This morning on the phone I was told, “I have had the same doctor and Anthem insurance for over 10 years, what do you mean they won’t accept my insurance now!” Finding a doctors who accept on-exchange health plans may be more difficult than it seems.
When many Nevadans purchase an “On-Exchange” (healthcare.gov) policy, they have difficulty finding doctors who accept on-exchange plans! So why is this? The new policy is from Anthem. The old policy is from Anthem. Their current doctor says they still accept Anthem… so what’s the problem!
The issue lies in the fine print. Insurance companies make a agreements with doctors called contracts. The doctors are paid based on what type of contract they have with the insurance company. For each contract, the insurance company creates a lists of doctors who accepted that contract called a Network List or Provider Directory. Many insurance companies have multiple provider directories. This means the doctor can accept some Anthem plans but they may not accept on-exchange health plans. The disconnect most people have involves a misunderstanding of how provider directories work.
For example, a doctor might say, “We accept Anthem”. What their doctor may be saying is they accept Anthem Small Group PPO offered through businesses. Members on the phone are hearing that they accept Anthem Individual HMO Pathway X for on-exchange participants. The two will not work the same way.
Locating a doctor who accepts your plan with your specific insurance company should be the first thing you do. This can be done even before purchasing a plan.
The best thing to do before buying an insurance plan is:
- Contact a Broker (Free to use and here all year)
- If you prefer a specific doctor, call them and find out the list of insurance companies they accept. Not to discredit anyone, but sometimes the person answering the phone is not the most knowledgeable person in the office. Just use this information as a starting point.
- Go to each of the insurance companies websites and see if you can find the specific doctor you need. Finding the Doctor Lookup for each insurance company who does business in Nevada can be a pain, so I’ve done it for you! Find a doctor in Nevada.
- Write down the name of the Network List the doctor is on: Eg: Prominence Premier HMO North, or Anthem Pathway X via Exchange…
- Tell this to the broker who you’re using and have them only show you plans that include your doctor.