Narrowed Physician and Hospital
Networks: Nobody Likes Being Excluded
To define is to exclude and negate.
Jose Ortega J. Gasset (1882-1955), The Modern Theme (1923)
are redefining doctors and hospitals with whom they will deal. This redefinition is called “narrowing of
networks.” This expression translates into dropping contracts with doctors and hospitals. Health plans justify the
process in the names of efficiency, quality, profitability, or simply staying in business. Without
profit, health plans believe they cannot function and and may cease to exist as viable business entities.
calls this practice or however one justifies it, those being excluded , which include hospitals, physicians, and consumers, do not
like it, and they are bringing political pressure and lawsuits to bear to stop
the narrowing process.
February 6 Bloomberg News, Megan
McArdle says people “ will fight with every fiber of their being when you tell
them to take their kid to a community hospital rather the top notch childrens’
hospital nearby (‘Doc Shock’ Reaches the Masses.)
On that same
day, February 6, the Wall Street Journal reported hospitals,
doctors, and the public are resisting exclusion (“Insurers Face New Pressure
over Limited Doctor Choice.”
likes being excluded from the best health care when it involves yourself and your loved ones and when it travelling
greater distances to reach your institution or your doctor of choice.
Hampshire, Wellpoint is the only insurer offering ObamaCare approved consumer plans on its
health exchange. The Wellpoint network
leaves out 10 of the state’s 26 hospitals.
Meanwhile, Aetna is pulling out of exchanges in Connecticut, Maryland, California, and New Jersey, figuratively leaving
out in the cold people in health plans in those states. First class
institutions and their doctors in places
Seattle Childrens Hospital, Sinai in California, and Yale-New Haven are
being excluded. Regulators and health
exchanges in states where these institutions are located and in Mississippi and
Pennsylvania are being lobbied to re-expand or restore coverage.
According to Kaiser Health News,
“Officials in at least a half dozen states are
pushing back against health plans in the new insurance markets that limit choice
of doctors and hospitals in a bid to control medical costs.
They’re facing regulatory action, possible
legislation, and in at least one case involving a high-profile children’s
The pushback against “narrow” provider
networks recalls the backlash against managed care and health maintenance
organizations in the 1990s. Protests from consumers and hospitals eroded
those attempts to restrain expenses by narrowing provider networks.”
Where is this latest round in the ObamaCare Merry-Go-Round (perhaps
Cherry-Go- Round is more appropriate since health plans are cherry-picking
to higher premiums for all.
If unlimited choice to the best and more
expensive prevails, higher premiums will inevitably follow.
are reacting negatively to health plan narrowing and exclusion from top-notch
hospitals and doctors, and regulators are being pressured to reverse the
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