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Patients cram in tests before Obamacare starts

Some top hospitals and experts are left out of 2014 plans under the Affordable Care Act.

By Money Staff Dec 30, 2013 3:32PM

This post comes from Timothy W. Martin at partner site The Wall Street Journal.


The Wall Street Journal on MSN MoneyThousands of people are cramming in tests, elective procedures and specialist visits before year's end, seeking out top research hospitals and physician groups that will be left out of some 2014 insurance plans under the new health law, health-care providers say.


Blood pressure © Photodisc, SuperStockMany insurers offering plans under the law are slimming down their networks of doctors and hospitals in a bid to lower the cost of policies, which begin coverage Wednesday.


Health insurers are especially focused on paring academic teaching and research hospitals from their networks because they generally charge more than community hospitals for similar services.


Ben Rosenthal, a 57-year-old freelance market researcher in Los Angeles, rushed to squeeze in a lung exam the day after Christmas. His new insurance plan under the health law won't cover care at Ronald Reagan UCLA Medical Center in Los Angeles, where he was referred under his current plan.


"I was forced to get it done this year," said Mr. Rosenthal, who said waiting would have required him to get a new referral for another facility.


The Obama administration said Sunday that more than 1.1 million people signed up for private insurance plans through by Dec. 24. Combined with numbers from Washington, D.C., and 14 states that run their own exchanges -- including California, which said Dec. 23 it had more than 400,000 enrollees in private plans -- that suggests a nationwide total of roughly two million people so far.


That is short of an administration estimate made before the Oct. 1 rollout of the health-care website that more than three million people would enroll in private plans through the exchanges by year-end. Enrollments accelerated recently, with more than 1.6 million signing up from the end of November to Dec. 23.


About half of Americans are covered by insurance provided by employers, according to the nonpartisan Kaiser Family Foundation.


The success of the new policies -- and the marketplaces that sell them -- depends in large part on how consumers react to the new networks, which are often more restrictive than the range of providers available in many current plans. More plans sold on the exchanges also require patients to obtain referrals to see specialists or receive insurer authorization before costly procedures.


Mr. Rosenthal's new plan from Blue Shield of California, for example, doesn't include UCLA's flagship teaching hospital, Ronald Reagan, or any facilities with which it is associated.


The health maintenance organizations of the 1990s, which were widely credited with holding down health costs then, encountered a broad consumer backlash over their restrictions on what doctors or facilities customers could use. But insurers say they believe things will be different this time because consumers care more about price than the range of doctors and facilities they can use.


Some 70 percent of new plans under the health law offer relatively narrow networks compared with many current plans, according to a recent McKinsey & Co. report.


"For exchange plans, it's about affordability and getting to a lower price point," said Juan Davila, an executive vice president at Blue Shield of California, which dropped about 40 percent of its physicians who didn't agree to lower rates for the new plans.


Many hospitals are part of broader health systems containing other hospitals, stand-alone clinics and physician groups. The exclusion of a single teaching hospital doesn't always mean that a health plan blocks visits to associated facilities or physicians. But health systems typically negotiate systemwide contracts with insurers.


The recognition by some consumers that their new plans won't always cover the facilities or doctors they want is triggering the boomlet in last-minute procedures, say health-care providers.


UT Southwestern Medical Center in Dallas has seen requests for complicated imaging tests and colonoscopies rise in recent weeks, said Bruce Meyer, an executive vice president. Barnes-Jewish Hospital in St. Louis has seen "dozens" of patients push up elective orthopedic surgeries, a spokeswoman said. Cedars-Sinai Health System, a top teaching hospital excluded from most exchange plans in the Los Angeles market, said it has fielded thousands of calls from people concerned about losing access and wanting to schedule elective procedures before Dec. 31.


"We have seen a big spike in December," said Thomas M. Priselac, chief executive of Cedars-Sinai Health System.


