As healthcare reform passed, millions of Americans worried whether they would still be able to choose their own doctor under the new regime, but it looks like it may not be the federal government they should be worried about. As health insurance and healthcare costs continue to spiral upward, private health insurers and employers trying to control costs may have more and more of a say about which doctors and other healthcare providers you will be able to go to.
A recent article discusses, this new trend in health insurers offering “limited network” health insurance plans as a more affordable alternative to more traditional full-network health insurance. The concept would be familiar to anyone who has been an HMO member: in return for relatively affordable monthly health insurance premiums and healthcare, restrict your choice of the doctors, hospitals, and other healthcare providers that you use to those on a limited list:
But choice — or at least choice that will not cost you — is likely to be increasingly scarce as health insurers and employers scramble to find ways of keep premiums from becoming unaffordable. Aetna, Cigna, the UnitedHealth Group and WellPoint are all trying out plans with limited networks.
The size of these networks is typically much smaller than traditional plans. In New York, for example, Aetna offers a narrow-network plan that has about half the doctors and two-thirds of the hospitals the insurer typically offers. People enrolled in this plan are covered only if they go to a doctor or hospital within the network, but insurers are also experimenting with plans that allow a patient to see someone outside the network but pay much more than they would in a traditional plan offering out-of-network benefits.
The insurers are betting these plans will have widespread appeal in the insurance exchanges as individuals gravitate toward the least expensive options. “We think it’s going to grow to be quite a hit over the next few years,” said Mr. Goulet of WellPoint.
Interestingly, the American Medical Association fired off a letter the country’s largest health insurance plans, criticizing their physician rating practices and urging health insurers to make their physician profiling practices public, “We have been talking for years about the unreliability of physician profiling, particularly in regards to the Rube Goldberg-esque systems used to assess so-called physician efficiency.”
Would you enroll in a limited-network health insurance plan if it were affordable? Tell us about it at the MyHealthCafe.com Forums.
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