Payer Behavior: Network Pool Restrictions
“Narrow Network”
In 2023, more payers opted for narrower provider networks as a method of controlling costs than ever before. Not only does this lead to decreased overall satisfaction by patient members - but this can also cause delays in care with the potential to put patients in harms way.
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According to a recent article in Consumer Reports, narrow network plans typically “have 25 percent or less of the physicians in the local area participating. The most restrictive plans have less than 10 percent of local doctors signed on.” Plans like these use restricted networks to ensure increased volume to a smaller number of approved providers, thus driving down cost. Private payers, ACA health exchanges, and Medicare Advantage are all capable of providing plans with such restrictions.
Furthermore, many Americans with narrow network plans do not realize they are under increased provider restrictions until after they have sought care. The article states that one in ten Americans were surprised to find out the healthcare provider they had elected to perform a service was not part of their network. Exacerbating this issue is the fact that a decreasing number of plans sold on the individual health insurance market offer any out-of-network coverage whatsoever - just 29% in 2018.
Read more here.