Some specialist groups also are seeing higher-than-normal volume this month. Illinois Gastroenterology Group, a team of 40 physicians, has seen "hundreds" of accelerated requests for colonoscopies in December due to concerns over access and higher deductibles in 2014, said Lawrence Kosinski, a managing partner.


Not all leading research hospitals say they have noticed a jump in patients moving up procedures to this year. Others, like University of Chicago Medical Center or UAB Hospital in Birmingham, Ala., aren't able to distinguish yet the reasons why certain patients have opted for an elective surgery. In addition, demand for some elective procedures normally rises late in the year in part because more patients have satisfied plan deductibles by then.


People can buy plans on the exchanges that offer coverage at a vast network of hospitals. But they cost significantly more, according to the McKinsey report, which analyzed markets where one insurer sold both broad and limited plans. The more-comprehensive coverage carried a median price increase of 26 percent compared with the slimmed-down alternatives.


"Not everyone can get a 50-inch flat screen. You might have to get a 32-inch. There will be segments of the population who can't afford to buy coverage to go to [every hospital]," said Paul Mango, a McKinsey director.


Still, consumers buying limited health insurance on the exchanges may not realize how restricted their access is, said Joanne Conroy, chief health care officer of the Association of American Medical Colleges, a nonprofit representing nearly 400 teaching hospitals and health systems. "We have a lot of people who aren't sick yet, don't need any procedures and will have a rude awakening when they realize they don't have access to the providers they want," Ms. Conroy said.


Daniel M. Adair, an orthopedic surgeon in Springfield, Ill., said one of his patients late last month moved up reconstructive knee surgery, even though the knee was in relatively good condition, on the chance it may encounter trouble in 2014.


The patient "told me, 'I don't know what's going to happen starting Jan. 1, so I might as well do this now,' " Dr. Adair said.


More from The Wall Street Journal:

Dec 30, 2013 4:17PM

But I thought Obamacare was THE best possible health care plan a person could get?????? Wasn't it supposed to save the health care industry and provide people with the most affordable health care possible?????

(that's sarcasm for anyone not getting it)

Dec 30, 2013 4:30PM
Wow....Over 1 mil people have signed up for Obamacare....That is less than one half of one percent of the population....
Dec 30, 2013 4:53PM

no surprise, obummercare is a disaster for Americans

Dec 30, 2013 4:40PM
I still believe less than I million will make the first payment by Jan 10th....
Dec 30, 2013 4:46PM
So basically the U.S. will be using doctors from other countries for the cheap plans.  So Dr. Ashrab, what is causing my problems.  Answer:  "I no speak English".  Thanks Nobama.  Now Wal-Mart will be practicing medicine. 
Dec 30, 2013 5:12PM

Thank God our company is self insured. we are exempt from Odumacare. my cost went from $19.85 to $21.00 per week with co pays and $1500.00 deductable intact. Why are they making hard working people suffer because a few want get off their lazy ASSES!!! Now everyone sees how the lie of keep your insurance and your doctor suckered in the DUMB MASSES!!!!!!!!!!!!!!  How's that working out for you!

Dec 30, 2013 5:32PM
the heck you say!! I cant believe our honerable president would push a law that removes services that the people wanted all to keep his law going..      (this is whre I break down laughing)  my god did anyone really read the law, ( more laughter)   but dont worry you can keep your plan and doctors persion ( chuckle more)   now seriously folks  who voted for this A-hole?  I know I know  the stupid, foolish, deramers and lazy ones thinking this would all be free and great no matter what it did to the country and those paying for it... 
Dec 30, 2013 5:18PM

This is very humorous!! Wait until those ObamaCare people go to the Dr or the hospital and find out that their insurance won't cover them because the infastructure of ObamaCare isn't hooked into the system, yet!!  They will scream and yell and jump up and down  but freakin get no where!! And wait until they realize that the HMO they purchased has a $12,000 deductable and they will have to go through a year of serious illness to cover their deductable!! They will scream and yell, etc, etc!! I am glad I didn't fall into that trap and switched my policy to Aetna, which was about $600 per month cheaper and the PPO I have means I can go to the Drs that I want to and the Hospitals I want to .......

