The Affordable Care Act will decrease the number of uninsured Americans, increase access to quality health care and to shed light on the value of prevention. The requirement that insurers provide affordable and quality health care is a vast improvement for consumers, but as insurers are finding ways to handle the influx of new policyholders and new consumer protections, there may be unintended consequences consumers need to be aware of.
A network consists of contracted doctors, specialists, hospitals, labs, radiology facilities and pharmacies. Those providers have agreed upon a set rate in which the insurer and the policyholder will pay. A narrow network is when the number of contracted professionals are limited in efforts to reduce costs. This can result in a shortage of network providers, causing delays in accessing care or additional out of pocket costs if consumers are forced to go out of network for care.
The ACA and Narrow Provider Networks
Officials in several states are pushing back against marketplace health plans that limit choice of doctors and hospitals. Coverage for new plans starts January 2014, many plans faced regulatory action, network expansion legislation, and litigation in 2013. In fact, some insurers have withdrawn from state exchanges and cancelled in-network contracts. BlueCross of Mississippi decided not to sell plans through the federally funded state exchange because of pending in-network protections.
State officials have spotted potential problems for consumers and are putting their foot down. Maine’s Insurance Superintendent blocked Anthem from transferring thousands of existing subscribers to a plan that did not include one of Maine’s largest hospitals. This past summer, Washington Insurance Commissioner Mike Kreidler did not allow five insurer to sell plans through the exchange, most for inadequate networks. The state of New Hampshire has enacted a new law that would force insurers to expand the number of contracted health professionals.
Critiques of Narrow Networks
Narrow networks are designed to lower costs associated with health insurance. But who benefits financially from a smaller network? Northwestern University professor David Dranove believes requiring broad networks could cause healthcare costs to increase. Typically, providers in narrow networks agree to low contracted prices which saves the insurers money. And maybe the insurers pass some of the savings off to consumers in reduced premiums.
On the flip side, others argue patients will now be forced to switch doctors or drive longer distances to receive care, especially if major hospitals are left out of networks. Senior director of policy for the American Cancer Society pointed out that narrow networks presents problems for patients with chronic conditions who may need immediate assistance. One of the plans Washington Insurance Commissioner denied would have required consumers to travel 50 miles to see a heart specialist and over 100 miles to see a gastroenterologist. Could the potential of saving a few bucks deter individuals from accessing quality and obtainable care? Widely noted, is the lack of psychiatrists across the county who accept health insurance. Any reduction in the number of mental health providers on network panels could be detrimental for individuals with a mental illness or substance use disorder.
Upon receipt of her policy cancellation letter, Diane Shore of California did not mind the slight increase in her monthly premium. Shore was more concerned that her physicians and hospital will no longer be included in the network. Her new plan through Blue Shield of California limits her choice of health care professionals and facilities just to Marin County. It is more convenient for her to travel to San Francisco to see her primary care provider and other specialists. The plan that she is now eligible for does not include her current providers and could potentially cause her to pay more out-of-pocket costs.
Do you plan on enrolling into a new health plan? Be sure to research whether your mental health provider is in the network of your new plan. Check out some of the other questions you should consider on our MHAMD Flyer.