What do you look for in a healthcare plan? If you’re like most people, price is your number one concern.
That’s only natural. Very few people expect to get cancer or have a heart attack. But they clearly see the benefits of saving a few hundred dollars on insurance.
Insurance companies – whose only real goal is profit – understand this. And they’ve come up with all sorts of tricks to provide “cheap” healthcare plans.
One of those tricks is called “narrow networks.” That’s when a health plan has a very limited pool of providers… which helps insurers control costs. And offer you a lower premium.
But there’s a catch. One, researchers at the University of Pennsylvania (UP) found could make the difference between life and death. Here’s what you need to know about narrow networks.
Save a Little Today… Gamble With Your Life Tomorrow
Narrow network plans are popular on healthcare exchanges because they offer a lower cost than most other plans. The UP researchers found something else that was lower in narrow networks.
Top-rated cancer care.
In a survey of 248 plans on the exchanges, about a third qualify as narrow network. That is, they include less than 25% of an area’s providers.
In the wider networks, 34% of included oncologists were affiliated with a top-rated cancer center. In narrow networks, only 17% were.
Which means your chances of getting what’s considered the most advanced cancer care are a lot slimmer in narrow networks. With rare or hard-to-treat cancers, that could decide whether or not you survive.
That’s not the only way you can lose out in a narrow network, either.
Bargain Basement Healthcare
As two surgeons recently wrote in the Neurosurgery Blog, narrow networks have nothing to do with value or quality of care. In these networks, insurers negotiate deep discounts with a handful of healthcare providers. So it’s really about cheap healthcare.
Patients have limited choices. And, in rural areas may have to travel unreasonable distances to find “in network” services.
The Affordable Care Act set standards for network adequacy. It requires plans to provide a network wide enough to ensure necessary care without undue hardship. But the language is vague.
So patents may be barred from top-rated healthcare… or face huge out-of-network costs. They may also have to travel significant distances for individual services (bloodwork, x-rays and CAT scans, etc.) when those services are available nearby… but “out of network.”
This bargain basement approach isn’t limited to the lowest coverage tier on the exchanges. The Robert Wood Johnson Foundation found 41% of the silver (mid-tier) plans had small or “extra-small” networks.
Here’s a practical example I’ve used before…
You need surgery. You consult with an in-network surgeon. You have the operation done at an in-network hospital. Then you’re hit with an unexpected bill for thousands of dollars, because the anesthesiologist isn’t in your plan’s network.
The narrower the network, the more likely you’ll have this problem. So what can you do?
Be Aware and Be Prepared
First, check with your state’s insurance commission. About half the states have rules requiring – and defining – adequate coverage for at least some marketplace plans.
Second, before you choose a plan, don’t just look at the price and services covered. Check on the in-network healthcare providers. If a plan doesn’t meet your needs, you could easily spend more in out-of-pocket costs than you’ll save on premiums.
Finally, don’t assume that all providers and services at your in-network hospital are covered by your plan. Double-check to ensure you don’t face any nasty surprises.
About the Author: Jason Kennedy is a celebrated investigative health writer and the author of The X-Factor Revolution and Beyond the Blue Zone. With over 10 years of experience working with today’s leading alternative and anti-aging doctors, Jason shares his insider status and access to the latest breakthroughs with thousands of readers from around world.
“Insured, But Still Barred From Top-Tier Cancer Centers,” MedlinePlus. Jlu 20, 2017.
Benzil, D.L. and Schimer, C.M., “Narrow networks have no connection to quality or value,” Neurosurgery Blog, via KevinMD Blog. Apr 28, 2017.
Polsky, D. and Weiner, J., “The Ski
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