In the last two years, pulmonary specialist Dr. Eduardo G. Martinez has become accustomed to the sight in his Hialeah office: newly insured patients flashing laminated healthcare insurance cards to show they are now covered under the Affordable Care Act.
鈥淢ost people hand you that card like they are giving you an American Express Platinum without a limit,鈥� said Martinez, vice president of the Dade County Medical Association, the largest physician group in the South Florida county.
Dr. Bernd Wollschlaeger speaks to a patient at his North Miami Beach practice in 2007. Wollschlaeger, a family medicine doctor, has had to educate consumers who know little about their Affordable Care Act coverage plans while also juggling a higher patient load, more paperwork and issues with reimbursement since the passage of the act. (Photo by Peter Andrew Bosch/Miami Herald)
But for many physicians, the so-called Obamacare cards also mean new challenges 鈥� consumer misinformation, increased paperwork, heavier patients loads and the worry of unreliable reimbursements and payments.
鈥淲e have turned people away,鈥� Martinez said. 鈥� I know some colleagues who said, 鈥楢t this time we are not taking any Obamacare patients.鈥� It鈥檚 a preventative action to avoid having these problems.鈥�
The ACA does not penalize doctors for refusing to take Obamacare patients, but those who do may be in violation of their their contractual agreements with insurance companies.
The stresses for providers then become evident from the moment new patients come in.
Some don鈥檛 know the name of their insurance companies. Many are surprised by high deductibles. Doctors are placed in the sometimes-difficult position of teaching patients that insurance doesn鈥檛 mean everything is covered.
鈥淭he level of health care literacy is difficult to deal with because it鈥檚 often very low,鈥� said North Miami Beach family physician Dr. Bernd Wollschlaeger. 鈥淎m I now the explainer-in-chief, after the fact?鈥�
Most new enrollees pick a plan based on sticker price 鈥� the monthly premium 鈥� ignoring other costs such as the deductible, the amount patients must pay before the insurer begins to cover costs, or co-pays, payments by the patient for covered services like doctor鈥檚 visits.
According to , a health insurance analysis company, the average 2015 deductible for a bronze plan, which is the lowest cost and least coverage plan, is about $5,000 The silver-level plans, which offer more coverage at a slightly higher price and are the most popular among consumers, have deductibles at about $2,650.
Until the deductible is paid, services doctors provide outside the ACA鈥檚 free preventative care screenings go unpaid, a situation that can become volatile when a screening reveals a chronic condition that requires deductible payments before treatment begins.
鈥淭hey look at you like if you鈥檙e crazy and say, 鈥楴o, but I have insurance,鈥欌�� Martinez said. 鈥淲e become the target of their frustrations. We are the doctors. We are the bad people. They have the card and [they think] we don鈥檛 want to see them.鈥�
Wollschlaeger said explaining deductible costs has led to 鈥渂ad blood鈥� between him and several of his patients, with some even leaving his practice.
鈥淚 have to explain that it鈥檚 not me, it鈥檚 the insurance plan they chose,鈥� he said.
Communicating with insurance companies and ensuring payment for services is often difficult, too.
Under the ACA, patients who stop paying their monthly premiums have a 90-day 鈥済race period鈥� to start paying their bills. After the first 30 days, these patients go into a 鈥減ending鈥� status with their insurance company. Once pending, the patients can continue to receive care, but physicians will not be reimbursed by the insurance company, and if the patients can鈥檛 cover the costs either, the doctors are left unpaid.
Martinez said his office staff spends up to 30 minutes on the phone with insurance companies to establish if ACA patients are still paying their monthly premiums. Even after insurance companies say the person is on the plan, they often add the caveat of 鈥渘o guarantee for payment,鈥� Martinez said.
Money isn鈥檛 the reason most doctors go into the profession, he said, but it is necessary to keep his practice afloat and pay his staff.
鈥淧eople don鈥檛 understand that running a medical office is like running a small business,鈥� Martinez said.
And then there鈥檚 the extra paperwork that must be completed, from charts for new ACA patients to quality of care self assessments.
Wollschlaeger said administrative tasks have become about 40 percent of his workload, up from 20 percent before the ACA. On Monday, he finished seeing patients and started paperwork at 6 p.m., a time he would have used for that modern-day rarity, house calls.
鈥淪omething has to give,鈥� Wollschlaeger said. 鈥淢ore paperwork means less patient care.鈥�
Steven Ullmann, director of the Center for Health Sector Management and Policy at the University of Miami, said the average load for a primary care doctor is about 3,000 patients a year. This year, Florida enrolled 1.6 million consumers in the federal marketplace, adding to the primary care burden.
According to a 2014 survey by the Physicians Foundation, 81 percent of doctors describe themselves as over-extended or at full capacity, up from 75 percent in 2012 before enrollment began. About 44 percent said they planned to cut back on the number of patients they see, stop taking new patients altogether, work part-time or retire.
Wollschlaeger has come up with his own solution to juggle the growing patient load: work more hours.
As the program continues to develop in the next few years, doctors say consumer education and streamlining of paperwork and payments will help.
鈥淭he success stories of the system are when a patient tells me that it鈥檚 the first time that they can get regular care,鈥� Wollschlaeger said. 鈥淚 want the system to work.鈥