Providers face uncertain exchange networks

More problems lie ahead for the new insurance marketplaces as many hospitals and physicians don't know which exchange plans include them in their provider networks and will pay them for services, Kaiser Health News and The Texas Tribune reported.

Hospitals and physicians in Texas are struggling with uncertain provider networks in the federal marketplace and questioning why insurers did not contact them to sign new contracts or ask if they wanted to participate in the new exchange plans, according to the Texas Medical Association, Texas Hospital Association and Texas Academy of Family Physicians.

"Physicians, they just want to know who's walking through their door and what kind of coverage they're going to have," Lee Spangler, vice president of medical economics at the Texas Medical Association told the newspapers.

Similarly, small and rural hospitals have asked the Texas Hospital Association how they can figure out if they're already participating through existing insurer contracts.

To prepare for when exchange coverage starts Jan. 1, 2014, providers must first ask "do I have contracts with the exchange payers?" Medscape Today reported. Since most insurers are not reaching out to contracted providers, hospitals and physicians can get that information from their state's exchange Website or insurance commissioner. Medscape Today also suggests providers interested in contracting with an exchange payer arrange a meeting.

An important question for providers that are contracted with exchange payers is how much they will get paid--as some insurers are using the reimbursement terms of existing contracts and others are trying to adjust the terms to match their bronze, silver, gold and/or platinum offerings, according to Medscape.

For more:
- read the KHN article
- here's the Medscape Today article

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