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Practice Management BY KARA NUZBACK


Grappling with small-business insurance


HOW ACA IS IMPACTING OFFICE HEALTH PLANS AND HOW TO GET HELP


T


he cost of offering health insurance to employees of a private practice is a big ticket item for physicians. Houston family physician David E. Auer, MD, says he was aghast when, in November, the premium for his


office health plan with Humana jumped 80 percent. “I almost fell off my chair. It was so absurd,” he said. Physicians like Dr. Auer, who acts as his own office manager, are responsible


for deciding whether to offer his employees health insurance and, if so, what insurance plan fits the office’s needs and budget. While the Affordable Care Act (ACA) made some insurance plans more affordable, it forced physicians like Dr. Auer to dig even deeper into their pockets. The Texas Medical Association Insurance Trust (TMAIT) assists members


in navigating insurance purchases, including helping private practice physicians offer suitable health plans to their employees. Dr. Auer says the renewal notice for his solo practice, which covered one full-


time employee, himself, and his two healthy daughters, showed the premium for him and his family jumped 80 percent — to $2,500 per month — a total of $30,000 a year, “with no services,” he added. He says the plan carried a $1,500 deductible. It was the largest increase Dr. Auer had seen in 20 years running his own


office. No one on the plan suffered any major illness in the previous year, so he called the company to ask why the rate had gone up so exponentially. He says neither he nor his insurance agent could get the carrier to explain


the reason for the rate increase; it would only say the increase was attributable to ACA. “I didn’t get any additional benefits due to the ACA,” he said. Dr. Auer says


he thinks that because the Humana plan was grandfathered — he purchased it before March 23, 2010 — the carrier raised his rates to incentivize him to give up the plan. “They want you out of that, so they price them so you quit,” he said. “And you


don’t have any recourse.” Under ACA, carriers must cover certain essential health benefits, including


emergency services, hospitalization and surgery, maternity and newborn care, mental health and substance use services, prescription drugs, lab services, and preventive and wellness services. Dr. Auer says the ACA coverage mandates mean more coverage for some patients, but insurance companies are charging more to all clients, including


March 2015 TEXAS MEDICINE 59


“We don’t just sell them something; we work for them


after the sale.”


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