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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.

Originally posted to Joan McCarter on Tue Jun 10, 2014 at 10:19 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (23+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Tue Jun 10, 2014 at 10:19:31 AM PDT

  •  On the other hand (2+ / 0-)
    Recommended by:
    ferg, worldlotus

    I just got a notice from Blue Cross (my ACA/exchange insurer) that they are requesting 12.5% rate hikes for 2015 on all individual policies including the ones sold through the exchange. (They're the only insurer in the exchange, other than the small Neighborhood Health Centers.) They helpfully point out that those of us getting subsidies won't see much if any increase, however, because the federal subsidies will absorb the increase.

    They do point out that they have to spend 85% on actual medical care; they claim, however, that they're currently spending far more than that, so it looks to me like they want to get it DOWN to 85% and reap the additional profits. They also highlight the increased uncertainty about the impact of the ACA on medical services usage, as the reinsurance arrangement is phased out in 2015 and 2016.

    Is this like student loans, which enabled colleges to raise their tuition rates exponentially for decades? As long as the feds are subsidizing it, the insurance companies can keep putting in 10-15% annual premium increases?

    If so, this is a bad consequence of the subsidy system. I hope the Feds (as well as the state regulators) will weigh in to keep premium increases low. Otherwise, the cost to the Federal Treasury could balloon up to the GOP's wildest dreams.

  •  Good (0+ / 0-)

    My rural county had only two insurers on the exchange, one of the Blues and their for-profit subsidiary.  Where's that Republican free market competition?

    My solution to the network problem...
    ...Let the providers charge any rate they want, but they must charge everyone that same rate.  The same rate for all insurers and for cash customers.  Lower rates are OK only for Medicaid, Medicare, and charity cases.

  •  This is great news. The demand is such (1+ / 0-)
    Recommended by:

    that it makes business sense to expand networks in the exchange. We just have to make sure Hillary gets elected to allow this new system to develop.

    Global Shakedown - Alternative rock with something to say. Check out their latest release, "A Time to Recognize": Available on iTunes, Amazon, Google Play, Spotify and other major online music sites. Visit

    by khyber900 on Tue Jun 10, 2014 at 12:24:24 PM PDT

  •  More positive things for ACA (1+ / 0-)
    Recommended by:

    Time for the GOP to repeal it for the 52nd time.

  •  Had a test the other day (1+ / 0-)
    Recommended by:

    at a major Minneapolis hospital.  The woman who conducted it told me that the hospital had seen the largest number of patients for testing in its entire history.  When I asked if she thought it had been because of the ACA, she said she was almost certain it had been because nothing else had changed to make her think otherwise.  

    -7.13 / -6.97 "The people never give up their liberties but under some delusion." -- Edmund Burke

    by GulfExpat on Sat Jun 14, 2014 at 03:00:46 PM PDT

  •  Here in New Hampshire, only one carrier .... (1+ / 0-)
    Recommended by:

    ... which was Anthem-Blue Cross - offered coverage for 2014.

    But beginning next year, an additional four carriers will be offering coverage.

    "We should pay attention to that man behind the curtain."

    by Ed Tracey on Sat Jun 14, 2014 at 06:02:19 PM PDT

  •  Me thinks..let them raise the rates...bolster o... (0+ / 0-)

    Me thinks..let them raise the rates...bolster our side to move it to single payer..."MEDICADE FOR ALL"

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