Obamacare Insurers May Be Required to Broaden Medical Networks

[highplainsdem]

Source: Businessweek

Insurers participating in Obamacare may have to expand their plans to include more federally funded health clinics, safety-net hospitals and other medical providers used by low-income people, under a U.S. proposal.

Health plans offered through government-run insurance exchanges may be required to cover 30 percent of “essential community providers” in each county in 2015, an increase from 20 percent this year, according to a document obtained by Bloomberg News. The proposal will be outlined today in a letter to insurers from the Health and Human Services Department.

As millions of Americans join health plans created through the 2010 Patient Protection and Affordable Care Act, consumers and regulators are paying greater attention to the breadth of available coverage. Insurers say smaller networks of hospitals and doctors help contain costs and improve care. Providers serving low-income people have complained that exchange plans won’t allow them to join the networks, said Sara Rosenbaum, a professor of health policy at George Washington University.

“Everybody is obviously very concerned that what’s going to happen is their patients will be swept away -- they will not be identified as preferred providers in networks,” Rosenbaum said in a phone interview. “Clearly something has set off alarm bells.”

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Read more: http://www.businessweek.com/news/2014-02-04/obamacare-insurers-may-be-required-to-broaden-medical-networks

[DonViejo]

1. But then again,...

Obamacare Insurers May NOT Be Required to Broaden Medical Networks but let's start a shit storm anyway.

[Sunlei]

2. Humana insurance from the exchange puts ONE provider on your card..you have to get that providers

'permission' for any healthcare you want. Humana even restricts where you can buy medications.

If you want the insurance that has several local Doctors 'in network' and gives some discount for out of network healthcare...you have to get the insurance that is called (on healthcare.gov) 'multistate'. That costs hundreds of dollars more a month.

I'm so sick and tired of insurance corp screwing people for profits.

There should be NO NETWORKS, NO RESTRICTIONS on healthcare 'insurance'. I think only the state of Vermont allows insurance holders to go to any Doctor or hospital they wish.

You don't have to first call and ask permission from some person who probably makes a bonus from the insurance company.!

[Herself]

3. definately needs a lot of fixing.

But if you are someone that didn't have any choices, it's better than the gop "Idon'tCare" option.

Last year I had several procedures done. 2 were 12k a piece. If you had no insurance, that is what you were looking at. When you can't pay within 90 days, your credit rating goes in the dumper, you get a lien on your home, and constant harassment on the phone.

[Sunlei]

4. you are so correct, 'Obamacares' is "better than the gop "Idon'tCare" option"

and much better because insurance can not refuse people anymore or ruin them.

My post was more of a rant from me, I want to be in control of my healthcare and not have to call some 'for profit' corp all the time to ask 'permission'. The Humana restrictions are on every single little thing.

I wish we had NON-PROFIT Medicaid/Medicare for all and just paid the Federal Gov directly premiums on the sliding scale. The Federal Gov. directly paid the Doctors and hospitals.

We need to cut out these 'for profit' middlemen insurance corps. You can see by their rising stock prices they still make a fortune off our Federal funds and us.

[crazylikafox]

5. This is not new for Obamacare ..this is how most insurance worked before.

It's called having a "primary care physician" who is your "gatekeeper" for specialists, etc. I've had very good insurance coverage in the past that worked this way. It's usually less expensive than policies that allow you to go anywhere you want and to any specialist you want without a referral. Same with using a network of pharmacies.

It's annoying, but please don't blame Obama for this one.

[Xithras]

7. This is how HMO's work. HMO's have always sucked.

Employers like them because they are cheap, but that's their only upside.

My current employer offers us two options. We can get a very good, completely free HMO plan that covers just about anything (for the employee only, the rest of the family costs extra), or we can pay a couple hundred a month to cover the difference and get a PPO plan that does the same thing. I pay the extra money, and have never regretted it. Having to ask permission from your PCP before seeing any specialists is idiotic. The system was designed for the sole purpose of denying people access to specialists. My father in law was once told by his PCP that his chest pressure "wasn't serious enough" to warrant a referral to a cardiologist...three months before he had his first heart attack. The doctor just wanted to "keep an eye on it" and prescribed some blood pressure meds. That's how an HMO is designed to work.

[Sunlei]

8. I know how insurance works and the "gatekeeper' restrictions have to change.

The blame is totally on the "for profit" insurance corps. Those middlemen want the biggest cut of our federal money they can grab.

I hope the Doctors excluded from the 'for profit' gravy train scream bloody murder. I bet they don't like being restricted from the 'in network' list. Pharmacies to are screwed out of new business because these insurance corps restrict where you can fill an RX.

[Xithras]

6. People do need to pay more attention to the networks in the ACA plans they select.

I know two people who traded in their private insurance plans for ACA Covered California plans to save money, and were floored to discover that their new plans only have a fraction of the doctors covered in their old plans. Sure, they were stupid to change policies without checking their coverage first, but it's a mistake that a lot of people seem to be making (our state insurance commissioner even had to make a public statement warning Californian's to look carefully at the provider networks before switching, because their office is getting swamped with complaints about it).

People need to be aware that the ACA plans offered by most companies seem to be scaled down and heavily restricted versions of the plans offered to private purchasers and employers. There's been an abysmal amount of public commentary on this...the insurance companies don't want to talk about it because they are trying to sell these plans, and the government doesn't want to talk about it because they're trying to promote the program, and you don't promote something by highlighting its flaws. The result has been a lot of people unintentionally losing access to their longtime doctors, specialists, and clinics. The loss of access to community health clinics in this article is just one example of that.

[Sunlei]

9. The ACA plans that don't restrict Doctors are called 'multi state' & they cost hundreds more a month

They also cover only about 40% for 'out of network'.

Insurance Corps who receive our Federal money should not be allowed to restrict any Doctors or services.