Workplace

Check before you click ‘yes’ on a bargain Obamacare plan

Updated: 2013-10-07T03:21:40Z

By ALAN BAVLEY and DIANE STAFFORD

The Kansas City Star

If you’re persistent enough to get onto the Obamacare marketplace website to shop for a health insurance plan, here’s something to keep in mind:

The best bargains to be found in the federal marketplace might not include all the hospitals or doctors you’re familiar with.

Blue Cross and Blue Shield of Kansas City, the area’s largest health insurer, is offering versions of many of its plans with just seven hospitals in their networks, rather than the 19 hospitals Blue Cross plans typically cover.

The low-cost plans do include such academic medical centers as the University of Kansas Hospital and Truman Medical Center, and large community hospitals such as Olathe Medical Center and North Kansas City Hospital, as well as about 2,000 doctors in a multitude of specialties.

But absent from the networks of these cheaper plans are the St. Luke’s Hospital system and the 300-plus doctors it employs, as well as Research Medical Center, Centerpoint, Menorah and the other hospitals owned by HCA Midwest.

Coventry is the only other company selling health insurance for Kansas City area residents on the federal marketplace. The St. Luke’s system is missing from its plans, but most other area hospitals are included.

The Affordable Care Act’s federal marketplace opened Tuesday and in its first three days had 7 million online visitors, a volume of shoppers and window shoppers that crashed the system repeatedly.

As insurance companies vie for this new business, many insurers nationwide devised coverage plans that keep premiums low by limiting the numbers of doctors and hospitals their plans fully cover.

In California, some marketplace plans have half as many doctors as the insurer’s regular network, the Los Angeles Times reported.

A recent report by the PricewaterhouseCoopers Health Research Institute found insurance companies in Chicago, Indiana, Kentucky, Tennessee and elsewhere were passing over major medical centers “in an effort to tamp down hospital and medical costs.”

These “narrow” networks aren’t new. In some ways, they harken back to the limited networks of the era of managed care in the 1980s and 1990s. Those insurance plans went out of favor because of the harsh restrictions they often imposed. But with health care costs exponentially higher now, narrow networks might get a more positive reception.

The insurance plans are likely to appeal particularly to younger buyers, who are more likely to shop by price and less likely to have a longstanding relationship with a particular doctor or hospital.

Networks of doctors and hospitals that have negotiated prices with an insurance company are a typical feature of health plans. Patients who go to a doctor and hospital outside their plan’s network usually pay a substantially higher portion of their bill.

By keeping networks small, insurance companies can negotiate lower prices from hospitals with the promise that they will be getting a larger share of the plan’s patients.

“It’s a key way to offer more affordable rates,” said Cynthia Michener of Aetna, Coventry’s parent company.

The narrow networks have raised some concerns that health care quality will suffer and that there won’t be enough doctors or hospitals in the networks to serve all the new patients who enroll.

According to America’s Essential Hospitals, an organization representing safety net providers, its members are being excluded by some health plans. Executives of the Anthem Blue Cross plan in New Hampshire have faced grilling by state legislators for excluding some doctors and hospitals from their plans.

In a statement to The Star, St. Luke’s explained its reason for not participating in narrow network plans for this area: “We believe the rates currently offered for new products by (Blue Cross and Coventry) are insufficient and would ultimately result in sacrificing the quality for which St. Luke’s is known.”

Federal regulators have rules for determining whether plans have adequate numbers of providers so that patients don’t have to wait an unreasonable time for care. And higher prices don’t always mean better health care.

“Study after study shows that there is little correlation,” wrote health policy author and blogger Maggie Mahar. “In fact, lower costs and higher quality go hand in hand: When more efficient hospitals coordinate care, there are fewer ‘medical misadventures,’ hospitals stays are shorter and both patient and doctor satisfaction is higher.”

Shoppers on the federal marketplace can still get plans with the full Blue Cross network, said Wayne Powell, the company’s vice president of executive services.

Its Preferred Care Blue network does include the St. Luke’s and HCA systems. Providence Medical Center didn’t make it into any Blue Cross network because it was undergoing a change in ownership that hampered negotiations, Powell said.

The big difference between Preferred Care Blue and the narrow network, called Blue Select, is price, Powell said. Select network plans are about 15 percent cheaper.

For example, a Blue & U First plan that would cost a 27-year-old $192 a month with the Preferred Care Blue network would cost $163 a month with the Select network.

Anyone shopping for insurance through the marketplace should seek the help of a licensed broker or someone trained to navigate the system, Powell said.

“You need to ask fundamental questions like, ‘How much will I pay to see my doctors? What will I pay out of pocket before my insurance kicks in? How much will it cost to go to the emergency room? How much will my medication cost?’”

The other key questions Powell listed are particularly important now: “Is the doctor I want in the network? Is the hospital I want in the network?”

To reach Alan Bavley, call 816-234-4858 or send email to abavley@kcstar.com. To reach Diane Stafford, call 816-234-4359 or send email to stafford@kcstar.com.

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