Recently a Becker Hospital Review article http://www.beckershospitalreview.com * noted: “Looking to appeal to consumers with lower premium prices, some health insurers selling policies through the Patient Protection and Affordable Care Act health insurance exchanges have turned to narrow provider networks.”
“Here are six key things to know about narrow provider networks.
• 1. Health insurers selling individual policies through the PPACA exchanges are turning to narrow networks as a way to compete on premiums by lowering their unit cost
• 2. Insurers forming narrow networks generally take one of two approaches…. They either include only low-price providers in their limited networks, or they give incentive payments to providers that meet certain quality metrics and help the insurer achieve the federally required medical loss ratio threshold of 80 percent.
• 3….. the McKinsey Center for U.S. Health System Reform found products with broad hospital networks had premiums 26 percent higher than narrow-network products of the same carrier, product type, metal tier and rating area.
• 4…. hospitals included in the networks face potentially decreased revenue by accepting lower payment rates than what they would receive from broader contracts, while those that are excluded risk losing market share.
• 5..…narrow network health plan enrollees face a more limited choice of providers and could face significant financial issues if they seek medically necessary care out-of-network. Health insurers should be required to meet a minimum standard for adequate access to primary care, according to the report.
• 6. Legal battles over narrow networks are already in progress across the country. …on the grounds that.. narrow network plans do not meet requirements for adequate access to care.
* to read the full BHR article “What Narrow Networks Mean for Providers and Patients: 6 Things to Know” by Helen Adamopoulos , highlight and click on open hyperlink http://www.beckershospitalreview.com/finance/what-narrow-networks-mean-for-providers-and-patients-6-things-to-know.html
Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.