Insurance Companies Have Cut Some Doctors From Plans, But It Can Be Appealed

NEW YORK (CBSNewYork) – Some seriously ill patients have lost their doctors due to the federal Affordable Care Act.

As CBS 2’s Dick Brennan reported, there is an appeals process, but some who’ve been through it say it looks like another bureaucratic mess.

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Insurance companies say they are cutting some doctors from their plans to save money, due to the program known by some as Obamacare.

Insurers are willing to make exceptions in certain cases. But in some instances, patients have to keep proving they are sick to keep their doctor, Brennan reported.

“What do I do at this point? Where do I go?” heart patient Anthony Lucatorto told Brennan.

The 79-year-old may need a new heart and a new doctor because of new rules under the Affordable Care Act.

“He’s open heart surgery, he’s had both carotid arteries done, he had an aneurysm. And Dr. Hess has been here all the way,” Anthony’s wife Nancy Lucatorto told Brennan.

Renowned Long Island cardiologist Dr. David Hess has been taking care of Lucatorto for 15 years, and now is a crucial time.

“His heart function is very poor,” said Dr. Hess. “I’m referring him to Mount Sinai for an advanced heart failure center and possible transplant or left ventricular assist device.”

But Oxford UnitedHealthcare told Lucatorto he had to get a new doctor because Dr. Hess was being dropped from their plan.

“I think it’s crazy. I think they’re playing with people’s lives. Would they do it or treat their parents the same way that they’re treating us?” Nancy Lucatorto said.

The Lucatortos appealed, and the insurer said Dr. Hess could remain as Anthony’s doctor. But that decision came with a catch.

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“Every three months, I have to attest to the insurance company as to how sick he is,” Dr. Hess said. “If they believe that he’s sick enough…they will continue to allow him to see me on a provisional basis.”

Hess said the new policy is a bad approach, especially for Lucatorto.

“Testing every three months as to how sick someone is is another bureaucratic impediment to the practice of medicine,” said the cardiologist.

“It’s just absolutely insane to come to people and say ‘choose a new doctor.’ The system is broken,” Nancy Lucatorto said.

CBS 2 reached out to UnitedHealthcare, but the insurer said they do not comment on specific cases for privacy reasons.

Meantime, there’s been a significant jump in enrollments for New Yorkers seeking health coverage under the Affordable Care Act.

More than 76,000 people have enrolled in the state’s health insurance exchange.

As of Sunday, more than 257,000 have completed applications.

Officials say the exchange has not had the repeated malfunctions experienced on the federal government’s website.

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