Narrow Network Reversed


Earlier this month I described how “narrow networks” work.  Basically, I detailed how the insurers are knocking doctors out of their plans because of “quality” reasons, which means they don’t want to pay them. I forgot to highlight the reverse.  Many physicians are not taking the plans from the exchange because they pay too little.   Here is a recent article from the USA Today describing this phenomenon:

  • Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say.
  • “The exchanges have become very much like Medicaid,” says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. “Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they’re not going to be in business very long.”
  • Kleinman says his members complain rates can be 50% lower than commercial plans.

The insurers adamantly deny that the ACA plans pay doctors less but:

  • To prevent discrimination against ACA policyholders, some insurance contracts require doctors to accept their exchange-plan patients along with those on commercial plans unless the doctors’ practices are so full they simply can’t treat any more people.

Far be it for the insurers to lie, huh?

To summarize, we now have a system where insurers are not taking some doctors and and a system where doctors are not taking some insurers.  Sounds like this is getting narrower and narrower.

60610cookie-checkNarrow Network Reversed