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Expect to be paid 40 percent less under ACA, psychologist says

New Hampshire Union Leader

November 18. 2013 8:23PM

Doctors and other health care providers who have joined the Obamacare exchange health care network will receive payments about 40 percent below the current payment schedule they have with Anthem Blue Cross, a New Hampshire psychologist said last week.

The exchange payments resemble those of Medicare, the government-run health insurance for the elderly and disabled, said Evan Greenwald, director of The Counseling Center of Nashua.

For weeks, several New Hampshire hospitals have complained that they were shut out of the Pathway network. Likewise, some providers are excluded from Pathway, the only health care program currently offered through the Obamacare exchange in New Hampshire.

Anthem has said Pathway premiums are about 25 percent lower than premiums in its current individual care plans. But no one has mentioned the difference in provider payments, in part because Anthem and other insurance companies make providers sign non-disclosure agreements when they negotiate prices.

Anthem spokesman Chris Dugan did not deny or confirm whether providers are taking a rate cut of 40 percent. But he said Anthem customers would face a 30 to 40 percent increase in premiums without the Pathway network. That's because of the costs associated with the previously uninsured and high-risk pool patients who will be signing up for coverage on the exchange marketplace.

"Without the use of the new network, all individual Exchange members would have seen much higher premiums than they will now see," Dugan said in an email.

Greenwald, whose practice is not part of Pathway, mentioned the 40-percent cut in a lengthy package he emailed to the New Hampshire Union Leader. His practice does not accept Medicare or Medicaid. He said a psychologist receives about $80 from Medicare for a 45-minute to hour-long session.

"It is financially not viable, not possible, to stay in business on Medicare reimbursement rates," Greenwald said. He said a solo practitioner may do so with answering machines and limited hours, but a modern practice with administrative staff cannot do so.

However, the New Hampshire Medical Society endorses the Pathway model, as well as Medicaid expansion, said Scott Colby, executive vice president of the Medical Society. He said Medicaid rates are lower than Medicare rates.

"The reality is when we look at the exchange product, we're looking at a population that is likely uninsured or underinsured," he said. So while the rates are low, physicians reason that it will be better to receive some payment as opposed to none, he said.

The Medical Society is concerned that Pathway will force patients who sign up to drop out if their doctor is not part of the network, he said.

Colby said there are enough primary care providers in New Hampshire to handle a population of 2.1 million to 2.5 million people, a number substantially higher than the state's 1.3 million population.

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