Health Insurance - Individual Plans Through MVP

I just received a phone call on Thursday from my GI doctor’s office stating that my appointment with them & my primary doctor was being cancelled because they did not accept my insurance.  At the end of the year (2013) my husband and I looked through our options for our medical coverage.  We were given the ON exchange & OFF exchange options with a few different companies.

Since we own a business and are a sole proprietorship we go through our local chamber of commerce to purchase individual insurance.  Otherwise we are looking at almost $3000 a month. 

We choose to go with the OFF exchange in order to keep it managed through the Chamber and not by the state (The Marketplace).

As we sat and did our research since our current insurance (CDPHP) was no longer participating with the Chamber, I looked into each company to ensure my providers were in the plan. 

We ended up taking MVP as our carrier.  Each one of my doctors were listed in their doctor search.  So why was I getting this call telling me otherwise!?!  Great question!

I called my doctor’s office back to inquire.  Still unsure and slightly confused I called & spoke to our representative at the Chamber (awesome help from both places). 

To my surprise doctors stopped accepting MVP insurance if you purchased INDIVIDUAL insurance plans.  This is for ON exchange & OFF exchange.  A little misleading?  I would say so.  I would never have signed up for a plan knowing my doctors did not accept it if there was another plan that was comparable in cost (which there was). 

We have to purchase the individual plan because we are a sole proprietorship with only 1 employee on the books. 

Doesn’t this mean that in the state of New York being that everyone must have health insurance, if you go through the exchange that you have an individual plan?  My understanding is YES….so this means for all of those individuals that signed up with MVP their doctor most likely is not accepting the insurance they are paying for.  Even though we went through the Chamber, we still pay a high price for coverage.  I wonder how long it will be before my next doctor/hospital no longer accepts the MVP coverage we have as INDIVIDUAL OFF EXCHANGE!!!

Come on New York… How is this supposed to help us? 

And, what difference does it make if it is individual or group insurance?  Why isn’t there a law in place to help those of us that did purchase individual plans to protect us from this happening!?! It really should be illegal!  And, MVP should be held accountable.

I found this article -  This article explains just why doctors/hospitals are dropping the INDIVIDUAL plans purchased. 

Even though I pay a high premium I am losing my choice of doctors due to greed on MVP’s part.  An excerpt from the article presented with a take-it-or-leave-it reimbursement plan by MVP some months ago for patients covered by insurance through the exchange.  The hospital rejected the reimbursement agreement because the health care reimbursements are significantly lower than those of other insurance providers, even lower than what MVP reimburses for group coverage and Medicaid.”  

At the time we purchased our insurance it was not upfront that our doctors would be dropping MVP individual plans.  MVP was not upfront with anyone & therefore has created a horrible situation for many people those that went through the exchange and the off exchange!!
This is a ton of information and I am still trying to understand it all myself, but I hope someone out there can help us understand more!



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