stethoscope on keyboardSUMMARY: Doctors and other providers will get paid less if they stay in new exchange insurance plans, according to a report from The Wall Street Journal.

“Insurers are slashing payments to medical practices in many of the plans they sell through the new health-law marketplaces—sparking worries that Americans signing up for coverage will have fewer doctors to choose from if low fees spark an exodus from the plans,” said the article, by Christopher Weaver and Melinda Beck.


“UnitedHealth Group Inc. sent some New York City physicians contract amendments as recently as this month setting rates well below what doctors normally see from private insurance, including less than $40 for a typical office visit and about $20 for reading a mammogram, according to confidential documents reviewed by The Wall Street Journal.

” ‘We have heard from a lot of physicians the rates [insurers] are offering them are very low, and physicians are questioning whether they are going to participate,’ said Sam Unterricht, a Brooklyn ophthalmologist and president of the Medical Society of the State of New York.

“Some of United’s rates fall close to what the state Medicaid program for low-income people pays for the same services. The fees for some office visits are less than half of what doctors in the city say they receive for treating people covered by employer-sponsored insurance.

“More physicians may leave the plans as awareness of the new rates spread, doctors and experts said. Many doctors surveyed in September by the Medical Group Management Association said they weren’t aware of the fees they would be offered for treating patients gaining coverage on the exchanges.  … Some doctors said they had learned of the fee cuts even as consumers began picking health plans. As a result, consumers may end up selecting doctors who haven’t yet agreed to participate in the plans. United is giving doctors who don’t want to accept the rates 30 days to opt out.” Christopher Weaver and Melinda Beck, Insurers Cut Doctors’ Fees in New Health-Care Plans – Wall Street Journal via Yahoo Finance.

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...