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By: Benita Zahn

New York may be getting closer to providing you with more health insurance protections.

Right now it’s tough to know what your premiums real buy and many New Yorkers are getting slammed with unexpected and exorbitant medical bills.

“Tell your insurance company that whatever they would accept as reimbursement I and my team are willing to accept as insurance and payment in full,” said Chad Glazer.

Despite that concession by a specialist, Glazer still had a herculean battle to get his health insurer to approve his son’s treatment by that doctor who was out of network. Glazer shared his story at a roundtable discussion organized by Republican Senators Kemp Hannon and Greg Ball.

Glazer told them about the fight 12 years ago when his son was born with a rare liver disorder. Glazer prevailed and won, his son survived.

Senators Hannon and Ball are working for changes to health insurance in line with proposals recently made by Gov. Andrew Cuomo – to insure emergency services are covered no matter where you are when in need, and to prevent surprise bills and excessively high charges, or provide out of network coverage – which would help families like the Glazers.

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Some doctors wary of taking insurance exchange patients

Now that many people finally have health insurance through the Affordable Care Act exchanges, some are running into a new problem: They can’t find a doctor who will take them as patients.

Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say.

“The exchanges have become very much like Medicaid,” says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. “Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they’re not going to be in business very long.”

Kleinman says his members complain rates can be 50% lower than commercial plans. Cigna and Aetna, however, say they pay doctors the same whether the plan is sold on an ACA network or not. United Healthcare spokeswoman Tracey Lempner says it’s up to their physicians whether they want to be in the exchange plan networks, which have “rates that are above Medicaid.” Medicaid rates are typically below those for Medicare, which in turn are generally lower than commercial insurance plans.To prevent discrimination against ACA policyholders, some insurance contracts require doctors to accept their exchange-plan patients along with those on commercial plans unless the doctors’ practices are so full they simply can’t treat any more people. But lower reimbursement rates make some physicians reluctant to sign on to some of these plans or accept too many of the patients once they are in the plans.

“I definitely feel like a bad person who is leeching off the system when I call the doctors’ offices,” she says.Shawn Smith of Seymour, Ind., spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.

Last week, Smith found a practice that would accept her as a patient. Caroline Carney, chief medical officer of MDwise, Smith’s insurer, says some doctors “might be participating with us, but just not able to take on new patients. It’s at the doctor’s discretion.”

Jon Fougner, a recent Yale Law School graduate, sued Empire Blue Cross this month because he couldn’t find a primary care doctor in his new ACA exchange plan…

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Doctors group rips New York version of ObamaCare

ALBANY — One of New York’s largest physicians’ groups says ObamaCare needs a checkup.
The head of the Medical Society of New York ripped the Affordable Care Act for failing to require insurers to offer out-of-network coverage to patients next year.

“It also exacerbates the problem we have seen in New York’s Exchange regarding the often-limited networks that reduce patient choice to see the physician best able to treat their particular condition,” said Dr. Andrew Kleinman, president of the society.

New York state outlined a full list of changes and criteria for users of ObamaCare on its Health Department web site.

Among the provisions is allowing patients to go to an out-of-network provider at in-network costs if there is no appropriate doctor in the network. It also protects patients from being charged with surprise out-of-network bills when a network provider was unavailable.

However, Kleinman said that the process for going out of network is flawed because it is subject to an “independent review.”

“New York State Exchange officials now must work to assure that health insurers voluntarily make such out-of-network coverage available,” he said.

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Andrew Y. Kleinman, MD, Elected President of State Medical Society

WESTBURY, NY (04/14/2014)(readMedia)– Tarrytown, NY (4/14/14) – Westchester plastic surgeon Andrew Y. Kleinman, MD, was elected President of the Medical Society of the State of New York (MSSNY) at its 208th annual House of Delegates (HOD) meeting in Tarrytown, NY, on April 12. He previously served as President-Elect of MSSNY. Dr. Kleinman has a private practice in Rye Brook and is on the plastic surgical staff of Montefiore New Rochelle Hospital.

A Phi Beta Kappa graduate of the Massachusetts Institute of Technology, Dr. Kleinman earned his medical degree from the University of Rochester. He received residency training in general surgery at George Washington University Hospital in Washington, DC and at Harvard Surgical Service in Boston. Dr. Kleinman worked as a research fellow at Massachusetts General Hospital and then completed his plastic surgery residency training at Baylor College of Medicine in Houston. He subsequently gained certification from both the American Board of Plastic Surgery and the National Board of Medical examiners.

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Dr. Andrew Kleinman shares his comments in a New York Times article about “Insurance Industry Report Faults High Fees for Out-of-Network Care”

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The New York Times

Dr. Andrew Kleinman shares his comments in a New York Times article about “Insurance Industry Report Faults High Fees for Out-of-Network Care”

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Dr. Andrew Kleinman has been interviewed by the Daily News discussing insurance companies and medical procedures calculations.

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