Out-of-network not an option in individual ObamaCare plans
Individuals shopping for health insurance in the ObamaCare marketplace are in for sticker shock: They’ll have to pay 100 percent of the bill if they dare use a doctor not included in their plan’s network, The Post has learned.
None of the medical plans listed in the New York Health Exchange for individuals offers “Out of Network” coverage — unlike many conventional insurance policies.
A Manhattan businessman who signed up at healthbenefitexchange.ny.gov said he was stunned to learn that not one insurer offered out-of-network coverage — even in the top-tier Platinum plans that run more than $600 a month.
“This is absolutely terrible,” said the small-business owner, who requested anonymity out of fear of retribution. “This is an absolute fraud. Basically if you want to go out of network, you pay through the nose. You’re screwed.”
New York officials and insurance companies confirmed they’re not providing out-of-network coverage. And they acknowledged that if patients use a doctor or facility outside the plan’s network of health-care providers, they’re on the hook for the entire tab.
They defended the decision as making affordability — not choice — the priority.
“We do not offer out-of-network coverage for individual plans on the New York marketplace or for individual plans of exchange,” said United HealthCare spokeswoman Maria Gordon Shydlo.
“We offer a broad network of providers for members to choose from and if they decide to go out of network, they would pay the billed charges,” she added.
Empire Blue Cross will honor out-of-network coverage for existing policy holders who have it, but only through 2015. Newcomers signing up on the exchange are out of luck, except for emergency cases, an Empire spokeswoman said.
“As we’ve seen in New York, the cost of out-of-network care can be extremely high. Interestingly, our company surveyed 55,000 people on a number of issues related to our plan offerings and found that price without exception was the priority,” said Empire’s Sally Kweskin.
Healthfirst defended its decision to bar out-of-network coverage because the nonprofit insurer is sponsored by 19 hospitals in the city and on Long Island.
“We felt our network was strong enough to offer adequate options,” said Healthfirst spokesman Harris Brandt.
Several insurers do offer out-of-network coverage in the new small-group market.