You Can Keep Your Doctor - If Your Employer and the Union Say So

The Sun Sentinel’s “School employees protest possible insurance switch” reports that 150 of Palm Beach County (FL) School District’s 21,000 employees have grave concerns with the pending switch from UnitedHealthcare (UNH) to BlueCross BlueShield of Florida as the administrator for their self-insured plan, Superintendent Art Johnson, said the agreement with the union will save employees approximately $30 per year.

School districts in Florida are countywide, so they represent big business in the context of the state. The district pays 100% of the “premiums” for employees and 60% for an additional 14,000 receiving dependent coverage.

The interesting part of the story is that the plan administrator rather than the self-insured employer chooses the doctors and hospitals in the network. UnitedHealthcare has 950 primary care physicians in Palm Beach County while BlueCross only has between 400 and 500. BlueCross says it has already convinced 22 of the 87 most used providers to join its network. But that’s not good enough for employees that have developed trust in their doctors.

The newspaper gave an example of an employee with a difficult to diagnose condition who is fearful of starting over with a new doctor. The importance of the article is that patients have very little security in maintaining their doctor relationships, regardless of the outcome of healthcare reform.

No politician, left or right, can guarantee that you can keep your doctor or your health plan. This is true even if you don’t change jobs. So let’s evolve beyond the dreamland of Ozzie and Harriet and Father Knows Best.

School board member Monroe Benaim (an eye doctor) was even rejected from joining the BlueCross network. Unsympathetically, he advised employees to go out of network to stay with their preferred doctors. Such irresponsible advice opens employees to the risk of balance billing.

The board has a final vote on the issue scheduled in two weeks.

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Comments

[VennData:]

OMG... what did you do before you met "your doctor?" Oh, Oh, it must have been horrible. There you were with "other people's doctors..." oh the horror...

It's a commodity. Get over it.

Aug 18 07:14 AM

[MKW:]

This is fundamental to how insurance works. Those doctors who are willing to abide by insurer X's schedule of fees are in network. Those who aren't are out of network. It's been that way for decades - it's how it works. The best advice is to find a doctor with a practice affiliated with a local hospital. You'll have the best chance of that doctor taking basically all insurance. I've had my doctor for eight years and five changes in insurance. It's never been a problem.

Aug 18 07:31 AM

[YoYoMama:]

I am wondering what was newsworthy about this article.... Not exactly shocking that groups change plans, and the plans are different!!

Aug 18 10:04 AM

[Crocodilian:]

The most common impediment to "keeping your doctor" is neither your union nor your employer: its your insurance company/HMO.

Neither your union nor your employer care which doctor you see: it is you health insurer who manages "the plan" and decides which doctors, PPOs et cetera will be included, and which will not.

Aug 18 02:24 PM