WHAT IS A NARROW NETWORK?
Narrow networks broadly refer to health insurance plans that offer a limited number of in-network doctors. While there is not a universal definition of the term, studies have found insurers are increasingly offering these plans.
WHY SHOULD YOU PAY ATTENTION TO NARROW NETWORKS?
Through narrow networks, insurance companies have created a false choice between high-quality care and affordable policies.
As more individuals enroll in cheaper plans with access to fewer doctors, they are less likely to be treated by in-network doctors and more likely to receive a “surprise bill” after an emergency.
NARROW NETWORKS LEAD TO:
More surprise medical bills
Increased patient out-of-pocket costs
Reduced cost-sharing responsibility for insurance companies
A 2016 analysis by the University of Pennsylvania found that the extra cost-savings from moderate and extremely narrow networks are not passed onto consumers in the form of lower premiums and deductibles.
SPECIALITY CARE IS OFTEN EXCLUDED
Speciality providers are most often affected by insurance companies’ narrow network strategies.
DIFFICULT TO ENFORCE
Anesthesia: In many cases, narrow network laws are difficult to enforce; however, in 2018, Texas fined Humana $700,000 for inadequate anesthesia networks
Pediatric: A 2018 Health Affairs study found that nearly half of all pediatric speciality hospitalizations would be out-of-network under network adequacy laws
Emergency Medicine: Due to EMTALA, emergency medicine providers are often excluded from networks to cut costs since insurers know their beneficiaries will be treated regardless
A SOLUTION TO NETWORK ADEQUACY MUST:
HOW YOU CAN GET INVOLVED:
Tell Congress to stand up to the insurance industry and demand they pay their fair share. Insurers, doctors, and hospitals all have a shared responsibility to provide high-quality care to patients across the country. It is time we fix the broken healthcare system and stop surprise medical billing.