'Phantom Networks' of Unavailable Doctors Plague Obamacare

Wednesday, 05 Feb 2014 11:37 AM

By Melissa Clyne

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The fears of patients across the country are being realized as they discover their doctors are not participating in the Obamacare health plans, The Los Angeles Times reports.

In late January, retiring Oklahoma Sen. Tom Coburn, a Republican who is also a medical doctor, disclosed to MSNBC’s Joe Scarborough that his Obamacare plan did not include the oncologist who has been treating him for prostate cancer.

In order to continue to receive treatment from the same specialist, Coburn has to pay out-of-pocket.

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The senator is just one among thousands of patients and doctors who are experiencing the same problem, characterized as a "phantom network" by a California woman who was thrilled to finally qualify for health coverage under Obamacare after years of being denied due to preexisting conditions only to realize she can’t find doctors participating in the network.

The issue hit home for Maria Berumen when she was referred to a specialist for numbness in her arm, according to The Times. At least four doctors wouldn’t accept her health plan despite the state exchange website and her insurer listing them as participants in her network.

Berumen’s case is not unique, according to her primary care doctor, Ragaa Iskarous, who told The Times she has repeatedly encountered the same situation with other patients over the past month.

"This is really driving us crazy," Iskarous said.

Fox News reported in December that analysts predicted the Obamacare system might resemble Medicaid, warning that because of the low reimbursement rate, doctors might refuse to participate in the networks.

"That will leave more and more patients jockeying to see fewer and fewer doctors," said Merrill Matthews, director of the Council for Affordable Health Insurance.

That’s what happened to California resident Danielle Nelson, who was promised "half a dozen times" by her provider, Anthem Blue Cross, that her oncologists would be covered under her Obamacare policy. But when she went to the doctors' office, a bright orange sign informed her that "Covered California plans are not accepted."

According to The Times, major insurers have drastically cut the number of doctors and hospitals in California’s new health insurance market so that premiums are affordable.
The state is being flooded with consumer complaints and lawmakers are working to "swiftly ease some of the problems that have arisen."

"There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care," California Insurance Commissioner Dave Jones said. "Network adequacy will be a big issue in 2014."

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