Narrow network plans could drive up costs

Insurers have been reviving narrow networks for plans they're going to sell through the health insurance exchanges, believing consumers will trade provider choice and access for lower premiums. But some healthcare experts fear the resurgence could actually lead to higher medical costs if patients can't see their doctors and receive necessary follow-up care.

The narrow network trend has been particularly obvious in California, where insurers have dramatically cut their doctor networks. For example, Health Net's exchange plans offer the fewest doctors, and some of its networks are half the size of its competitors in Southern California. But it also boasts the lowest rates, including some monthly premiums that are $100 cheaper than its competitors, reported the Los Angeles Times.

Consumers who select a Health Net exchange plan in Los Angeles County, for instance, would only have access to 2,316 primary care doctors and specialists. And in San Diego, Health Net customers would only be able to see 204 primary care doctors.

Health Net intends to offer its low-cost, narrow-network plans on health insurance exchanges in 13 regions in California as well as Oregon, FierceHealthPayer previously reported.

Blue Shield of California also has narrowed its network for exchange plans, restricting its members to about 50 percent of its regular physician network.

But California officials have been trying to compel Health Net, Blue Shield and other insurers to expand their networks. Covered California, the state exchange, says it's monitoring enrollment, including scrutinizing what capacity physicians have to accept new patients.

"Our interest is in assuring everyone enrolled in a plan has ready access to the clinicians they need," Peter Lee, executive director of Covered California, told the LA Times. "That means if a plan can't serve patients, we'll close it down from taking new enrollment. That is in some ways the nuclear option."

What's more, health policy experts worry about the repercussions of these narrow networks. "We are nervous about these narrow networks," said Donald Crane, chief executive of the California Association of Physician Groups. "It was all about price. But at what cost in terms of quality and access? Is this contrary to the purpose of the Affordable Care Act?"

It's not only in California that consumers will find narrow network plans. A McKinsey & Co. analysis found 47 percent of 955 plans proposed for the online marketplaces were for health maintenance organizations or plans with similar designs.

To learn more:
- read the Los Angeles Times article

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