Do Not Assume Your Provider Network Will Be The Same As It Was Last Year

A description of PPO, HMO, EPO and a search tools for all carriers is available here.

EDIT 2/18/14:  Connect for Health Colorado updates the provider directory once per month.  It is possible therefore that the list may not be up-to-date at all times.  If you have questions, you can call your carrier directly, or contact the provider directly.  

For people who want to make sure they have coverage at specific doctors’ offices and hospitals, checking provider networks has always been part of the process of selecting a new individual health insurance policy.  But it’s especially important if you’re shopping for a policy in Connect for Health Colorado.  In order to keep prices a low as possible within the exchange, some carriers are limiting the scope of their provider networks.  Plans can no longer underwrite based on medical history, and there are robust requirements in terms of the essential health benefits that all of the plans must cover and the actuarial value that they must all provide.  So narrower networks are one of very few options carriers have for reigning in costs and competing based on premium amounts.

A recent Colorado Springs Gazette article explains more about the narrower networks for new plans in Connect for Health Colorado.  And although it’s true that networks are smaller than they were last year, this isn’t necessarily a cause for alarm in and of itself.  An excellent New Republic article focused on networks in Southern CA and the exclusion of prestigious Cedars-Sinai Medical Center by many of the new plans (the piece starts by mentioning the original works by Picasso and Warhol that grace the hospital’s walls… I’m reminded of an article I wrote several years ago about how hospital bling doesn’t really serve to make health care more accessible).  Although the exclusion has outraged people who previously had coverage at Cedars, the article diligently tracks down outcomes and ratings that place other local hospitals higher in terms of performance, but much lower in cost.

Anthem Blue Cross Blue Shield Network PPO HMO ChangesLong story short, it might not be such a bad thing to have narrower networks, as long as high quality providers are included.  And the trade-off is lower priced health insurance, which is a selling point for all but the most wealthy among us.

But with that said, it’s also important for consumers to be aware of the fact that networks are changing.  Anthem Blue Cross Blue Shield will probably be the most notable one for many people, simply because of their large market share and name brand recognition – and the fact that all of their products on Connect for Health Colorado have narrower networks than their traditional pre-2014 PPO plans.  The exchange plans are all HMOs instead.  If you had an Anthem individual plan in 2013 and you’re buying an Anthem plan in the exchange during open enrollment, do not assume that your network will be the same as it was last year.  Your best bet is to contact your doctors directly if you have questions about their network participation.  You can also use Anthem’s provider search tool, but make sure that you enter the correct plan type in section 4.  The main point is that you can’t just assume that an office that “takes Blue Cross” will be in-network with your new plan.

For people who aren’t particularly attached to a certain doctor or who have previously been uninsured, the lower prices of the narrower network plans is likely a very attractive trade-off.  For people with complicated medical histories who want to be sure that they have continued access to their existing doctors however, it’s wise to pay close attention to the network that comes with the health insurance policies you’re considering.

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP. Follow on twitter and facebook.

Comments

  1. Maggie Mahar says:

    Louise –A great post!

    Thanks much for pointing out that Cedars Sinai in L.A. isn’t providing great value for the prices it charges. As you say, “bling” doesn’t improve hospital care, though it can add to the perception that the hospital is better. (In fact, we have no evidence that higher prices correlate with higher quality.)

    Also when consumer reports looks at insurers (using NCQA quality measures) it finds that HMOs (that have narrower networks) get high ratings for preventive care, making sure that patients chronic diseases are managed, and patient satisfaction than PPOs.http://www.healthbeatblog.com/2011/10/patients-prefer-hmos-and-other-healthcare-surprises/

    Non-profits also rank “head and shoulders” above for-profit insurers. This is something people might keep in mind when picking a plan.

    Finally “integrated health plans” (that both provide health care and insure you) such at Group Health in Wisconsin, or Kaiser in Colorado anywhere are, by definition narrow networks and get very high ratings. http://www.healthbeatblog.com/2013/05/who-will-sell-insurance-in-the-exchanges-non-profit-insurers-for-consumers-this-is-great-news-part-1/

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