What a joke!

Dec 30, 2013 5:37PM
This is a disgrace! The idea of the ACA is good. It has morphed into a nightmare beyond comprehension. My employer plan is perfect. I had $80,000 worth of heart work done. It cost me less than $1000 out of pocket. I pay $150 a month for this plan. Under ACA I would have to file BK.How is that helping the American people. This was supposed to be modeled after the plan in Mass. Did the insurance industry write this bill? They make all the money and cover little!!! WTF..
Dec 30, 2013 5:30PM

Obamacare? Aka, The National Affordable Health Care Law. Well, I really don't know where to start. After being denied insurance, inappropriately, I have attempted to simply find someone to talk to at my states health care offices, but nothing. I am cut off after waiting 30-minutes to speak to someone that might help. So, I've tried waiting in queue at the live-chat on-line. Again, repeatedly I am cut off just as I am about to have my turn to speak.

But, I'm trying to make something positive out of this. Let me call it "my hobby."

Some people collect stamps and coins. Me? I try to get assistance with Obamacare.

Dec 30, 2013 4:45PM
How about if you cannot afford healthcare you don't get to go to the hospital.  I bet prices would drop then.
Dec 30, 2013 5:30PM
Welcome to the new age of healthcare - Give insurance to the few (1.5 million approximate) which 50 million lost theirs. Pushing everyone into less equipped facilities that don't have the newest cutting edge technology. These better facilities will be for teh elist in our country like Odama and democrats.
Dec 30, 2013 5:45PM




Dec 30, 2013 5:53PM
New exciting reports show a whopping 1/3 of 1% of American's have signed up for Obamacare.  Thank goodness we have Obama to save us all.
Dec 30, 2013 6:51PM
OK! How many people out of the one million people that signed up for Obamacare are illegals with stolen identities?????????
Dec 30, 2013 6:51PM

I went to the web site and was told to apply for Medicaid. I applied to our states department of human services for Medicaid and was told I didn't qualify.

Then in sundays paper was a partial explanation, a breakdown in communicating/understanding the rules between the state and federal levels.

Now I am part of 16,000 people who are denied coverage by obamacare and denied Medicaid coverage in my state. Also seems that my state isn't the only one facing such a snafu.

Just gotta love Obama pushing through 2500 pages of crap in less than a year without thinking about consequences.

Dec 30, 2013 6:28PM
""Not everyone can get a 50-inch flat screen. You might have to get a 32-inch. There will be segments of the population who can't afford to buy coverage to go to [every hospital]," said Paul Mango, a McKinsey director."

...good try comparing to flat-screen televisions. Something tells me the average person could purchase a small movie theater with what the Unaffordable Healthcare Act will cost them!
Dec 30, 2013 5:42PM
After applying they quoted me 600.oo to 900.00  a month. I have not worked in over 5 years and almost finished living off my 401k. Useless to me.
Dec 30, 2013 6:32PM
2 million signed up and 5 million lost coverage with cancelled plans? That sounds like a net loss of 3 million consumers more who don;t have coverage than did before this joke was passed into law? Anybody else do the math? remeber the admin quotes total numbers of people when they want it sound like millions will need coverage and then they quote a percentage to minimize whos' going to be left out - funny thing is if you do the math the actual number of people is the same between the the new coverage and the new ones who lost coverage - basically this is a net of zero that costs the taxpayers miliions and millions of $$ - but that shouldn;t suprise anyone who knows that this entire admin is a net Zero - waste of air being breathed by anyone in the admin -
Dec 30, 2013 7:14PM
One need only look the UK's government health care system to see where we are headed.  The system is overburdened and hemorrhaging.  The "rich" pay additional to see the good doctors and all others in this European Socialist Utopia get to wait in line to see the less qualified doctors. 
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