Some insurers' narrow networks include a mismatch among providers where in-network doctors don't have privileges at any of the in-network hospitals.
Saturday, May 31, 2014
Obamacare and Narrow Network Exclusions
This has become more apparent as patients and providers line up with the nitty-gritty real-time effort to provide care and specialty referrals. Narrow networks without adequate regional coverage for specialists and hospitals do not become evident until the time when it is needed. The consequence of this is delayed treatment and decreased quality of care.
Although there are private insurers participating in the Affordable Care Act, the provider lists for the ACA are not the same as regular insurance policies. And there is often a mismatch or an absence of an urgent care center in a narrow network, causing a patient to have to go to an emergency department. This has the paradoxical effect of a very expensive ED visit, for which the patient is further penalized with a high co-pay. Doctors aren't the only providers complaining about the mismatches--hospitals also want a solution to narrow network problems caused by health plans failing to sort through the physician admitting relationships, the article noted.
Such discrepancies may lead to tougher restrictions for insurer networks. The Centers for Medicare & Medicaid Services already proposed a policy requiring payers to expand their networks to include essential community providers or risk being kicked out of the marketplaces