In case you missed it, a recent story in The New York Times discussed new efforts to address complaints about limited access to doctors and hospitals in certain health insurance exchange plans, also known as narrow networks. There are many criticisms from patients who have gone to in-network hospitals, but have been treated by doctors who don’t participate in their insurance plan, resulting in hefty bills that may take them by surprise. This is because costs for out-of-network care typically do not count towards the maximum amount patients can be required to pay out of pocket. This maximum is set at $6,850 for an individual and $13,700 for a family.
The story also highlighted recent research from Harvard that found certain health insurance exchange plans “completely lacked in-network physicians for at least one specialty.” The most common specialties excluded were rheumatologists, endocrinologists, and psychiatrists. Limited coverage options are especially problematic for patients managing chronic conditions who may need to see a particular specialist for their disease. This is similar to concerns about coverage of prescription medicines; patients must be able to access the medicines they need regardless of pre-existing conditions.
New standards from the National Association of Insurance Commissioners would require insurers to have enough doctors and hospitals in their networks to provide all covered services “without unreasonable travel or delay” and protect patients from exorbitant costs for unexpected out-of-network care. We need to ensure the same is true for coverage of prescription medicines.
Check out AccessBetterCoverage.org for more information about health insurance coverage.
Allyson Funk Ally is a former senior director of public affairs at PhRMA focused on advocacy issues for the biopharmaceutical industry. Her expertise includes Medicare, Medicaid, 340B, health reform and more. Prior to PhRMA, her experience included leading health communications for a large membership organization, supporting public affairs clients and working for the governor of Louisiana.