Some Finding Coverage Problems Under New Health Exchange

By: Nancy Amons (GP)
By: Nancy Amons (GP)

FRANKLIN, Ten. (WSMV/CNN) -- It's been less a month since the Affordable Care Act started providing health coverage for people who bought insurance through the exchange, and now some people who are going to the doctor for the first time are finding some complications.

"We have health insurance that is worthless," said customer Shawnna Simpson.

Simpson found out last week the new insurance for which she is paying $600 a month was a bad choice for her family.

Her 15-year-old daughter was hurt in a cheerleading accident, so Simpson called her family doctor only to learn they don't take her new health plan: Blue Cross Network E.

Ever since, she's been on the phone with the healthcare exchange, looking for a family doctor in Williamson County that accepts her plan, but finding none.

"We can't use it in the county where we live," she said.

The problem is Blue Cross Network E is a micro-network - a very small network with limited doctors and hospitals. Vanderbilt University Medical Center isn't in it, for example, and neither is TriStar Medical Center.

Simpson's problem is not isolated, as many people who are just now using their insurance are finding out.

Last year, Channel 4 News interviewed David Pearce, who was excited about enrolling in the healthcare exchange. Then, he showed up for his doctor's appointment last week.

"Handed them my card, and the girl had this deer in the headlights look and said, 'I'll be right back,'" Pierce said.

It turns out his doctor in Murfreesboro doesn't accept Blue Cross Network E either.

Simpson says the new healthcare law is not working for her family and she says other families may be in the same situation.

"Obamacare is not working. A lot of people that have the same issues we have and don't know it yet, until they try to use it," she said.

If you have enrolled in a plan and then discover you made a mistake, you can either wait and change your plan during the next enrollment period in November or cancel your insurance and re-enroll effective March 1.

The downside of the canceling is your family won't be covered at all for a month.

A representative for BlueCros BlueShield of Tennessee released the following statement:

"BlueCross BlueShield of Tennessee offers a wide range of plans on and off the Marketplace to meet a variety of health care and financial needs. Our extensive research showed that those shopping for individual coverage on the Health Insurance Marketplace put a high priority on plan price. In response, BlueCross created the high-value Network E for some of its Marketplace products.

"BlueCross has partnered with a primary health care system and its affiliated providers in each of Tennessee's major markets - - Chattanooga, Knoxville, Nashville and Memphis. Through these partnerships, Network E hospitals and doctors offer specially negotiated rates for services. This allows BlueCross to pass on savings to members who commit to using a particular hospital system and providers in their area. Members pay a lower copay amount using Network E providers.

"It's important to confirm your doctor or hospital is in your network before receiving care, otherwise you will pay more. You can use the Find a Doctor tool on our website or the myBlueTN mobile app. You can also call member services at 1-800-565-9140. Our website is designed to help members and Marketplace shoppers understand the process of choosing a plan and using network providers to reduce costs."


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