California Insurers Slash Number of Doctors You Can See
The new health reform law removes health insurance limits on spending, but gives insurers free reign to limit the doctors and hospitals you have access to. A strange discrepancy that maybe someone else can explain. Anyway, expect a lot more of this going forward:
The availability of doctors varies by each narrow network. Woodland Hills-based Health Net, one of the first to promote the strategy in California, features 47,000 doctors in its full HMO network but just 7,000 physicians in its Silver plan.
The change [to a “Silver” network] roughly cut in half an expected 13% increase in premiums, and most employees were able to keep their doctors, who were part of the smaller network.
An even smaller network, Bronze, has 1,600 doctors in Los Angeles, San Diego and San Bernardino counties, and can shave as much as 24% off insurance bills.
Full article on “narrow network” HMOs.
As a patient, I’m not feeling a lot of love here.
Tom, I think youv’ve got that right. Pick a number and wait until you’re called. Make that wait and wait and wait.
This is a trend we will likely see more and more.
The only leverage a health plan has when negotiating fees’ doctors is the power to say “no”. In return for discounted fees, insurers can send more business to the doctors in the network. Pharmacy Benefit Managers have been doing this for years with drug makes.
I especially thing this will become common for hospitals.
When a medical system has too few resources to adequately handle the demand in a non-hospital setting it is referred to as a mass casualty incident or (MCI). Apparently this scenario will be called status quo in the future for hospital/clinic based care.
I think Simon may be right. I also think that is not good.
For people paying privately for their insurance, I bet it’s possible to reverse-engineer your insurance such that you pick your doctor and then figure out which insurance he/she carries. People with employer-sponsored plans aren’t so lucky.
Ultimately, I think you just have to either shell out the cash for the doc you want or suck it up and go in-network. I personally don’t visit doctors that much for my selection to really be a problem. At this stage in my life, medical care is sort of a commodity for me; there is not much differentiation. However, I can see how others would want more choice, especially if they had had extended illness.
The reality is that there is a vast array of costs for the same procedure. The cost of a colonoscopy in Sacramento ranges from 2850 to 8400 (and that is in a tiny part of CA). So if insurers cut out the providers charging the highest – premiums go down. I would welcome this choice – if you want an expensive doctor, you should have to pay more. How can a price range like this be justified?