Due to changes in healthcare reform and the Affordable Care Act we have had some questions asked of us regarding our participation with these particular plans.
Some quick background, Alliance Pediatrics participates with a Group Physician Association (GPA) that assist in credentialing our providers so they are able to accept patients with various insurance carriers as well as they assist small practices with contracting.
Our current Group Physician Association (GPA) does not participate in individual marketplace health plans through the Affordable Care Act. This has been a very tough transition for our patient’s families as well as our staff. We have found that we are receiving conflicting information from the insurance companies about the health plans as to if we are in network with a patients specific plan or not, then from when you call customer service line.
Please note, when we call to verify your benefits we call the “Provider Services Line,” we are not able to call the customer service line phone number that you call. We have found that we have to call more than once to have the insurance carrier provide us with correct benefits. The insurance carriers are also going through a transition period and we know how frustrating this transition has been and we strive to make the transition with as much ease as possible.
Our website currently states the Insurance Carriers that we participate in, however there are hundreds of plans under each carrier available and we are unable to list them all. If you have an ID number already we can call to verify whether or not we are a participating provider. We are not a participating provider for individual marketplace Affordable Care Act plans.
We do not want to see any of our patients leave our practice because we are not in network with these plans. In making your health insurance choices please verify that your family’s physicians participate with the plan you select so that no unforeseen issues arise. We are learning more everyday about what the new plans are and how they work. Each insurance company has structured the naming and type of plans offered very differently which is why we feel there is still so many questions you may ask that we do not have answers to.
For further information on healthcare reform and the Affordable Care Act, please visit:
http://www.hhs.gov/healthcare/facts/timeline/
https://www.healthcare.gov/marketplace/b/welcome/