Florida doctors won’t touch Obamacare with a 10 foot pole

Florida doctors

Certain Florida doctors are rejecting patients even though -or perhaps because- they have bought coverage on the Affordable Care Act’s healthcare marketplace exchanges. The patients were denied treatment despite the fact that the doctors they went to see were included in their insurance providers’ networks. It’s like these patients had a doctor’s appointment in 1992 for a mole in their shoulder and were told to wear a gown though they specifically wore a tank top so they wouldn’t have to put on a gown, and ever since their medical history chart says that they are difficult.

Floridians like 60 year-old Miranda Childe and 48 year-old Sal Morales are part of the 63 consumers who have complained to Florida's Department of Financial Services about not being able to see a physician in their ACA exchange plan’s network. They have not only been refused service, but they have been mistreated, humiliated, made to feel like “second-class citizens” who have “a horrible disease that they couldn't, or wouldn't, or didn't want to cure, or at least see and examine,” like  rash that keeps spreading and itching really bad. Childe bought a plan from Humana which she could afford thanks to financial aid from Obamacare, while Morales bought his from Florida Blue. Nevertheless, both were repeatedly turned down by primary care physicians. They finally found doctors they like, but the almost had to go all the way to the end of the alphabet to doctor Zimmerman.

Furthermore, Morales only saw his new doctor for the first time on July 1, four months after his insurance had become effective. During those four months he paid his $145 monthly premium even though he was not receiving any care. Sure, federal subsidies help to pay that premium, as well as out-of-pocket costs, but according to Florida Blue spokesman Paul Kluding “based on the contracts our providers have signed (…) they have agreed to treat our members regardless of how they obtained their insurance coverage.” Klundig’s Humana counterpart Nancy Hanewinckel adds that “these providers voluntarily agreed to participate and signed an amendment to their existing contract.”      

So why are they refusing service? Some cite a fear of not being paid by either insurers or patients. As executive vice president of the Florida Academy of Family Physicians Jay Millson puts it, they “don't want to be in a situation where (they) provide service, and turn around and there's no contract in place to reimburse (them).” Additionally, they claim insurers are not properly notifying them of their inclusion in exchange plan networks. Internist and vice president of the Dade Medical Association Eduardo Martinez adds that a 20% drop in cash flow for one week could be the difference on whether a practice stays afloat or goes under the following week, and that “nobody wants to take a chance” on patients whose benefits can’t always be timely or accurately verified. Other physicians are worried about the 90-day grace period.

Fortunately, Florida patients can find Dr. Bernd Wollschlaeger ahead of Dr. Zimmerman -not only because W goes before Z, but also because Dr. Zimmerman doesn’t even exist. Dr. Wollschlaeger says he doesn’t ask patients where they bought their insurance. Moreover, when he does encounter instances of insurers delaying reimbursements for patients, he says it’s not a systematic effort by insurance companies and so it doesn’t affect his cash flow. As a former president of the Dade County Medical Association, Wollschlaeger noticed stark opposition to Obamacare from the very beginning, and that some doctors still resent the Affordable Care Act. However, he feels that it’s only a matter of time and getting accustomed to the healthcare reform, which he says is better than dealing with uninsured patients and will evolve to fix physician payment rates by insurers and other issues.

Meanwhile, Millson recommends providers to “work with the patient to receive a co-payment or payment up front and let the patient go back to the insurance company and collect it.” Of course, this would put more financial pressure on patients who already have a low income -which is why they qualified for federal subsidies in the first place. And as Wollschlaeger says, “once you're a provider for an insurance company you cannot discriminate.”