Hospitals push back on limited health exchange networks

Seattle Children's Hospital has sued Washington state's Office of the Insurance Commissioner, claiming the health insurance exchange will prevent some patients from receiving care at the hospital, KPLU reported.

Of the eight insurers on Washington HealthPlanFinder, six have excluded 323-bed Seattle Children's Hospital from their networks. The hospital's suit aims to remove Coordinated Care and Molina from the exchange.

The insurers say they will decide if patients need access to Seattle Children's on a case-by-case basis, which pediatrician Sandy Melzer, M.D., warns will delay care and expose families to higher costs, KPLU noted.

Most plans sold through health insurance exchanges limit patient choice of doctors and hospitals, believing consumers will trade provider choice and access for lower premiums.

In fact, a national survey conducted by Anthem Blue Cross and Blue Shield, the only insurer approved to sell plans on New Hampshire's federal exchange, showed an overwhelming number of people favor lower prices over access to healthcare, reported Seacoast Online.

With that in mind, Anthem cut about 40 percent of the state's hospitals from its network. Portsmouth Regional Hospital, Frisbie Memorial Hospital and Parkland Medical Center are among the 16 facilities that didn't make the cut, Seacoast Online noted.

Cutting almost half of New Hampshire hospitals has led to strong opposition from some senators who are particularly concerned that Anthem's narrow network plan lacks adequate services for women, FierceHealthPayer previously reported.

Like Seattle Children's, hospitals have been fighting back after being excluded from exchange plans built around limited networks. In a print ad, Danville, Pa.-based Geisinger Health System accused Highmark's Community Blue health plan of forcing patients away from its hospitals, saying: "It's inappropriate, inconvenient, insensitive and simply wrong to force our neighbors to leave home to seek the care they desperately need."

To learn more:
- here's the KPLU article
- read the Seacoast Online article

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