Today's "Seattle Times" has a big article on the health insurance plans inside the exchange using very narrow networks of providers to whittle down their costs.
Health-exchange plans’ limits shock shopper
Many insurers offering plans through the Washington Healthplanfinder, the exchange marketplace where shoppers can apply for subsidies, are using narrow provider networks. These networks are not the broad, include-all-providers networks that many big employer plans currently enjoy.
More after the mating orange tape worms.
Many insurers offering plans through the Washington Healthplanfinder, the exchange marketplace where shoppers can apply for subsidies, are using narrow provider networks. These networks are not the broad, include-all-providers networks that many big employer plans currently enjoy.
Premera says its pared-down “value network” helps contain costs, keeping plans affordable for people who must buy their own insurance. And while skinnier networks may not always equal lower premiums, Coordinated Care, with the fewest in-network hospitals, also has the lowest prices.
If a patient needs a covered service, such as a heart transplant, but it’s not provided at in-network hospitals, insurers must cover it elsewhere.
But for patients in other circumstances, plans with lower premiums could end up costing more if they receive care from a provider outside their plan’s network.
Not only could they wind up paying most or all of the bill, they would lose the law’s cap on out-of-pocket expenses.
Some of the excluded providers are the most expensive and the most important. Harborview is the region's Level 1 trauma center and burn center, and excluded from many plans. Nobody wants to go to Harborview. But if you need to, you NEED to.
Seattle Children's Hospital is the go-to place for serious medical problems for children. Expensive and irreplaceable. Seattle Cancer Care Alliance (University of Washington Medical, Fred Hutchinson Cancer Research, Seattle Children's) is another critical facility for many. Some of the insurers say that they will consider paying case-by-case. If you are unconscious and the paramedics call the helicopter to get you to Harborview, what happens with the bill? I know a man who had a horrible car crash and a $2 million bill at Harborview.
My union retiree health insurance is better than anything for sale privately, and we are very grateful. I've suggested to my state legislators that they pass laws to give the Insurance Commissioner the authority to require all providers to charge all insurance and case customers the same rate. They can charge whatever they want, and Medicare, Medicaid, and charity cases get discounts, but everyone else pays the same. No negotiated rates with one company but not the next. It would be better for the Insurance Commissioner to require coverage where ever one goes due to a medical necessity.
Best of all would be a state single payer...or Medicare-done-right-For-All.