California Healthline: They Annoy Patients. They Scare Docs. But Narrow Networks Might Be a Good Thing.

by Dan Diamond, California Healthline Contributing Editor

Is it better to confuse patients — or lower their bills?

Narrow networks seem to be doing both.

The model, under which insurers use quality and cost metrics to limit the number of health care providers participating in a given plan, isn’t new. But narrow networks have been in vogue in the post-Affordable Care Act world, as payers seek to roll out offerings that serve patients who are potentially older and sicker — while keeping premium costs within a certain band.

McKinsey found that about 70% of hospital provider networks on the ACA’s exchanges are either narrow or ultra-narrow, which the consultancy defined as having 14 or fewer hospitals. Closer to home in California, only about one-third of San Diego-area doctors were covered through Covered California, one expert noted.

Patients and providers have raised concerns that by limiting plan participants, narrow networks are creating unexpected access challenges. For instance, Californians who were used to shopping through the individual market and have been pushed to the exchange may find that they can’t access the doctors they’ve been seeing for years. Some patients have said they can’t find the specialists they need.

(In a further complication for patients attempting to pick a plan, many insurance exchanges’ online provider directories have been broken or misleading.) 

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