The Skinny on Narrow Networks in Health Insurance Marketplace Plans

Since their inception, narrow networks have been expanding due to consumers being increasingly willing to have reduced provider choices in exchange for lower premiums.  Insurance companies are able to keep the premium lower by taking out high-cost employers.  In addition, due to the high amount of enrollees entering the narrow networks, insurers are able to promise increased volume to physicians/hospitals in exchange for the ability to offer lower premiums to their consumers.  Sounds like a win / win, right?

The concern is being able to navigate, as an average consumer, through the online maze of finding a provider that is in network with these ‘exclusivity’ based models.  Often, a consumer will end up going to a provider or facility, where they are out-of-network with the provider, and end up with a much larger bill than expected.  Due to this confusing process, consumers may not be able to pay what they owe, thus affecting both the consumer and the provider.  Communication, education, and transparency, or lack thereof, are obviously key issues when looking at the payer to consumer dialogue.

A key analysis was recently completed by the Leonard Davis Institute of Medical Economics with the University of Pennsylvania and the Robert Woods Foundation.  The first of such a detailed study of physician participation in plans offered via state and federal marketplaces.  You will see, among many interesting statistics and angles to the models, that 41% of these networks are considered either small or extra small.  Again, confirming access as enemy #1.

http://ldi.upenn.edu/uploads/media_items/the-skinny-on-narrow-networks.original.pdf