Users trying to navigate their way through the state health exchange marketplace are finding glitches. One is that some people who turn 65 in 2014 are having difficulty enrolling in coverage. The State Health Department says it's working on that issue, but something that won't be fixed is the lack of an option for out-of-network coverage for individuals. Erin Billups filed the following report.
Most individuals looking for coverage through New York State of Health will only be able to choose between different HMO plans, which do not have out-of-network coverage.
At first, Tim Laslavic says he didn't see it as a problem.
"Quite frankly, I've never had to go out of network,” Laslavic said.
The exchange's deputy director says most individual plans, pre-Obamacare, don't have out-of-network coverage, except for a handful in Western New York. They based the decision not to require it on the current industry standard.
"Any plan offered on the marketplace has gone through that review to make sure there is an adequate provider network available to them. If there is not an adequate supply of providers inside the network, you have the option to go out of network and pay your in-network cost sharing,” said Danielle Holahan, a deputy director at New York State of Health.
But while trying to figure out which plans covered his doctors, Laslavic wound up with more questions than answers.
"Many times, the doctors are as confused by the new Affordable Care Act exchange rules as I am. They will tell you yes we’re in the exchange for Empire or for EmblemHealth," Laslavic said.
But he found out that his doctors actually accepted different plans, from the same insurers. With less options, out-of-network coverage became more important.
"I think people are going to feel very betrayed very disabused when they find out their doctor isn’t in the network,” Laslavic said.
A Health Department spokesman says it's their goal to provide accurate information and says they haven't seen widespread issues of concern.
The exchange plans are still evolving, with several major hospitals accepting only a limited number of exchange plans.
"It’s the insurance companies and the providers who negotiate their networks, it’s not something that’s new with the market place,” said Holahan.
NYU Langone says it's taking a "semi-conservative" approach in participating with exchange plans.
A spokesperson for Memorial Sloan Kettering says they're hopeful they can work out more agreements with insurers they currently have contracts with, including Aetna, Blue Cross Blue Shield and Cigna.
Laslavic did eventually get coverage he's content with, but warns others to do their homework.
"People should be careful when they buy a plan that the information they're getting is accurate,” he said.