Oregon is among a dozen states whose health insurance policies offered ample provider choices last year, according to a new report.
That’s according to the Robert Wood Johnson Foundation and the University of Pennsylvania’s Leonard Davis Institute of Health Economics. The report, which studied silver policies available on states’ health insurance marketplaces, found zero networks in Oregon that were narrow, which the researchers defined as considering fewer than one-quarter of doctors in the area in-network compared. That’s compared to as many as 83 percent of networks in Georgia to be narrow. It costs much less to see in-network providers compared with those considered out-of-network.
The Affordable Care Act placed a number of restrictions on the insurance policies companies can offer. It limited the amount policyholders would have to pay for health care each year. It required they cover a list of essentials, such as emergency care and prescription drugs. It made companies offer policies within certain metal tiers, such as bronze — the least expensive policies which cover about 60 percent of health care costs — and up to platinum — which are the most expensive and cover about 90 percent of health care costs.
With all of those restrictions in place, there aren’t many things insurance companies can do to keep variation among their different plans, said Dan Polsky, one of the report’s authors and executive director of the Leonard Davis Institute of Health Economics.
“Narrow network is like another lever that can be pulled,” Polsky said. “If you restrict all these other levers, that lever is going to be one that may be more attractive because it’s important to be able to offer low-cost products to consumers who are very price sensitive.”
Narrow networks aren’t necessarily a bad thing. It just means there’s a shorter list of doctors policyholders can see compared with other plans. On the bright side, it could keep policies cheaper, and fewer choices might not be problematic for some people.
Small business owners in Oregon, for example, have urged the state’s Insurance Division not to limit their ability to offer narrow network policies to their employees, said Gayle Woods, a senior policy adviser with the division. In many cases, that’s the only way to keep the coverage affordable.
The downside, however, is that narrow networks could limit access to certain providers, especially specialists, and policyholders might need to wait long periods of time to see the providers covered under their policies. And with all the focus on how much policies are going to cost every month, not everyone thinks about which providers are covered under those policies when they choose them.
Kristine Akenson, a health insurance agent with High Desert Insurance in Bend, said she first helps clients check whether their primary care providers are covered under the plan they’re considering. After that, it’s also important to check on the specialists they might also want to see during the year, especially alternative medicine providers like chiropractors and acupuncturists.
Coverage for mental health providers such as therapists and psychiatrists can be especially tricky, she said.
“Those are the ones I run into the biggest problem making sure that they’re covered,” she said.
Some states, such as California, Colorado and Florida, have rules in place that require carriers have enough providers of each type located within a certain distance in their policies. Interestingly, Polsky’s study found no connection between states that have such rules, called network adequacy rules, and the proportion of narrow networks in those states.
In Florida, for example, 79 percent of silver policies had narrow networks last year, according to the report. Its network law requires plans to have an “adequate regional network of providers.”
California’s law requires insurance companies to submit annual reports to the state summarizing their provider networks, including where they’re located, their ethnic composition and what languages services are available in.
Polsky guesses that’s due to the fact that state regulators don’t have information on the proportion of networks that are narrow versus medium and large.
“No one has a clue,” he said. “How are regulators supposed to enforce network adequacy rules when nobody knows which doctors are in-network and which ones aren’t?”
Oregon is still in the process of developing its network adequacy rules, which will take effect at the beginning of 2017. Oregon companies that sell policies via HealthCare.gov will have to submit annual reports to the Insurance Division detailing their plans for including a “sufficient” number and type of providers in their networks. (That rule will not apply to large group plans.) What information they’ll have to include is still being hashed out, but Woods said it will likely include a list of providers.
A new federal rule that takes effect in 2016 will require all carriers to feature up-to-date provider directories on their websites, including which are accepting new patients. The information will need to be broken down by type of policy in the event the company’s bronze, silver and gold plans have different networks.
Akenson said she sees both the good and bad in narrow networks. While it’s nice to have a broad array of providers to choose from to eliminate any worry about not being able to be seen, many people are fine with a plan that simply covers the doctor they want to see.
“It doesn’t make sense to pay more money for a plan that just gives you more options for who to go to,” she said. “I think some of it comes down to our own mental, ‘Don’t tell me who I can go to.’”
— Reporter: 541-383-0304,