Every week, Archelle Georgiou, MD, strategic adviser at Healthgrades, will explain one facet of the Affordable Care Act.
While the Affordable Care Act offers more Americans access to health insurance, one little known secret about the plans offered through the Exchanges is that some insurers are limiting the number of doctors and hospitals that are covered. Why? Insurance companies say that smaller networks helps assure that patients go to less expensive providers that still provide high-quality care. The real reason: Narrowing choice simply makes it easier for insurers to control premium costs.
You shouldn’t automatically avoid health plans with narrow networks, but you do need to do your homework to make sure that the in-network hospitals you will have access to are those that deliver high quality care.
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Here’s why it matters. The unfortunate reality is that hospital quality differs wildly within the same community, and the hospital closest to you is not necessarily where you are likely to get the best care. For example, a recent Healthgrades report found that out of 96 hospitals performing total knee replacement surgery in the New York/New Jersey region, complication rates ranged from 1.8 percent to 32.3 percent — that’s an 18,000 percent difference! If you are selecting a health plan on the Exchange and anticipating needing knee surgery, you probably want to be sure that the hospitals with the best outcomes are included in your network.
Where can you get this kind of information? Data on the complications, mortality rates and safety profile of hospitals is free and readily available to consumers on websites such as hospitalcompare.gov and healthgrades.com. Buyer beware: Pick your provider before you pick your plan.