To minimize costs, many insurers providing healthcare plans through the online marketplace are limiting the number of doctors and facilities available in a particular network.
Proponents of the Affordable Care Act have made the case that insuring a greater number of people will help ease the burden of healthcare costs by including those who have previously sought care through emergency rooms or other taxpayer-funded facilities.
Tightening provider networks, insurers argue, is another effective way to reduce premiums and out-of-pocket costs. Many have excluded providers such as research hospitals from their lower-level networks, as these facilities tend to charge more for the same services and can drive up the insurer’s cost of coverage.
One explanation for this move is that price, not provider, is of primary importance to consumers shopping on the exchanges. Many of these consumers are currently uninsured and up to 90 percent of them will qualify for tax incentives available to offset premiums. Because of this, most of them will not be trying to maintain an established provider relationship.
Those consumers who do want to keep their current provider will have to do their research and may have to enroll in a higher-level plan to do so – one benefit of higher tiers is greater access to providers.. In certain states there is a greater concern for keeping the same doctors, while in other states the main goal is to find the lowest price possible. Insurers have also indicated that they will not tighten networks as much in areas with fewer doctors available, though in densely populated areas networks may only include 50 percent of available providers.
Contributing to consumers’ frustration are ongoing technical glitches that make it difficult, if not impossible, to see if one’s doctor is in a plan they are considering.