In principle, I think narrow networks in health insurance plans are a good idea — if that means that doctors within the network coordinate care with each other and truly manage the patient’s care, in the manner of the original HMOs, in which, after all, the entire concept was “health maintenance,” and reducing the overall healthcare cost by working with the patient to stay healthy, manage diseases appropriately, etc. In fact, if it were up to me, I’d have Medicare move entirely to an “HMO” concept in which primary care physicians (or physician’s assistants or nurse practitioners) exercise genuine coordination of care regarding the multiple specialists and dozen-odd drugs seniors are likely to take, since, let’s face it, as you age you’re less and less able to manage your healthcare in a “mindful consumer” sort of way.
In practice, so far as I understand, anyway, the way the “narrow network” plans are working is simply by including only those providers willing to accept lower levels of reimbursement.
And, given our family’s admittedly minor-in-the-grand-scheme-of-things brushes with high-cost healthcare (here and here, plus others not chronicled), that’s why, when a plan appeared among the open enrollment choices this year with a substantially smaller premium than the rest but with my usual OB/GYN provider not listed as in-network, I started digging. “Surely this is a mistake,” I thought, as I’ve never (not since our HMO days, long ago) seen them missing from the lists of providers, and I made some phone calls, eventually ending up on the phone with the insurer, who said, “usually this provider is covered, but your employer is offering a narrower network plan.”
Now, I’m as much a bargain-hunter as the next one, but I simply don’t want to be in the situation of being at the hospital getting emergency care for myself or someone in the family, and worrying about whether the doctor on staff is in the network or not. In fact, if it were just about the OB/GYN practice, I’d switch — I don’t really care for infrequent check-ups. But I’m more concerned about what this suggests about their network, in general.
In fact, that’s one crucial piece of information that’s missing, in the way our employer, and likely yours, too, provides health insurance plan information. Sure, you can check if any particular doctor is listed. But I’d rather see a metric: “percent of doctors within 10 mile radius of selected zip code who are in the plan’s network.” Oh, and “percent of brand name medications which are included in the plan’s formulary” wouldn’t hurt, either.
So how’s your annual enrollment going?
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