Is there a part of ACA that limits doctor visits for those with employer insurance?

[madfloridian]

I heard that from someone this week. That their doctor said that there were now under ACA certain limits as to when he could see this patient.

I have done a search to see if I could find which part would do that, but I can't find anything pertinent.

This is a person with good insurance under an employer plan. It has paid well and few restrictions in the past.

Is that person or the doctor misunderstanding or is this a glitch in the program some way?

I don't like to argue with someone unless I have facts. This is not someone on Medicaid or Medicare.

[daredtowork]

1. I hope not because

I saw my primary care physician today, and I was extremely frustrated because for the third time in a row she was running really late so I got short shrift on my appointment. We got to only 1 issue on my list, she didn't get get to any of the FOUR notes that had been sent to her by specialists and the ER, and we didn't get to my referrals that had been derailed (by doctors not taking Medi-Cal, etc.). So I have medical issues being dragged out for months at a time. This doctor was so overbooked that I couldn't even try to reschedule another appointment for next month. I have to keep calling and see if someone cancels.

If there is an "appointment limit" then I suppose all my appointments are just being wasted on this sort of thing...

The limit might be coming from the HMO rather than the ACA.

[elleng]

4. Sounds like a bad situation, daredtowork.

Any way you can get a different primary care physician?

[madfloridian]

9. Doctors are likely seeing many more patients now.

And that could lead to problems.

[elleng]

2. I doubt it.

Have 'employer' insurance and medicare, so my experience is not the same situation, but have seen several doctors several times recently, and no such issue has been raised.

[madfloridian]

5. It bothers me a lot because her doctor used the ACA as an excuse.

I was unable to question her about it because I just didn't know.

[elleng]

8. IF POSSIBLE, for you and her,

I suggest you tell her to insist that her doctor show her where/why the doctor thinks this is the case. She has to advocate for herself, vigorously; we all do. (Fortunately I have no such situation.)

[Skittles]

3. my belief is

blaming it on ACA seems to be the thing to do, regardless of whether or not it is true

[madfloridian]

6. Well, I would love to find out to explain it to her correctly.

But on a thorough search I found nothing.

[elleng]

7. Of course it is 'the thing to do.'

Our health care 'system' is NOT a system, it's extremely random, so patients have to be vigilant in representing their own interests. Takes work.

[Skittles]

12. a system that SUCKS

[SharonAnn]

10. Employers either define the contract to the insurer or buy a pre-determined plan from the insurer.

The employer makes the definition.

I pointed this out to a co-worker who was getting the runaround from our employer insurance administrative company. She said, "I don't get it. I'm their customer." I pointed out to her that she was not their customer, our employer was their customer. Therefore, go to whoever in our company handles the insurance and related contract issues, probably HR. She contacted them, complained about what was happening, and the issue was resolved by the end of the day.

In a nutshell, your employer buys/defines what it wants the insurance to cover.

[Egnever]

11. That doesn't sound right at all.

I think this guy is trying to game the system.

The ACA does have a pay for performance portion and that may be what he is referring to but it is not a restriction on how many visits she is allowed to have.

Here is a page with info on it.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78

Serious concerns have been raised about the impact of pay-for-performance approaches on poorer and disadvantaged populations. In particular, there are fears that these programs may exacerbate racial and ethnic disparities in health if providers avoid patients that are likely to lower their performance scores.

Sounds to me like this is exactly what this guy is doing.