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How Narrow is Your Network?

If you’re covered by an Obamacare health insurance exchange plan, be careful: its coverage may be narrower than you think. And that can add up to a significant increase in your out-of-pocket expenses for health care.

Let’s say, for example, that your doctor is concerned about your thyroid and thinks it makes sense for you to see an endocrinologist.  Small problem: you research your network information and discover that there are no endocrinologists listed. Could this really happen?

Sadly, the answer is yes and it happens more often that you may think. According to a recent study published in JAMA, the journal of the American Medical Association researchers at Harvard’s T.H. Chan School of Public Health determined that as many as 14 percent of health plans sold on the federal government’s insurance exchange are lacking doctors in at least one common specialty from their networks. In fact, of the 135 “silver” health insurance plans in 34 states that the researchers reviewed, 19 of them lacked in-network specialists in some critical areas. The most common missing specialties were, psychiatry, rheumatology and endocrinology.

If you find that your plan is missing a specialist, this can result in unexpected out-of-pocket costs. Many plans don’t cover out-of-network visits at all. Some require that participants pay at least half of these expenses.

Nearly 12 million individuals have enrolled in the Affordable Care Act’s health insurance exchange plans. With open enrollment upon us, and with it the opportunity to review and renew coverage, take the time to examine your network for specialists. Although the US Department of Health and Human Services regulates plans and is required to provide an adequate network of providers, this is not the case for all plans. Be sure you get what you pay for

For additional information, contact EAB HealthWorks.