Insurers Restricting Hospital Access Under Obamacare

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Monday, 09 Dec 2013 07:57 AM

By Melanie Batley

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Some of America's leading hospitals will not be participating in Obamacare in a bid to cut costs, leaving patients with fewer choices of facilities and doctors covered under their new plans.

According to the Financial Times, many consumers will not initially realize whether the plans they purchase on the insurance health exchanges will cover preferred medical providers. Most plans, for example, will not cover two of the nation's top cancer centers — New York's Memorial Sloan Kettering and Anderson Cancer Center in Houston.

"We're very concerned. [Insurers] know patients that are sick come to places like ours. What this is trying to do is redirect those patients elsewhere, but there is a reason why they come here. These patients need what it is that we are capable of providing," Thomas Priselac, president and chief executive officer of Cedars-Sinai Health system in California, a top research and teaching hospital, told the Times.

In some cases, patients who wish to access certain hospitals or doctors will incur high "out-of-network" costs or pay exorbitant out-of-pocket expenses.

Experts say the situation may be one of a number of unintended consequences of the law which was designed to offer affordable care while mandating a broader level of coverage. As a result of the new regulations which add costs for insurers, companies are restricting the facilities that are seen as too expensive.

And some experts say it could also have an adverse effect on the ability of hospitals to develop innovative treatments that require a pool of some of the sickest patients who will no longer have access.

The Obama administration, however, disputes suggestions that coverage from the insurance marketplaces will limit care, saying access to medical providers will be "vastly" increased.

"Decisions about which private health insurance plans cover which doctors is a decision currently made by insurers and providers and will continue that way," a Department of Health and Human Services spokeswoman told the Times.

The development may lend more ammunition to critics of the president's signature healthcare law who say health coverage under Obamacare will be inferior to existing coverage.

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