ACA provider list: What's in store for Cowetans?

by Wes Mayer

In response to questions about Coweta-area doctors and physicians and the plans they accept under the Affordable Care Act, The Newnan Times-Herald has researched the health care plans and number of doctors available to Coweta County residents.

Those seeking to apply for medical coverage under the Affordable Care Act can apply online at HealthCare.gov. There, visitors will find three main options on the home page - 'apply now for health coverage,' 'see plans before I apply' and 'using your new coverage.' To help out the application process, HealthCare.gov also has numerous links to pages of tips and checklists.

One important tip listed on these pages is for applicants to research the plans' 'provider directories.' Here, they may make sure their preferred doctors will accept a new plan under the Affordable Care Act before they apply.

These provider directories are found under the 'see plans before I apply' option. Follow the link to find two options, personal/family or small business coverage. Users may click on their option and then choose either health or dental coverage. Users then have the option to put in their location and age, and may click the next link - 'No thanks, just show me my plans in my are' - to see their options.

According to HealthCare. gov, a 35-year-old person applying for personal health coverage in Coweta County has 26 different health plans on the marketplace from which to choose. These plans are divided among three providers: Kaiser Permanente, Humana, and Blue Cross Blue Shield.

Each plan's name contains either the word 'bronze, silver, gold or platinum,' depending on the total average cost of care they cover, according to HealthCare.gov - information on the page explains what this means. A catastrophic option is also available to some, but not a 35-year-old.

In addition, each plan falls under a certain category all available Kaiser and Blue Cross Blue Shield plans use Health Maintenance Organization (HMO) plans, and the available Humana plans all use the National Point-of-Service (POS) plans.

According to HealthCare. gov's glossary, an HMO is, 'A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.'

A POS is 'a type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.'

According to Humana's website, a POS basically combines an HMO with a Preferred Provider Organization (PPO) plan - 'A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network. You can use doctors, hospitals, and providers outside of the network for an additional cost,' according to HealthCare.gov's glossary.

In other words, a POS will pay more for in-network doctors but consumers may also go out of network for an additional cost, while an HMO is more limited to in-network doctors.

Users can view each of the plan's details on HealthCare. gov by clicking the 'details' link.

These links lead to the individual providers' doctor search websites. Here, users may type in their location to find nearby doctors and see who accepts their chosen plan, or they may search for a particular doctor to find which plans they will accept.

According to Kaiser Permanente's doctor search, there are 151 doctors who accept Kaiser plans within 10 miles of zip code 30265. Of these, only 23 accept HMO plans, according the Kaiser Permanente's website. The majority of doctors, 132, say they accept Multi-Choice or POS plans.

According to the website for the Piedmont Physicians Group at Newnan Professional Center, the Kaiser HMO plan is one of the listed accepted plans. It is just limited to a smaller network of physicians. According to Piedmont Healthcare assistance operators, all of Piedmont Healthcare accepts the Kaiser HMO plan.

According to Humana's doctor search, there are 131 doctors in Coweta County who are part of Humana's National POS - OpenAccess network. Almost all the doctors listed say HMO in their details, but because the HealthCare.gov Humana POS plans function like PPOs, all 131 of these doctors are available.

Using Blue Cross Blue Shield's doctor search which isn't as straightforward - even though the plans say HMO on HealthCare.gov, you search 'Pathway X / IND via Exchange' instead of 'HMO' to find the Affordable Care Act plans' options - there are 64 doctors within 20 miles of zip code 30265 who accept the Bronze DirectAccess plan.

HealthCare.gov suggests checking the plan's provider directory, and call doctor's offices to see if they accept the chosen plan.

Local assistance can be found by calling the University of Georgia Coweta County Extension at the Coweta County Fairgrounds at 706-424-6123. Other numbers can be found by clicking on 'Find Local Help' at HealthCare.gov.

According to the Associated Press, the number of people enrolled in the Affordable Care Act topped 1 million by the end of December. According to the AP, President Obama's administration originally planned to have 3.3 million sign up by the end of 2013 - their next goal is to have 7 million enroll by March 31.



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