Introduction to the Affordable Care Act

The Affordable Care Act and its impact on A to Z Pediatrics

Because of changes mandated by the Affordable Care Act, we have been forced to alter the administrative policies of A to Z Pediatrics Medical Group.  These pressures are being felt nationally, and are perhaps most acutely in small, traditional medical groups that do not use physician extenders, such as nurse practitioners or physician assistants.

Under the Affordable Care Act, families are having their insurance changed to new insurance products, as mandated by federal law.  As a result, traditional insurance products utilizing legacy PPO networks are no longer accessible for many of our patients, though some who obtain their insurance through unions or government agencies may still have access.  The state of California has not adopted the federal extension allowing individuals and families to keep their plans for an additional two years, so in most cases families do not have the choice to keep their legacy networks or the doctors who are in them.

While our contracts with insurers have not changed, the policies insurers offer has. Insurers have manufactured new, “narrow” networks that have arbitrarily excluded A to Z Pediatrics.  Insurers admit that these new, narrow (usually EPO) networks are designed to fulfill insurance companies’ needs for a minimum number of “providers or prescribers” and to fulfill the needs of the insurance companies’ members at the lowest cost to the insurance company. Confusingly, many of these new network plans are marketed and advertised as PPOs, which we believe they are not. We have not been allowed to participate in many of these insurance products. In fact, Anthem has told us that we are not even allowed to apply for membership in their new network.  In addition, despite our requests, no insurer has informed us prospectively of our status in their new networks. We have only ascertained the truth after families accessed our services.

As a result of the Affordable Care Act, and because of diminished access from new limited insurance networks, and although our existing relationships with insurers has not changed, we have been forced to implement new billing polices to remain viable.

Three alternative choices are available.  Please review the options and explanations under the “Billing Policy” Tab and select which option is most convenient for your family.

We appreciate that our families value the traditional and high quality services they have come to expect, and that we expect from ourselves. With apologies for any inconvenience this may cause, but assuring you of our best attention at all times, it is our intention to continue to provide the caliber of care our patients have enjoyed for the last twenty years.

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