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Narrow Networks of Healthcare Providers

Health plans available for purchase from the state insurance exchanges may be structured differently from plans available elsewhere. Many exchange plans will offer smaller or narrower networks of hospitals and physicians. Since metal plans are designed to offer a range of premium costs, insurers have created “narrow networks” in the interests of managing monthly premium costs while expanding coverage of the Essential Health Benefits mandate. A narrow network is a network of doctors, hospitals, and other healthcare providers where there are fewer healthcare providers for a population of enrollees than would be the case in a standard network.

A network refers to all of the doctors, hospitals, and other healthcare providers that provide health care services for a particular health plan at a predetermined price. Generally, visits to a physician in your plan’s network will be partially covered by your insurance plan, leaving the remainder to be paid out-of-pocket by you. A visit to an out- of-network doctor might not be paid for by your insurer, leaving you responsible for all of the costs and fees incurred. In other cases, the visit may be covered by the insurer but at higher out-of-pocket costs as compared to an in-network doctor.

Criticism of narrow networks includes concerns that patients will be limited to physicians that provide a lower quality of care and that access to specialists will come with higher out-of-pocket costs. Advocates of narrow networks state that a smaller pool of available healthcare providers does not mean that quality of care will be lower than a broader network could provide.

In New Hampshire, Anthem Blue Cross Blue Shield is the only insurance company to offer plans on the state exchange. The provider networks for these plans exclude 10 of the 26 hospitals in the state. Some critics contend that limiting access to hospitals will result in inferior healthcare for some New Hampshire residents depending on their region.

The quality of a health plan depends on the quality of individual doctors, nurses, labs, hospitals and other healthcare providers within a network. Whether a network is narrow or broad, the same standards of quality apply. It is expected that the quality of health networks will be monitored carefully over the next few years as the state exchanges expand.



Sources:

http://www.modernhealthcare.com/article/20130817/MAGAZINE/308179921
http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html?pagewanted=all



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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.