One of the valid complaints against the Affordable Care Act is that insurers, in a money-saving move, have limited the choices of doctors and hospitals they will cover in plans sold on the health insurance exchanges. In some states
that's about to change.
In states including New York, Connecticut and Ohio, insurers have bolstered their health-care provider networks in recent months. In California, three of the biggest insurers— WellPoint Inc. WLP -0.80% 's Anthem Blue Cross, Blue Shield of California and Health Net Inc. HNT -0.92% —have all added substantially to their lists.
"There have been quite a few network additions…and there are more to come," said Jeff Rideout, senior medical adviser to Covered California, the state's health-law marketplace. "We continue to ask the plans to expand their networks to meet the needs of the enrollees that we have."
CareSource, based in Dayton, Ohio, has added more than a half-dozen hospitals since the start of the year, and it hopes to roughly double the number it currently has to more than 50. Fidelis Care, a New York nonprofit focused largely on Medicaid, has added more than 4,500 providers, including 13 hospitals, since the start of the year. More hospitals and doctors have joined "as we've started to get more enrollment, and as we've shown that we are paying claims accurately and timely," said David Thomas, chief operating officer.
The insurers say that more providers are interested in joining networks, which in some cases reimburse the doctors and hospitals less than traditional employer-provided plans. According to a McKinsey & Co. analysis cited in this story, 48 percent of the plans in the exchanges nationally have limited networks, and 69 percent of the least-expensive plans have narrow networks, all to keep costs down. But the success of the exchanges in this first enrollment period has broadened interest. In some cases, like CareSource in Ohio, the demographics of who signed up made them expand their network. CareSource found that the average age of its enrollees was 41 years old and because many of those new customers have families, they sought to include a children's hospital in Cincinnati.
This is a trend that's likely to continue as the enrollments in the exchanges grow, as more insurance companies join the exchanges and as insurers seek to become more competitive on the exchanges.