Peggy Salvatore of Healthcare Talent Transformation did an excellent job of hosting this week’s Health Wonk Review, and there are several really good articles included. I particularly liked David Williams’ thoughtful article about the short-sightedness of narrow health insurance networks. Small networks might initially provide more leverage to both providers and health insurance carriers, but it’s hard to see how they would benefit patients, who are the healthcare industry’s consumers.
When Jay had knee surgery a couple years ago, we ended up having to pay an additional $400 on top of our $3000 deductible because the medical supply company that our in-network hospital used wasn’t in our health insurance network. My mother fell off a roof and broke her femur earlier this year, and the ambulance was out of network. Since it was an emergency, and people don’t have much choice in terms of who comes to get them when they call 911, her health insurance policy paid reasonable and customary charges for the ambulance. But the actual charges were several hundred dollars more than that, and despite appealing to both the insurance carrier and the ambulance service, my mother ended up having to pay the extra charges out of pocket, in addition to her deductible. Incidents like this are frustrating, especially when you’re sick or injured. And narrowing provider networks are pretty much guaranteed to make stuff like this more common, with fewer doctors at each hospital included in various networks, and patients more likely to see at least one out of network provider (or lab, or supply company, or….) during a hospital stay.
As David pointed out, there’s also likely to be frustration for patients as providers move in and out of networks. This can happen regardless of the size of a network, but if networks are purposely kept small, it’s more likely to happen. Patients tend to be wary of having to find new doctors, and having to do so simply because of network changes isn’t likely to make people happy. Hopefully the idea of narrow provider networks won’t become a widespread trend with employers, medical providers, or health insurance carriers.
