East Texans at odds with health insurance and limited providers in network

East Texans at odds with health insurance and limited providers in network

EAST TEXAS (KTRE) - Confusion and frustration are the emotions felt by thousands of East Texans signing up for health insurance during this year's open enrollment. 
 A huge number of independent East Texas physicians have opted out of accepting certain health insurance plans offered by the marketplace.  From patients to providers, the change has caused headaches for all parties involved.

After punching the clock faithfully for twenty years, Daniel Meyers, of Lufkin, is caught in the crunch with thousands of East Texans who reached a standstill when deciding on picking healthcare insurance offered by the Health Insurance Marketplace or Obama-care.

"I had to leave work due to my health," said Daniel Meyers, an Angelina County resident.  "A couple months ago I found out that Blue Cross wasn't going to offer PPO plans. They had HMO's only."

"All the insurance companies in January 2014 pulled out of all the small counties," said John Wynn of Wynn Insurance.

Self-employed or a low income resident, it affects you.

"It's very stressful. I've had a couple nervous breakdowns," Myers said.

"For someone who's been doing it, it's still hard to understand, and the fine print is very fine," said Eddy Furniss M.D. of Furniss Family Medicine.

The downfall for Meyers, and many East Texans, began after healthcare insurance company, Blue Cross Blue Shield, switched from preferred providers to health maintenance organizations or from PPOs to HMOs. It left behind a trail of puzzled patients and flustered physicians.

Healthcare experts tie the 'big switch' to the Affordable Care Act's requirement that healthcare insurance providers cover pre-existing conditions.

"Medical providers have had to learn more about the business of medicine and insurance than we ever wanted to," Furniss said.

The change will cause Meyers to leave his long-time physician.

"I've been going to him for eight years now, and I don't want to change. I realize that there is a very distinct possibility that I have to,"Myers said.

"Having to restart a relationship over and over again fragments care in a way that we've been trying to solve for years," Furniss said.

An East Texas independent physicians association known as POET (Physicians of East Texas) is one essential group with many physicians who won't accept the HMO plans.

However, the members of independent physicians associations do make personal decisions on what insurance plans they will accept.

Speaking of physicians in general, Furniss said, "When we feel like a network is not doing a good job and denying care, we will opt out of those networks."

Patients with HMO plans seeing POET physicians have little choice but to pay out of pocket or schedule their appointments elsewhere.

"It's kind of like your job telling you, you have to divorce your husband or family and go see someone else," Myers said.

It's a big issue in Angelina County as East Texans of all counties come here for medical care. That could soon change, as only three primary care providers in Angelina County will accept the HMO plan.

Under the HMO plan, patients must first see a primary care provider who would then refer them to specialists. These physicians must all be a part of the network. Under the PPO plan, a patient was allowed to go directly to the specialist of his/her desire.

"There are very few doctors in the networks,"Wynn said.

"Insurances more and more are shifting costs onto patients and providers making it very difficult for patients to find care and for providers to give care," Furniss said.

"This is devastating to patients, to the health insurance industry, and it's affected everybody. This is the law that was placed on the books," Wynn said.

Patients are filled with fear.

"Is it going to have a detrimental effect on me and my family?" Myers asked himself.

Physicians feel uncertainty.

"For even the most seasoned economist in medical economics, the future of our healthcare system is very cloudy," Furniss said.

As patients, physicians, and insurance representatives strive to find a solution fit for each situation, they have one hope for health.

"We're going to have to understand that through faith, at the end, this will all work out," Wynn said.

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