While narrow provider networks may lower premiums, they have the potential to limit access to care and increase out-of-pocket costs. So it's still uncertain if narrow network plans can work under the Affordable Care Act, according to a new policy brief from the Urban Institute.
A balance is required for plans to maintain a sufficient provider network. If insurers can't negotiate with providers, premiums could rise. And when choosing a plan, consumers must feel confident that they will not endure financial risks due to an inadequate network, notes the brief.
While there may not be one single policy that can achieve the perfect balance between consumer choice and cost containment, the authors propose the following actions:
Establish regulatory standards
Insurers must meet a minimum standard for adequate access to primary care. Yet insurers must have flexibility regarding non-emergency specialty care--often, providers are unable to meet certain quality requirements or charge high rates.
Insurers who lack experienced in-network hospital services should provide coverage for that service out-of-network, free of cost. That way, consumers are not held accountable for unnecessary payments when the care they need is located out of their network.
Transparency will help protect consumers
Insurers must also provide adequate information to their consumers regarding all aspects of a plan as to enable thoughtful and educated decision-making, the authors write.
Insurance companies should have to disclose how they choose their networks, such as what factors make a provider high performing or efficient, Ezekiel Emanuel, a former White House health adviser, recently wrote in the New York Times. Moreover, "the size of a plan's network should be as transparent as its premium," FierceHealthPayer previously reported.
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