Friday, January 10, 2014

Even doctors want to know what health plans they are in

Striking a balance of price and reasonable access to quality medical care is an evolving issue nationwide, Insurance Commissioner Mike Kreidler told a leadership gathering of the American Medical Association on Jan. 10.

The key topic for the panel on Jan. 10: How insurance regulators, medical providers and insurance companies can guarantee patients access to quality care.

Several of the larger health insurers kept their rates down by limiting their provider networks,” Kreidler said during a panel discussion at the AMA’s 2014 State Legislative Strategy Conference in Tucson, AZ.  “This has upset both consumers and providers.”

Kreidler said that he noticed a trend by insurance companies last summer to develop “narrower networks” of doctors and hospitals in the new health plans they offered for the first time on Washington’s Health Benefits Exchange, which manages the Washington Healthplanfinder.

That’s the online site where consumers can shop for 46 health plans and, in many cases, get subsidies to help pay for premiums.

Consumers can also choose from 51 plans in the outside market, where subsidies are not available. Although narrower networks are found in these plans as well, the concern is more prominent in the Exchange.

In some cases, insurers did not contract with doctors and hospitals that had traditionally been part of their networks. The new business model emerged as a way for insurers to keep premiums as inexpensive as possible for consumers.

This development has raised a red flag for consumers and doctors alike. Kreidler recognized the issue when insurers began filing new plans last year. His office is now developing further guidelines to make sure that consumers have reasonable access to services.

More transparency about which doctors and facilities are included in the plans is another key aspect – for both consumers and the medical community. 

His office has already received many comments from consumer groups, doctors, insurers, Indian tribes, legislators and more. Draft rules will be ready in February and will be open for more public scrutiny.

Kreidler noted that this is just a first step.

 “We want to make sure that we have up-to-date information so that consumers know which networks their doctors are in,” Kreidler said. “Doctors also want to know the networks they’re in. What we want to do is establish a common frame of reference for everyone.”