined 43 percent care more about policy costs than they do about where their healthcare needs are met.

Urgent: ObamaCare Is About to Strike — Are You Prepared?

Insurance companies depend on narrowing networks to keep those costs down, said Micah Weinberg, a senior policy adviser for California's Bay Area Council.

"Narrower networks is one way to keep costs (of these policies) down," said Weinberg. "Some of the networks may be too thin, at least for now anyway."
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