Narrow Network Plans: lower premiums for less provider choice
Many insurers will be offering plans with limited or narrow networks on the new health insurance exchanges, believing consumers will trade provider choice and access for lower premiums, especially the young and healthy. California will see many narrow network options on the Covered California marketplace and in Maine, Anthem Blue Cross Blue Shield has received much attention for its collaboration with MaineHealth to form a narrow network.
Anthem Blue Cross Blue Shield has also received criticism for its narrow network plan in New Hampshire which provides access to 74 percent of the state’s primary care providers, 85 percent of specialists, and 16 of the state’s 26 acute-care hospitals according to the Associated Press. Anthem president Lisa Guertin told state senators:
“What we’ve done as one insurer in the marketplace is create an offering that we really believe represents the best value and the best balance of access and affordability,” she said. “All a business like ours can do is seek to understand what the majority of consumers will be interested in and want and prioritize, and then develop something we believe best meets those needs.”
Cigna, which intends to participate in the exchange market in Arizona, Colorado, Florida, Tennessee, and Texas, also intends to utilize narrow networks. According to a New York Times article, Lower Health Insurance Premiums to Come at Cost of Fewer Choices, Joseph Mondy, a Cigna spokesman stated: “The networks will be narrower than the networks typically offered to large groups of employees in the commercial market.”
Many narrow network plans have been designed with fewer providers who have agreed to accept lower reimbursement rates; in exchange for lower reimbursements, the limited networks will allow participating providers to see an increase in patient volume.
However, there are concerns regarding the limited provider networks. An article from FierceHealthPayer, Narrow network plans could drive up costs, reports that some experts fear that these narrow networks could lead to higher medical costs if patients can not obtain access to healthcare providers and receive necessary care. Consumer advocates fear that patients will not be able to gain access to the care they need, despite having insurance and that patients with complex medical problems will be forced to seek care outside of their plan’s limited provider network, leading to higher out-of-pocket expenses.