Obamacare Pressures Insurers to Extend Doctor Choice

Thursday, 06 Feb 2014 09:30 AM

By Drew MacKenzie

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The federal government is stepping up the pressure on healthcare insurance companies to provide a wider range of top-class hospitals and specialty doctors in their plans.

In an attempt to keep down the cost of coverage under Obamacare, federal officials have put forward proposals for stricter reviews of doctors and medical centers for plans being sold next year, according to The Wall Street Journal.

But the government proposals to extend doctor and hospital choice have already come under fire from America's Health Insurance Plans, the industry's largest insurance group.

A spokesman for the company told the Journal that plans with fewer healthcare providers are "one way health plans can help to preserve benefits and mitigate cost increases for consumers” under the new reform law.

Insurance companies say they can suppress costs to the patients in part by agreeing to reduced fees in exchange for a greater amount of business with fewer competitors.

The proposed shake-up has come after a series of complaints by consumers that their current plans do not offer the best doctors and leading academic hospitals because health networks leave them out of their coverage due to their higher fees.

Patients have complained that under President Barack Obama’s healthcare reform law they are forced to change doctors and hospitals, which means that they are not getting the best possible healthcare treatment.

According to the Journal, insurance companies have been dumping a long list of doctors and prestigious health network facilities from the private Medicare Advantage program due to their expensive billing.

Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said that the current guidelines for what doctors and hospitals are included in various plans are based on reviews by state health regulators and independent organizations.

But under the federal proposals for next year, insurance companies selling plans in the federal marketplace would have to submit a complete list of health providers to the Centers for Medicare and Medicaid Services before their plans are approved. There would also be new federal standards for the amount of providers in each plan.

The changes would mean the federal government getting even more involved in arranging patient healthcare, says Pollitz. "It's a substantial change," she said. "It's much more specific, and it's going to involve a lot more direct federal oversight."

Under the proposals for next year, plans in the federal exchanges would include a greater number of “essential community providers," which are hospitals and clinics used by lower-income people.

A spokesman for the Centers for Medicare and Medicaid Services said that it is "working to strengthen the network adequacy requirements that took effect for this year."

Some states, including Pennsylvania and Mississippi, are also mulling over legislation that will force the health insurance companies to make changes in their coverage to add top-class physicians and health facilities. And states like Washington and New Hampshire are planning to review their standards to help increase patient access to potentially better health providers.

California Insurance Commissioner Dave Jones said his agency is planning to upgrade its hospital and doctor choices to "make sure when people purchase health insurance, they have reasonable access to health-care providers."

The American Medical Association is supporting the planned changes in federal and state exchanges, saying it planned “to implement proactive solutions we believe can enhance the public health and welfare by eliminating inadequate networks.

The AMA added that narrower provider networks could "endanger patients' health if they cannot access timely, convenient, quality care."

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