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View Diary: Insurers widen profits by narrowing choice of doctors (96 comments)

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  •  Choice has a price tag. (1+ / 0-)
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    Ian S

    Networks are a cost cutting measure that insurance companies have been using for at least 20 years now.  The fact is that you can never cut costs in health care if you are going to fund everything that anyone might want, including compete choice of provider regardless of that provider's cost.  

    The Post article quotes an insurance executive who stated that their surveys show that consumers would rather have lower cost policies with narrower networks.  I suspect that is pretty much true, especially for the currently uninsured.

    In employer-based plans there is more room for choice, as the insured is usually paying only a fraction of the actual cost.  In the individual market and on the exchanges, keeping costs down becomes paramount, and that means using networks with negotiated fees.  

    As the market develops, there may be plans that offer more choice, for those who are willing to pay the extra freight.  However, I suspect that most people buying on the exchanges will still opt for lower cost plans.  

    The "keep your own doctor" thing has been a distraction for decades and is really pretty meaningless.   Nobody can be guaranteed to keep the same doctor for life.  Anyway, there is nothing in the ACA that says you can't go to any doctor you want as long as you pay for it yourself.  It's only a question of which providers will be paid for.  If you want to drive a Ferrari rather than a Ford, you have to pay the extra cost.  Choice isn't free.  

    •  Choice isn't the only question here (0+ / 0-)

      Are the networks going to have the capacity to handle the number of patients that are covered?

    •  What Obama was doing was comparing how the (0+ / 0-)

      ACA would work with the system in the U.K., where, as I understand it, the national health system assigns you to a doctor.

    •  If you choose a PPO plan then there should be (1+ / 0-)
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      coinsurance payments.  My plan will pay 50% to out of network providers.  So I can see any doctor I want.

      I've also noticed that my Grandfathered plan on the Individual market has a smaller network in the Blue Shield database than some of the big group plans.

      Congressional elections have consequences!

      by Cordyc on Tue Nov 26, 2013 at 12:58:41 AM PST

      [ Parent ]

      •  Be Careful (0+ / 0-)

        What will likely happen is that your insurance company will pay 50% of the "reasonable and customary charges" -- which does not equate to 50% of the bill charged by your out of network doctor, who is then free to balance bill you for the amount not paid by the insurance company. This is exactly what has been happening for years in states such as NY with very high-priced specialists. The insurance company uses zip codes or their own formulation to come up with "reasonable and customary charges" and it never equates to one-half of the physician or medical facility charge - leaving consumers with huge, unexpected bills.


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