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Posted by on Oct 18, 2013 in Uncategorized | 0 comments

Public exchanges lack provider search tools

Consumers are finding it difficult to determine which health plans will allow them to keep their doctor.

Many exchange websites lack quick and easy to use provider search tools. Most of the states that operate their own exchange, as well as the federal exchange, do not offer provider directories or search tools through their exchange sites. In order to search for providers, consumers must link to the insurer’s website. However, even the provider directories available through the insurer websites are not always clear or easy to use. According to an article from The New York Times, “Only exchanges in Colorado, Kentucky, Nevada and Washington State currently have search tools on their Web sites that allow users to type in a provider’s name and quickly see which plans include that provider in their network.”

The inability to search for specific physicians should be of concern for those looking to purchase coverage through an exchange due to the heavy use of narrow networks in exchange plans. The use of limited networks has allowed insurers to offer plans with lower premiums. Many insurance companies believe consumers, especially the young and healthy, will choose plans based on premiums. According to an article from the Denver Business Journal, Anthem Blue Cross and Blue Shield of Colorado, “narrowed the networks for individual plans offered in the exchanges by 40 percent from the size of physician networks offered outside the network on comparable plans this year, said Janet Pogar, regional vice president of provider engagement and contracting for the insurer.” Anthem hired a consulting group to determine what was most important to consumers; “One hundred percent of the answer was ‘Price, price, price,’” Pogar said, noting that the company only narrowed the network in urban areas, not in rural areas where there already are a more limited number of physicians.”

The lack of provider search tools may be made worse by the fact that many provider search links available on exchange websites take consumers to the insurers’ overall provider directories instead of the specific directory for an exchange plan that may only provide access to a narrower pool of physicians and hospitals. It is often not clear which provider network a plan will utilize, making it difficult for consumers to navigate the provider directory for a specific plan.

As consumers look for health coverage through exchanges, the decision making process can be simplified by the implementation of provider search tools allowing consumers to easily determine which health plans allow them access to their doctors.


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Jillian Carlile Research Analyst & Health Exchange know-it-all Strenuus

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