Provider network complaints flood insurers

Consumers, lawmakers and regulators continue to push back against narrow networks, Kaiser Health News reported. While policies with limited networks of doctors and hospitals existed before the Affordable Care Act, the backlash has been growing against narrow networks since exchange coverage kicked in.

Some enrollees used to more comprehensive employer-based coverage have been hit with surprises when doctors who treated them last year no longer take their insurance, the article noted.

To avoid network surprises, federal officials are developing new standards to determine whether ACA plans have enough doctors and hospitals in their networks, FierceHealthPayer previously reported. Under the new standards, insurers must have contracts with at least 30 percent of essential community providers that treat low-income people, as well as networks with sufficient numbers and types of providers.

In addition to new regulations, some critics are taking legal action to fight narrow networks. For instance, California's Anthem Blue Cross has been hit with two class-action lawsuits. Consumer Watchdog has sued Anthem for allegedly misleading millions of members about whether physicians and hospitals were participating in new plan networks and not giving consumers full information until it was too late for them to switch coverage.

Anthem told KHN it plans to offer out-of-network coverage next year in some regions where it does not offer it currently.

Amid the complaints from consumers and regulators, insurers maintain they're trying to provide affordable coverage options in a challenging healthcare landscape. They're also heeding research that has shown most consumers consider price above all when selecting health plans, KHN noted.

Several industry experts recently said that while narrow networks aren't going anywhere, insurers need to strike the right balance among value, access and affordability. That involves giving consumers sufficient information about provider networks and timely notification about any changes.

For more:
- read the KHN article