What is the Affordable Care Act (ACA)?

Hey, Nick here! Welcome to our new blog. Here, you will find helpful tips that will allow you to better care for your children. I am fully committed, as your director, along with each of your doctors and nurses, to provide you the best possible care. We are on your team, and we will do whatever we can to make sure you and your children feel comfortable. Now, onto the fun stuff…

There has been much talk over the last few months regarding the Affordable Care Act (ACA), or more commonly referred to as “Obamacare”. Here, we will refer to the Act as the ACA. I am sure you have been equally confused, and sometimes frustrated, with the ACA as we have. So, education is paramount to the success of the Act. I have been spending a ton of time researching how the ACA will not only affect Riviera Pediatrics, but you, the patient, as well. Admittedly, I am honestly less concerned about how it will affect the practice, but more concerned about how it will affect you and your family. Moving forward, I will do my best to ensure you have all of the necessary information to make informed decisions. If you do your homework, you should be just fine. Of course, we are your team, so we will be by your side every step of the way.

The ACA is intended to provide those who are uninsured the ability to purchase affordable healthcare. Of course, there are a ton of other intended purposes; however, that is the basic premise. What does this really mean to you, though? Well, the year 2014 is going to be a year of change for the medical industry. As a team, we have been working very hard to prepare for all of the necessary changes, because, yes, things will be different.

I am sure you have heard about the Healthcare Insurance Marketplace, or more commonly known as the “Exchange”. The Marketplace Web site (healthcare.gov) has had all sorts of technical issues, which has made “shopping” for insurance rather difficult. The Marketplace is just that — a market for people to go shopping for insurance policies. This is no different than going to, say, the grocery store. Every state has different products on the Exchange that you can choose from. In Indiana, for example, there are two products: Anthem and MDwise. Keep in mind, these two products are separate from any other product Anthem and MDwise might provide through their typical HMO or PPO. If you are eligible to purchase through the exchange, meaning your place of work either does not provide their employees healthcare insurance, or the insurance is not affordable, you can then choose from either product that best fits your family’s needs.

As a practice, we have chosen to accept the Anthem product on the Exchange. So, should you end up utilizing the Marketplace, you would need to choose Anthem to continue seeing our physicians. However, the problem with the Anthem insurance is that IU Health hospitals, St. Vincent hospitals and St. Francis hospitals will not accept the Anthem product from the exchange. (Note: we are currently exploring the option of accepting MDwise; we will have more information on this in future blogs.) For instance, should we need to send you to a specialist at RileyHospital (which is part of IU Health), you would likely have to pay out-of-network fees, which would likely include most of the visit. CommunityHospitals (and other outlier hospitals) in the Indianapolis area is accepting the Anthem product from the exchange, and unfortunately, they do not have the amount of specialists the other hospitals have.

What do you need to do next? The biggest advice I can provide to any of our families is to check their current insurance policy. Talk to your insurance companies or your human resource representative. Ask them how the ACA is going to affect their policy. If you have insurance through your employer, the exchange may not affect you (unless your company purchases the company insurance through the exchange); however, your policy will likely be affected, if it does not meet the ACA standards. Understanding your policy has always been your responsibility, and with these new changes, that will be ever more important. We will do everything in our power to assist you through this process. Yes, things will be confusing, even for us. But, as long as we stick together, we will work through it as a team.

Of course, if you have any questions, please call me. I am here for YOU. I pride myself on being accessible to all of our patients, so if you ever have any questions, just ask for me, and I will be more than happy to help you.

Be sure to check out our new Web site at www.RivieraPediatrics.com where we will be posting all kinds of educational information to help you better care for your child. We are also working on a monthly newsletter that will provide helpful tips and news.

For the children,

 

Nicholas J. Hannah

Director of Business Operations

Riviera Pediatrics