This page contains a Flash digital edition of a book.
healthy ones, for those added servic- es. Carriers are also removing choice from health care, he says. Dr. Auer referenced a quote from


“Everybody loves the


patient part, but the business side … it’s just so crazy.”


Marcus Merz, the chief executive of Minnesota-based insurer Preferred One, who said, “We have to break peo- ple away from the choice habit that everyone has.” The New York Times published the quote May 12, 2014, in the article, “More Insured, but the Choices Are Narrowing.” “That is a scary statement from a


health insurance executive,” Dr. Auer said. The government is telling carri- ers what to cover, so carriers are go- ing to compensate for more services by raising fees and cutting consumer choice, he added. “That is just sad,” he said. “And this is not the ACA plans pur- chased through the [federal market- place] website,” he added. “The big insurers are offering such poor plans, they’re ruining their brand.” Dr. Auer told Humana he would


“absolutely not” renew the plan. With help from a broker, he purchased in- dividual coverage through Humana in December, which cost more than he was paying last year but less than the grandfathered group plan would have. But then the carrier threw Dr. Auer


another curve ball. Barely a month into the plan, Humana sent him an- other letter notifying him of a 17-per- cent increase in his individual plan. Under ACA, all individual health


plans cover a calendar year, beginning Jan. 1. So although Dr. Auer had his plan for only a month, the plan was up for renewal Jan. 1, and thus a rate increase. “I’m 30 days in, and I’m getting an-


other bump,” he said. “I don’t know what I’m going to do.” To top it off, Dr. Auer says as of


mid-January, Humana had not sent him a bill to show him exactly how


+ 60 TEXAS MEDICINE March 2015


much the carrier would charge him each month in 2015. “It’s just such chaos,” he said. “You


just can’t win.” Dr. Auer says physicians spend


enough time wrestling with patients’ carriers to get paid for services. To struggle with the same companies over your own health insurance exac- erbates physicians’ frustration, he says. “Everybody loves the patient part,


but the business side … it’s just so cra- zy,” he said.


Help without hassle Physician employers can apply for small-group coverage year-round. In- dividuals, however, are largely limited to the federal open enrollment period running from approximately Nov. 15 through Feb. 15 of each year; Dec. 15 is the deadline for coverage starting Jan. 1.


TMAIT takes the reins for mem-


bers by shopping around for small- group insurance, comparing rates, and coming up with quotes for physician employers within two working days. TMAIT small-group sales representa- tive Kerrie Rodriguez says Dr. Auer’s situation is not uncommon, and she is there to help when physician-employ- ers see a drastic rate hike. “I can’t change the rates, but I can


try to find something more affordable,” she said. Ms. Rodriguez says there’s no catch-all plan for everyone, and TMAIT helps physician practice own- ers find a plan based on their needs and priorities. Plus, after members purchase insurance through TMAIT, the trust continues to act as a liaison between the group and the carrier. “We don’t just sell them something;


we work for them after the sale,” Ms. Rodriguez said. “If they have a claim that won’t get paid, they’ll call us, and we’ll investigate the problem.”


Texas Medical Association Insurance Trust: www.tmait.org


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68