May 2014
May 09, 2014

Are your doctors in the plan?

Many people assume that insurers use the same participating hospital and physician network for all health insurance plans. They may not know that the insurers may be using a “nar­row network” of health care provid­ers for certain products to make the premium less expensive. Health care providers in the narrow network may offer better discounted fees to insurers in exchange for an increased volume of patients.

According to the February 2014 Kaiser Health Tracking poll, 55 per­cent of people (ages 18-64) covered through employer-sponsored health plans prefer a broad range of doctors and hospitals even if it costs them more money. This contrasts with peo­ple who are uninsured or pay for their own insurance, who prefer less costly plans and would accept a more lim­ited provider network.

Some experts suggest the real is­sue is not the narrow network itself. To be effective, the network must be composed of high-quality health care providers with a sufficient number of providers in each specialty in each geographic region. Independent and transparent measures for quality and adequacy need to be developed be­fore consumers will gain confidence in these narrow networks.

For more information concern­ing this topic, please access www.nytimes.com/2014/03/06/opinion/in-health-care-choice-is-overrated.html.

— Sue Klug