NARROW NETWORKS

Less Care,

More Costs

 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

INADEQUATE PROTECTIONS

Pediatric: A 2018 Health Affairs study found that nearly half of all pediatric speciality hospitalizations would be out-of-network under network adequacy laws

PERVERSE INCENTIVES

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: 

1.

Offer quantitative measures, including:

  • The ratio of specialty physicians to covered lives

  • Geographic accessibility

  • Emergency department wait times

2.

Apply to all insurance products:

  • ERISA, HMO and PPO

3.

Offer effective enforcement mechanisms and penalties for non-compliance

 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.