Narrow networks have sparked concern that they will unduly limit patient care and lead to increased patient use of out-of-network providers with higher out-of-pocket costs.
As health plans and purchasers struggle to keep premiums low and quality high, many are turning toward narrower networks. However, limited networks have sparked concern among consumers, plan sponsors and policy makers who worry that they will unduly limit patients’ access to care and lead to increased patient use of out-of-network providers with higher out-of-pocket costs. New York has passed a new law to protect consumers from unexpected out-of-network costs and many states are considering tougher standards for network adequacy.
READ: Narrow networks set to increase in 2015
When plan members face unexpectedly high costs or receive a bill for services they thought were covered, it affects how they value their benefits and, in the case of employer-sponsored plans, the sponsor’s overall satisfaction with the plan. In addition, insurers may find themselves spending valuable time and resources dealing with frustrated members or time-consuming appeals. For narrow networks to work, they must work for everyone--plans, purchasers, plan sponsors, participants and providers. That means delivering access to timely, accurate and user-friendly information to ensure that plan members get the most out of their provider network.
Plans and benefits advisors will need to:
Support plan sponsors
Insurers, consultants and brokers who advise plan sponsors can support the decision-making process by providing customers with clear, concise resources and tools that outline the specifics of their health plan options, and what they mean for members. It is important to help decision-makers understand the costs beyond premiums--deductibles, encounter fees and cost sharing in both in- and out-of-network scenarios.
Communicate from the beginning
It is critical that members understand their network options before they enroll. Health plans should provide linguistic, culturally specific, easy-to-read educational tools and benefit summaries at the point of enrollment. Plan members should understand they are signing up for a limited network, and that costs may be significantly higher if they seek care out of network. Consider providing side-by-side comparisons that outline each plan’s cost-sharing obligations and out-of-network coverage for services.
Make sure members know the cost consequences of going outside their network, and some unexpected but common ways that can happen--for example, receiving care from an out-of-network anesthesiologist at an in-network hospital. Remind members to inquire whether all the healthcare professionals and facilities involved in their treatment participate in their network before they receive care.
Provide context for decision making
Offer cost estimation tools alongside the provider network lookup on your plan’s website to help members understand the higher costs they might incur if they go outside their network.
Keep the provider directory current and accessible. Make sure that plan sponsors and members have easy access to complete, accurate and current information about healthcare organizations, professionals and services in their network.”
It’s also important to remember that providers need this information, too. Plans must also take steps to: