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Struggle to understand healthcare coverage could mean delays at the doctor

Although more than two million people now have healthcare coverage through a state or federal exchange, getting covered doesn’t always come with a good comprehension of what you’ve actually received.

“Because it was a very rough and rocky enrollment period, the majority of people still don’t know what they have,” says Florida Medical Association President Dr. Alan Harmon.

Harmon practices medicine in Jacksonville, and he tells me there is a lot of frustration at his office when they have to turn people away because their coverage doesn’t cover what they thought.

“Not only which doctors are covered, but which hospitals are covered and what their out of pocket expenses will be,” he says.

Harmon describes this “getting to know your coverage” process as difficult as best.  A lot of people he’s spoken with say enrolling without the assistance of a Navigator is too complicated, and even with that help it can sometimes take more than two hours to go through the process.

Access seems to be the key hang-up for Harmon right now. He says once you can find all your appropriate care providers, you will get quality healthcare.

But that’s not to say doctors and healthcare providers haven’t been dealing with their fair share of questions and problems as well.

Part of the new law includes a requirement to update to electronic records.  He also has concerns about the narrowed network options given for healthcare enrollees and a 90-day grace period he doesn’t believe was sanctioned in the law itself. This grace period basically allows you to receive coverage for up to 90 days if you miss a premium, but Harmon says the insurer is only required to pay for 30 days. He says that could leave care providers on the hook for those intermediate 60 days.

“A lot of improvements need to be made or the plan may not survive,” he says.

While overall, he’s happy to see the administration has been willing to make changes and delays as needed- as in extending the mandate on small businesses to provide coverage- he says there are many problems that continue to linger.

All the confusion can also trickle to consumers who have not made a switch under the marketplace. He says the new constraints on care providers in addition to the extra time they need to give to people who are sorting out their plans can cause delays on your next visit to the doctor’s office.

If you have any questions, Harmon says the best resource is your insurance provider.

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