Patients surprised by narrow networks

A reality occluded by President Obama's promise that "if you like your doctor, you can keep your doctor" is the tradeoff between access and cost. As insurance companies look for ways to shave costs so they can compete more effectively in the health insurance exchanges, they will naturally look to limit patient access to the most expensive providers. In the long-run, this trend will probably benefit patients since it will force providers to increasingly compete on value (which factors in both cost and quality). Providers who consistently charge more than what their surrounding peers do will probably see a drop in patient volume, unless patients require -- and are willing to pay for -- access to these doctors. Providers who become nervous about this drop in patient volume will experience pressure to offer better value through a superior service, a lower price, or both.

In the short-run, however, some patients can be in for big surprises. For example, Associated Press reports that cancer patients are surprised that their providers do not accept some of the new plans that are offered via the health insurance exchanges. The surprise is likely a result of many different factors. Even besides the reassurances that the presidency offered that turned out to be false, the industry (whether the health exchanges or the health insurance companies) has been rather quiet about the tradeoff. Additionally, as the Associated Press article points out, consumers often have to do their own investigations in order to figure out whether a specific medical group accepts specific insurance plans. Faced with a plethora of daily tasks, and not told to expect otherwise, it isn't difficult to imagine patients optimistically assuming that their beloved medical group accepts a new plan offered by a major insurance carrier. It's unfortunate that there wasn't greater patient education warning of this pitfall.