Monday, February 10, 2014

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)

Health plans 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. 

Whatever one 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.

In the 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.”  

No one 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.

In New 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   like Mayo,  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 hospital, litigation.

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 providers) going?   

 Probably  to higher premiums for all.  If unlimited choice to the best and more expensive prevails, higher premiums will inevitably follow.

Tweet:   Consumers are reacting negatively to health plan narrowing and exclusion from top-notch hospitals and doctors, and regulators are being pressured to reverse the narrowing process.

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