Tags: obamacare | networks

WaPost: Obamacare's Narrow Networks Are Going to Make People Furious

Image: WaPost: Obamacare's Narrow Networks Are Going to Make People Furious

Tuesday, 14 Jan 2014 08:32 AM

By Lisa Barron

Many health insurance plans are limiting the scope of doctors and hospitals available to their subscribers under Obamacare as a means of keeping costs down.

But these narrow networks may mean that a patient can no longer keep their healthcare provider, a trend that is likely to infuriate many, reports The Washington Post.

Those signing up for healthcare benefits on the exchanges established by the Affordable Care Act are likely to find that the plans don't pay for trips to doctors that are not in their restricted network or they charge higher co-payments to see an out-of-network doctor.

"Insurers can no longer compete by trying to be the best at only covering healthy people, or by endlessly lowering benefits and raising deductibles. So limiting provider choice emerged as one of the few levers that health plans had to hold down premiums," writes Sarah Kliff in the Post's Health Reform Watch.

Indeed, a December study by consulting firm McKinsey and Co. found that two-thirds of the Obamacare plans have either narrow or ultra-narrow networks, with narrow defined as excluding at least 30 percent of the 20 largest hospitals in the region.

Covered California, that state's new insurance exchange, is a prime example, reported Time magazine, noting that when Blue Shield of California was designing the healthcare plans it would offer individuals it asked providers to accept reimbursement rates of up to 30 percent less than what it had previously paid.

As a result, just 60 percent of the doctors and 75 percent of the hospitals that take part in the Blue Shield of California's group plans will be included in Covered California.

"We're very concerned with the impact that has on patients," Cedars-Sinai CEO Thomas Priselac told the magazine, explaining that some insurers designing networks based on cost are leaving out world-renowned research institutions like Cedars-Sinai in favor of lower-priced community hospitals that my not offer the same level of care.

Across the country, Anthem, a leading provider of individual plans, excluded many of the large hospitals in Maine and New Hampshire from its network under Obamacare, meaning residents in rural areas may have to travel long distances to reach in-network providers.

"If you're in central Maine, you have to go to Portland to find a hospital and some people were kind of upset about that," Karen Pollitz, a senior fellow at the Kaiser Family Foundation told Time.

And in the south, Texas Oncology, the largest cancer-care practice in the state, has reportedly said it will not participate in the networks of any insurers selling policies through the Obamacare exchange.

They are just part of a growing number of major healthcare providers either opting out of 2014 plans or being excluded by insurers.

"This is market competition," said Pollitz. "Whether you like it or not, this is what we signed up for."

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