In a recent Washington Post article it was reported that, “Consumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage” This is not necessarily a negative though as the smaller networks are typically negotiated contracts with the healthcare provider to offer lower costs which results in a lower premium price.
An analysis by Avalere Health said, “Compared with traditional employer coverage, exchange plans had networks with 42 percent fewer cancer and cardiac specialists; 32 percent fewer mental health and primary-care doctors, and 24 percent fewer hospitals.” As stated above the negotiated contracts between healthcare providers and insurance carriers helps control cost. There are plans on the healthcare exchange that provide broader networks, but you are paying for that network in higher premium.
The real issue is not that the network is small, but whether a doctor stays on the network for the entire calendar year. At DesignTM Health we have seen instances where an individual signs up for their health plan in January and their doctor is in network, but by March the doctor has ended their contract and is no longer participating in that network. Unfortunately a consumer is locked into their health plan for the calendar year, unless there is a qualifying event, whereas the healthcare provider can jump ship.
Often times consumers are informed of the network access their health plan provides and understand that there are both in and out of network providers. When the consumer is informed they go to great lengths to make sure their provider is in-network so they do not end up with a full out of pocket payment for services. Although, for those not informed they believe they can go to any doctor because they have insurance. In this instance it doesn’t matter if the network is narrow or broad, if a consumer doesn’t do their research they run the risk of paying much higher prices.
Are you a consumer that understands your healthcare network? When you enrolled in healthcare did you make sure that your doctors were included in the health plan you chose?
Read the full article from the Washington Post HERE