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How are health plans’ 'narrow networks' affecting your medical care?

by AirTalk®

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A healthcare reform specialist helps people select insurance plans at the free Affordable Care Act (ACA) Enrollment Fair at Pasadena City College on November 19, 2013 in Pasadena, California. David McNew/Getty Images

Consumers in some parts of the country—including California—are finding that the plans offered under Obamacare give them access to fewer health care providers than their old plans.

Insurance companies narrow their provider networks to save money—promising select providers more patients in exchange for lower reimbursement rates. It’s not a new phenomenon but, as KPCC’s Stephanie O’Neill reports, it’s become more visible as insurance companies compete in Obamacare’s new exchanges.

Narrow networks happen for one of two reasons, O’Neill reports. An insurance company excludes doctors or hospitals it considers too expensive—or a doctor or hospital rejects the reimbursement rates offered by the insurer.

There’s also a lack of accurate information about which providers are—and aren’t—in Covered California plans, leaving some consumers surprised and frustrated when their new plan doesn’t cover a visit to their longtime doctor.  

 For example, analyses show that many of the specialty providers and hospitals relied upon by cancer patients are largely left out the new health insurance exchange plans in states including California, New York and Texas. A recent study of 20 metropolitan areas in the U.S. found that two-thirds of Obamacare plans had narrow networks, with 30 percent of the top 20 hospitals excluded.

Have you had trouble keeping your doctor under your new plan? How difficult has it been to determine which providers are covered under which plans?


Stephanie O’Neill, KPCC Health Care Correspondent

Jeffrey Miles, a Marina del Rey insurance broker and two-time past president of the California Association of Health Underwriters

Dylan Roby, Assistant professor of Health Policy and Management at the UCLA School of Public Health

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