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    ZinscoMan's Avatar
    ZinscoMan Posts: 12, Reputation: 1
    New Member

    Dec 5, 2017, 08:00 AM
    Establishing Primary Care Doctor, does ACA require frequency of visits?
    My grandfathered health insurance is being cancelled by the insurer.
    My primary care facility is no longer accredited as a primary care doctor (they switched to urgent care only). So I've never had to shop for a primary care doctor since the ACA went into effect. Someone told me the new doctor will want a physical. Is that required before the doctor will see me for a sick visit?

    My concern is since I don't take any prescriptions that I usually don't visit the doctor even once a year. If I establish a new primary care doctor going through all the physical exam tests and then don't need to go for a couple of years, will they drop me as a primary care patient? Does the ACA require me to visit a primary care doctor so many times like at least once a year or they won't recognize them as my primary care doctor (and thus won't let me pay the copay but make me pay the whole bill)?
    joypulv's Avatar
    joypulv Posts: 21,593, Reputation: 2941
    current pert

    Dec 5, 2017, 09:58 AM
    The huge quagmire of all health insurance, including the ACA, is compounded by the fact that requirements go by state, and also by plan, even within the ACA. And if all that isn't enough, rules and coverages and costs also can change on Jan 1 of each year.
    We can't answer this!

    I'm guessing that the answer to all your questions is no. I'm also guessing that, because a once a year physical is covered with no co-pay in all plans I know about, but not required before a 'sick' visit, that you can find a doctor who will see you without one. It's up to each doctor. Some doctors drop patients, for all sorts of reasons, as they get big case loads or as they get ready to retire - who knows. And doctors are allowed to refuse any kind of insurer they want. I know of many who won't bill Medicaid.

    A clinic would be a better option for you, if there is one near you. Many hospitals have an affiliated clinic, a walk-in, with rotating doctors. Some have a clinic but appts are required.
    If not, you will have to call around and ask each doctor's staff.

    The best part of a physical IMO is a blood test, more than the standard panel. You and a doctor can discuss what might go into it. I think that the ACA covers it without copay, and it's an excellent diagnostic too.
    ma0641's Avatar
    ma0641 Posts: 15,681, Reputation: 1012
    Uber Member

    Dec 5, 2017, 07:34 PM
    1. Does the ACA require me to visit a primary care doctor so many times like at least once a year or they won't recognize them as my primary care doctor...
    2. Not sure of ACA but, I have been on Medicare 11 years. Each year my PCP schedules a yearly checkup. Other than that, I have never been back so I would think it is reasonable similar.
    talaniman's Avatar
    talaniman Posts: 54,328, Reputation: 10855

    Dec 6, 2017, 05:33 AM
    You could ask your insurer, and should, but I don't believe there are MANDATORY doctor visits. I have never heard of a penalty NOT to take advantage of a benefit. I have heard of doctors insisting on it though.

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