Insurers restricting choice of doctors and hospitals to keep costs down

washington post ^ | Sandhya Somashekhar and Ariana Eunjung Cha,

[Morgana]

As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.

The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.

The decisions have provoked a backlash. In one closely watched case, Seattle Children’s Hospital has filed suit against Washington’s insurance commissioner after a number of insurers kept it out of their provider networks. “It is unprecedented in our market to have major insurance plans exclude Seattle Children’s,” said Sandy Melzer, senior vice president.

The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

[darkwing104]

Democrats, to paraphrase the insane raving lunatic from central Florida, wants you to "die quickly."

[Repeat Offender]

First to the bottom wins!

[Blood of Tyrants]

Then how come the premiums all cost MORE?

[RightGeek]

How does restricting the number of doctors keep costs low? Can someone explain?

[ConservativeChris]

“many of the plans exclude top-rated hospitals.”

“Top-rated” usually means, “more expensive”.

I can only assume the same applies to the doctors themselves, if your doctor is “top-rated”, you are excluded from seeing him.

[what's up]

I don’t read it as restricting the number of doctors. I read it as keeping the better-quality of doctors out. If you use the better doctors (and hospitals), costs go up.

[Venturer]

You cannot keep your Insurance.

You cannot keep your Doctor.

And Now you cannot even keep your Fricking hospital;.

This is way beyond clusterphuck.

[catnipman]

Just when you didn’t think Obamacare could get worse. Exchange plans are basically
nothing more than Medicaid, only a WHOLE lot more expensive! The reason is that
obamacare says that exchange plans must cover care at “essential community providers ... that serve predominantly low-income, medically underserved individuals.” (Sec. 1311c(1)C) That means clinics, public hospitals and hospitals largely serving the Medicaid community.

Many exchange plans exclude the top-drawer academic hospitals like Cedars Sinai in Los Angeles, the Mayo Clinic in Minnesota and New York Presbyterian in New York City. This is EXTREMELY bad news but it’s bad news for consumers who had access to esteemed hospitals and doctors under their old plans and then got pushed into the exchanges.

[tbw2]

Exclude top notch hospitals that do everything to save the patient, keeping those that do the minimum not to get sued and process as many people as possible.
Exclude hopsitals in poorer areas, quietly denying immediate care to the poorest individuals who will run up the most bills.
Don’t include as many hospitals in the network, and there is less administrative work tracking the payments and reimbursement with each. In that regard, it is like a company winnowing its supplier list as a cost saving measure, because you don’t have to maintain as many entries in the database or financial records or update as many people when polices on payments change.
If you limit the number of doctors, those doctors see more patients per capita. They’re more likely to follow insurance guidelines and mandates in order to stay in network. And it is easier to run audits when there are more patients were doctor to look for suspicious trends.
Having far fewer specialists in a plan is de facto rationing. If there is only one kidney specialist, all patients wait longer to see him or pay out of pocket to see another. Longer waits for specialists in plan means fewer specialist visits.

[rawhide]

Restricting doctors and hospital will cause them to lower their prices if they want to be included in the insurance plans. Not sure that is necessarily a bad thing.

Some insurance companies have been this for years. I think Kaiser Permanente is one that already does this?

[Rembrandt]

“Restricting doctors and hospital will cause them to lower their prices if they want to be included in the insurance plans. Not sure that is necessarily a bad thing.”

Perhaps you’re right. Perhaps, instead, doctors, maybe even hospitals, will decide on a new, different plan which leaves government and government supported patients chasing after a scarce resource, government doctors and gov’t hospitals.

I’d bet on the latter rather than the former. Doctors don’t need the miniscule compensation that Obama feels is right for their efforts when they can receive a fair wage for a fair service rendered to a grateful and healthy patient.