Provider Networks Shrinking in All Markets

No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want. These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans.

doctor-mom-and-sonSmaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans. Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.

“We have to break people away from the choice habit that everyone has,” said Marcus Merz, the chief executive of PreferredOne, an insurer in Golden Valley, Minn., that is owned by two health systems and a physician group. “We’re all trying to break away from this fixation on open access and broad networks.”

(Reed Abelson, New York Times)

Comments (7)

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  1. Crawford says:

    And I thought that I was able to keep my own doctor? Hah what a joke

  2. Laura says:

    So you are forced to go with the doctor they appoint AND he will have a heavy workload due to the large amounts of patients he has to provide care to? I feel like quality of care is definitely going to go down…

  3. Lindsay P. says:

    Economically, this is completely inefficient! If you have an equilibrium via the free market, then the federal government should keep its hands off. However, if you reduce the supply and demand remains the same, then economically a shortage will occur. Inefficiencies will start showing all over the market soon enough. What a terrible strategy!

  4. Devon Herrick says:

    I don’t necessarily think of this as a bad thing if done correctly. Health plans can often negotiate deeper discounts by working with doctors who agree to lower fees in return for a large volume of patients. The same is true of pharmacy networks. But where I think this is the most advantageous is when health plans negotiate with specific providers for costly procedures. CalPERS did this in California with hip replacements. It didn’t exclude most hospitals. Rather, it provided a list of the ones that were good and offered a good price ($30,000) and informed their enrollees they would pay the difference if they chose a hospital that charged more than the reference price.

  5. Diane says:

    Just what I want to do when I’m dealing with an illness: research doctors, deal with insurance regulations, and worry about money. Ugh.

  6. John Fembup says:

    Do you believe that all clinicians are equally competent?

    If you do not, perhaps you actually believe in narrower networks.