Narrow Provider Networks Are Not All The Same. Know the Difference…Someone’s Life Could Depend Upon It.

With the official arrival of healthcare reform, a lot has been written lately about the topic of “narrow networks.” In fact, we’ve recently written about it here Keep Your Doctor? Your Preferred Hospital? Do Your Homework Before Selecting A Plan.

Employers and their employees should know this: There could be a huge difference between established narrow networks of healthcare providers (developed and offered prior to 2014) and some of the new networks created primarily to accommodate the new lower cost Obamacare plans offered on the exchange.

Many of the narrow networks offered prior to 2014, for example, placed a more discerning emphasis on contracting with high performing providers. These networks gave a nod toward the combination of higher quality and lower cost.

Many of the new narrow networks created for the exchanges are aimed primarily at low cost and bear a striking resemblance to Medicaid networks. They are comprised mainly of only those providers willing to accept Medicaid-like fee-schedules.

Describing how carriers built these new networks, one highly respected industry insider indicated that contracts containing these low fee-schedules were mailed out to the provider community. Carriers then waited to see which of the providers would accept this low rate of pay and sign-up. The new networks were then built accordingly.

So what’s the net for all of us?

Caveat emptor. If you or your employees know anyone considering plans utilizing a narrow network, especially one of the lower cost Obamacare plans on the exchange, it’s more important than ever before to review and understand what providers are in the network before selecting a plan. Ultimately, someone’s life could depend upon it.



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