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Doctors Groups Share Concerns About Narrow Networks, Confusion With White House

The nation’s top physician groups told White House officials Tuesday they are worried about what consumers will encounter after Jan. 1, when millions are expected to gain coverage under the Affordable Care Act.

Photo by Karl Eisenhower/KHN

The groups expressed worries that patients may unknowingly be signing up for “narrow network” plans that don’t include their current physician or local hospital, said Bob Doherty, a senior vice president for the American College of Physicians.

They’re also concerned about people who switch coverage while in the middle of treatments for cancer and other serious illnesses, which may force them to change providers or prescription drugs.

He also said there were concerns about whether patients might think they have enrolled successfully in plans when they have not. “We talked about whether some people will show up and think they have coverage, but it may not be clear [that] they successfully enrolled in a plan or [that] the health plan got all their information,” Doherty said.

While the meeting was not focused on problems with, some physicians groups did note that the federal portal and other state insurance sites do not make it easy to find out which doctors are in which health plans, Doherty said.

In the hour-long meeting with White House health care advisors Chris Jennings and Jeanne Lambrew, the groups also stressed the need for a permanent change to the Medicare reimbursement formula for doctors, known as Sustainable Growth Rate, or SGR, to avert the annual threat of deep pay cuts to doctors. They also asked to extend the law’s two-year Medicaid pay raise to primary care doctors beyond 2014.

Doherty said the administration officials listened to their concerns. “This was not viewed as a PR exercise,” Doherty said.

Other groups attending the meeting included the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Osteopathic Association and the American Association of Nurse Practitioners.