Many of the policies being offered through the Obamacare health insurance exchanges are super cheap because they offer a very limited number of healthcare providers.
Major insurance companies deliberately created what Consumer Reports called “junk health insurance policies” to sell through the exchanges, articles in both The New York Times and The Los Angeles Times show. These policies will not pay for healthcare at many major hospitals and will only cover services offered by a limited number of doctors.
“Our exchange products will have smaller provider networks that cost less than bigger plans with a larger selection of doctors and hospitals,” David Sandor, a vice president of Health Care Service Corporation (a Blue Cross and Blue Shield provider) admitted to The New York Times.
Chad Terhune of The Los Angeles Times wrote, “Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.”
Insurers Deliberately Excluded Major Medical Centers from Obamacare Networks
“Insurers passed over major medical centers” when selecting healthcare providers, a survey by PriceWaterhouseCoopers cited by The New York Times stated. The consulting firm’s Health Research Institute made that conclusion after reviewing Obamacare exchange policies offered in several states.
The reason for this action was to lower premium prices, the survey found. The same survey also found that policy holders might face higher out-of-pocket expenses because of the limited number of facilities in the plan.
Only two of the policies on California’s health insurance exchange would pay for treatment at Los Angeles’s vaunted Cedars-Sinai Medical Center, Terhune found. Cedars-Sinai is widely regarded as one of the best hospitals in the country.
Large public hospitals which serve poor people and working class communities are being excluded from Obamacare networks, Bruce Siegel alleged. Siegel, the head of America’s Essentials Hospitals — a trade association — made that allegation to The New York Times.
“We don’t want you in our network,” is the message Siegel said his organization’s members were receiving from health insurance companies. Many community hospitals in rural areas are also being excluded.
Anthem Blue Cross Blue Cross Shield policies being sold through the exchange in New Hampshire excluded 10 of the state’s 26 hospitals. The exclusion means that many patients cannot use either the hospitals or the doctors associated with them – or closest to them.
“Many consumers will have to drive 30 minutes to an hour to reach other doctors and hospitals,” Peter L. Gosline, chief executive of Peterborough’s Monadnock Community Hospital, complained. Gosline said his hospital had been excluded from the Blue Cross Blue Shield plans for no reason.
Sicker Patients being excluded
Many doctors will not be able to take the exchange policies because they too often don’t pay enough to cover doctors’ expenses. Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, told the New York Times that the exchange policies reimbursed doctors at a rate that was “often below our cost of doing business, and definitely below commercial rates.”
Some insurance companies are excluding specialists from their networks in order to discourage people with pre-existing conditions from buying their policies, The New York Times alleged. They do this by offering a narrow network of healthcare providers that doesn’t include specialists.
“Those narrow networks won’t work because they cut off access for patients,” Dr. Richard Baker told The Los Angeles Times. Baker is the head of an urban medicine program at Los Angeles’ Charles Drew University of Medicine, and he believes the networks will be a roadblock for persons seeking care.
If a doctor is not included in an insurance company’s network it won’t pay for services Baker provides. Persons that go to an out-of-network provider will have to cover the costs of services even if they have insurance.
If that wasn’t bad enough, a California plan offered by a company called Health Net excluded two thirds of the doctors from its regular network from the exchange plans.
Even the head of California’s health insurance exchange, Peter Lee, admits that some of the plans offered don’t provide access to enough doctors.
Daniel R. Hawkins Jr., a senior vice president of the National Association of Community Health Centers, told The Times, “We serve the very population that will gain coverage — low-income, working class uninsured people. But insurers have shown little interest in including us in their provider networks.”