Are narrow networks hurting the quality of patient care?

Although the Affordable Care Act has improved access to health insurance coverage, the worrying trend of narrow networks has developed alongside it. The tendency by insurers to assemble narrow provider networks, has sparked a debate regarding the quality of health care. So the question now being asked is – are these narrow networks hurting the quality of patient care.

Health insurers justify narrow networks, because they lead to lower premiums. They also say that by limiting the networks, they create a band of affordable, high-quality physicians. However there have been claims that the selection process is not transparent, despite there being standards in relation to ‘network adequacy.’

  • Consider the following:
    Narrow networks limit the access of patients to physicians. The exclusion of clinicians from the networks, means that patients are missing out on the opportunity to be treated by doctors that are willing to offer them service. In some cases, doctors say they are dropped from the network without being told the reason for it. As a result, patients often find that their desired provider is no longer in the network.

 

  • Narrow networks often force patients to travel long distances to see clinicians. This places undue stress on patients, especially those with complex illnesses. If these illnesses are not treated properly, it will end up costing the patient more in the long term.

 

  • There are instances in which more affordable narrow networks don’t necessarily have high quality providers. Consequently, patients may choose a cheaper physician, but end up sacrificing quality of care.

There is no doubt that narrow networks are resulting in quality of care concerns for some patients. If you have questions regarding this matter, contact Nelson Hardiman, LLP, Los Angeles for more information. Please send an email to [email protected] or call 310-203-2800.

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