When
searching for a health plan, the first decision filter for most people is the
premium. While the premium is an
important component in the final decision, perhaps the most important place to
start is with a review of the network.
That’s the assembly of hospitals and doctors that participate with the
insurance plan; thereby allowing for negotiated discounts with the insurance
carrier for services rendered.
Additionally, office copays and other parameters of the health plan,
such as deductibles and out of pocket expenses, are lower when you are treated by
a network (participating) physician and in a network health care facility.
As a result
of the health care reform, many consumers were confused after enrolling in an
inexpensive individual policy. One of
the major points of confusion surrounded the narrow networks. People signed up
for coverage only to learn that their doctor and/or hospital was not
participating in the network. One reason
why the plan was inexpensive was because of the negotiating power that exists
with a smaller network of physicians and hospitals. In essence, the smaller network works like
this: People are compelled to choose
in-network doctors and hospitals to decrease out of pocket costs. The network of doctors and hospitals is
limited, thereby increasing the volume of patients to those physicians and
facilities. For that trade-off, those
physicians and hospitals will negotiate a lower rate of reimbursement for care from
the insurance company than what would normally be charged.
A narrow network exists to cut down on health
care costs. In theory, it is not a bad
idea, providing that the network includes desired physicians and
hospitals. The problem is that many of
the narrow networks exclude some of the best facilities and doctors desired by
many to see for care. Certainly
economics is important and, when given no other choice, choosing a
narrow-network is better than not having health insurance at all. But, health care is a very personal affair
and, before you decide which plan is right for you, I suggest you review the plan
to ensure that your choice of doctor(s) and hospital(s) is part of the network
of participating providers.
Initially,
public exchanges did not make networks available on the websites. In fact, narrow networks became a front page
news story for months as people realized that desired doctors and hospitals
were excluded from the list of participating providers. A professional benefits broker can assist you
in understanding the plan’s network and limitations and can assist you in
understanding the differences between the many alternatives that exist for no
additional fees. Many times, the
incremental dollars invested for a larger network is well worth it, especially,
if you like your doctor. In any event, it
pays to know your network!
