A key provision in Obamacare requires doctors to spend at least 80% of their gross revenue on patient care, leaving them 20% for overhead.
It seems that the onerous MLR rules for carriers also apply to physician practices.
Some doctors say they need to charge the extra fees because of the rising costs of running a practice. Some even cite the Affordable Care Act, also known as Obamacare, as adding to their costs.
Anthony Wright, of the consumer watchdog group Health Access California, says that reason doesn’t fly.
“The Affordable Care Act has another provision that puts a limit on how much your premium can be spent on patient care, rather than administration and profit. So, again, having an outside fee that is for administration is in violation in the spirit of the law, which is to try to limit the amount of money that’s spent on administration profit, and really target those dollars towards patient care,” Wright said.