Recently a New York Times editorial http://www.nytimes.com * noted: “Republicans contend that the Affordable Care Act is a failure because many of the plans sold on the online health exchanges limit a consumer’s choice of doctors and hospitals. Many plans do, indeed, limit choice — deliberately so, to keep premiums down. But a vast majority of consumers can almost always buy a plan with a broad array of doctors, hospitals and other providers if they are willing to pay more for the policies.”
“There is no clear definition of what constitutes a “narrow network,” the term used in public and political discourse, but there are protections built into the Affordable Care Act and federal regulations that require all networks to have enough doctors of various types to ensure that services can be provided “without unreasonable delay. Most plans probably have the experts needed, but there are concerns that in the hectic rollout of the health exchanges the primary emphasis has been put on enrolling people, not on making sure that all networks were adequate.”
“Any shortcomings that have emerged can be addressed with better public education and regulatory fixes. Some consumers have been surprised to find that their own doctor may accept the insurance company they are using but not the particular plan they have chosen from that insurer’s offerings. Or that a new doctor they wanted to see, though listed as taking their plan’s insurance, was not accepting new patients because the practice was already full. These problems can be solved by requiring more accurate and up-to-date information about doctors in the plan, preferably posted on the government’s website, not just on insurance company websites.
*to read the full NYT editorial “The Phony “Narrow Network” Scare”, highlight and clck on open hyperlink http://www.nytimes.com/2014/07/25/opinion/the-phony-narrow-network-scare.html?_r=0
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
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