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Georgians are experiencing troubles with their health insurance as the providers listed on the Georgia Access website often end up not accepting the insurance.
Georgia Access is the state-based exchange where patients can enroll in health insurance pathways when their insurance is not provided by their employers. You can shop for different health insurance options that provide you insurance based on your needs.
Several doctors are listed as accepting the insurance plans, but when patients arrive at their appointments, they are told the doctor won’t accept their insurance.
So, what should you do in this situation and who do you communicate this problem to?
Bryce Rawson, a spokesman for the Georgia department of Insurance and Safety Fire, said, “Georgia Access is a platform where you go to purchase the plans, so these are plans that were submitted from insurance companies to our office. We reviewed them and approved them.” According to Rawson, the state cannot provide any help or compensation in terms of what happens between providers and the insurance.
Instead, Rawson says these problems are occurring between the insurance companies themselves and the medical providers. “Those contracts are subject to change. So, in between the time that people have signed up for a plan on Georgia Access and the time they go and see their doctor, there probably are some situations in Georgia where the contract has changed,” Rawson said.
The open enrollment for Georgia Access also ended in late 2024, and consumers experiencing these difficulties are stuck with these plans until next year. The only exceptions are if the patient qualifies for a special enrollment period, something that is often only done with a change in the patient’s career, lifestyle, or living situation.
There are also not many simple options for getting health insurance outside of Georgia Access and employer-sponsored plans unless you go straight to the insurance company yourself.
While you can buy an off-market insurance plan in Georgia, keep in mind you will pay full price with no tax breaks. While private insurance coverage is widely accepted by doctors, it also comes with heavy premiums. Unfortunately, when it comes to health coverage in Georgia, you often get what you pay for, with many doctors refusing to accept plans deemed affordable for most families.
Despite these problems, the insurance commissioners office — which is the agency responsible for handling complaints about insurance providers — claims it is not responsible for the confusion and points the finger and insurance companies and medical providers. “We as the insurance commissioner’s office, we do not step into those contracts. They are securely held between the provider and insurance company,” Rawson said.
Meanwhile, Georgia residents are left to scramble to find providers who take the insurance they were told their doctor would accept.
Poesy Young
Poesy Young is a contributor to the Georgia Sun. Her passions include education, the arts, and the Georgia community. Previously, she has worked with the Marietta Daily Journal digital department. Poesy currently lives in Johns Creek and has been a Georgia resident for 15 years.
