Marketplace Update

Marketplace Update

By: Nicholas J. Hannah

December 30, 2014

With 2015 quickly approaching, we turn our attention to the Marketplace, which is part of the Affordable Care Act (or commonly referred to as “Obamacare”). If you recall from past blog posts, the “Marketplace” is simply an online tool to help you shop for different plans that insurance companies offer.

For 2014, there were essentially only two insurance companies that provided plans on the Marketplace: Anthem Blue Cross & Blue Shield and MDwise. For the year 2015, six new plans will join: All Savers (UnitedHealthCare), Assurant Health, CareSource, Coordinated Care, Ambetter (Managed Health Services), Physicians Health Network, and IU Health Plans.

Not all of these companies will offer policies in every county. For example, IU Health Plans will not be offering plans in the central Indiana area. Not all physicians will also be accepting plans from all insurance companies, either.

This is where things get tricky. How on earth are you supposed to know what a doctor accepts? How do you know which insurance companies are offered in your area?

Let’s start with the insurance company, as it is far more simple. When you log into the Marketplace or seek to purchase a plan directly from the insurance company, they will only show you policies that are available in your area. So, if nothing shows up, then you cannot purchase the plan.

From a provider standpoint, every practice is different. Since we are a private practice, we are afforded the opportunity to make our own decisions on what to accept and what not to. When we make these important decisions, we take into two different factors: what is best for the practice, and more importantly, what is best for our patients. Within those two factors, we analyze a wide range of variables. In other words, we are not in the business of making quick, uneducated decisions.

With all of that said, my overall philosophy (and I know our physicians agree) is that we want to accept as many plans as possible. One might argue this is because we want more business. While I would be lying to you if I told you this was not the case, this is not the only reason. My main focus is to not lose the current patients we already have. We take great pride in the relationships we have built with each of our patients, as you put a tremendous amount of trust in our physicians, nurses, and staff. Changing doctors can be really daunting for anyone, so we try to limit such decisions on behalf of our families.

So, which networks will Riviera Pediatrics apart of? We are currently in-network with Anthem, MDwise, AllSavers, Assurant Health, and Ambetter. We have applied for CareSource, but we have yet to hear back from them. Of course, once we do, I will make sure we post the exciting news on the front of our Web site.

As always, we recommend to all of our patients when selecting a new insurance policy: do your homework! Ask the insurance company if we are part of your network. Unfortunately, sometimes it is very difficult for us to know exactly for sure, as some we are automatically included and some we have to apply. For your peace of mind, double check, that way you do not get stuck with out-of-network costs.

Remember, we are YOUR advocate! However, understanding your insurance is your responsibility. If you have questions, we are more than willing to help you. We will ultimately file claims to almost every insurance, but we cannot guarantee benefits.

Hopefully this helps you and your family move into the new year. Thank you for being such loyal patients. If there is anything I can do to help in any way, shape, or form, please contact me at 317-297-3507, option 6.


Your friend,

Nicholas J. Hannah, MSM

Director of Business Operations

Riviera Pediatrics

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