Many LI doctors confused by NY health exchange plans

As was originally originally published February 19, 2014 10:12 PM and updated February 19, 2014 10:59 PM By RIDGELY OCHS, many Long Island doctors say they are being listed on New York's health exchange plans without their knowledge, generating confusion and frustration among the physicians.

Some doctors said they are surprised to find out they are apparently listed with a plan. Others said they are shocked to learn they don't belong to a particular plan. Many say they have no idea what the reimbursement rates are, and all complain they are getting few answers.

"I'm getting patients with insurance I've never heard from before," said Dr. Deborah Dienstag, a pediatrician in Lawrence. "I tell people I don't know if this is real . . . [insurance] or not covered."

Dr. Sam Unterricht, president of the Medical Society of the State of New York, said in many cases the only way for doctors to find out if they are part of an insurer's network is to go to the website to see if they are listed.

"Most of them [websites] are horrendously bad, and it's quite difficult to know if you're in a plan or not," said Unterricht, who lives in Hewlett and is an ophthalmologist in Brooklyn.  Ordinarily, Unterricht said, doctors sign a contract with an insurance company and are given a fee schedule.  "With the exchange plans, they just put you on the plan automatically," he said. Unterricht said he believes he is listed with six exchange plans that he did not actively sign up for.

Training office staff to capture updated insurance information from the patient and then verifying patient eligibility in that plan during the appointment scheduling process can help to offset some of the confusion and frustration when the patient is actually in the office.  Staff should also be knowledgeable to which plans the providers actively are enrolled in so they may notify patients when they are seeing a physician out-of-network.  While the exchange plans by state and carrier are updated daily, MDeverywhere's HIX Exchange page may be a useful resource to help clarify which plans are active in which states and which are federally versus state run plans - especially those lesser known plans.  It won't, however, identify physicians active or listed in each plan.

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