The federal government and state insurance regulators are coming up with new rules in response to unexpected bills that have resulted from narrower choices, constricted coverage, and misunderstandings over insurer networks, The New York Times reported.
A number of insurers have sought to reduce their costs by excluding cancer treatment centers and children's hospitals in their networks.
Some consumers signed up for the cheapest plans without reading the fine print about provider network limits. And staff working in some doctors' offices are confused about what networks their physicians were in.
Even consumers who tried to sign up with insurers that promised the coverage and continuity they wanted sometimes found themselves surprised.
In Los Angeles, Joshua Worth chose Anthem Blue Cross for his family after confirming that their obstetrician and pediatrician participated. But the family was told their doctors were "out of network" only after his wife had given birth. "It felt like bait and switch. I was lured into paying for something, but then when I tried to use it, it didn't work."
"There was definitely confusion in the marketplace," said Stephen Shivinsky of Blue Shield of California. "The front-office staff in many doctors' offices were also confused about what networks they were in," according to the Times.
"We are increasing our review of provider networks," said Aaron Albright of the Centers for Medicare and Medicaid Services, to ensure that there are enough physicians and other medical services available.
Washington State insurance commissioner Mike Kreidler said many consumers "were upset to find their health plan no longer included their trusted doctor or hospital" with some enrollees realizing this only after they had signed up.
A New York state law now allows patients to go to a provider outside their network at no additional cost if an insurer does not offer a physician with the expertise they need.
Based on the federal government's experience with Medicare, Washington knows how many doctors and specialists need to be included to provide adequate coverage in a given network.
Health insurers are balking at new rules insisting consumers should be able to purchase cheaper no frills policies with fewer doctors and facilities, the Times reported.
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