Tag Archives: narrow networks

Lawsuit alleges Centene’s narrow networks led to surprise medical bills

Photo: Paul Sableman via FlickrCentene’s St. Louis-area headquarters.

Policyholders of St. Louis-based Centene allege in a new lawsuit that the health insurer’s narrow network system is overly restrictive and limits access to doctors in 15 states. One policyholder who served as a plaintiff in the suit said she received surprise medical bills for treatment from out-of-network doctors.

In Harvey v. Centene Corp., filed Jan. 11 in U.S. District Court for the Eastern District of Washington State, policyholders Cynthia Harvey of Spokane, Wash., and Steven Milman of Travis County, Texas, said they bought their policies from Centene subsidiary companies. Continue reading

Reporters offer state, local story ideas for covering ACA #ahcj15

The first day of Health Journalism 2015 featured a session “The ACA: Will it survive? And how to cover it now” with Kaiser Health News’s Julie Appleby and Vox’s Sarah Kliff. Their major themes included:

Julie Appleby & Sarah Kliff

Julie Appleby & Sarah Kliff

  • The King v. Burwell Supreme Court case over federal subsidies
  • What’s next in Congress?
  • Exchanges
  • Medicaid
  • And – the topic that got by far the most attention from the crowd – narrow networks.

Here are some of their highlights and story suggestions, with an emphasis on stories that state and local reporters can tackle. (Here are Kliff’s slides.) Continue reading

Adequacy, transparency of provider networks among things to watch

Narrow networks

Photo: Niklas Morberg via Flickr

At a recent San Francisco Bay Area chapter event, health journalists received a primer on the narrowing networks of current health plans and the delicate balance between managing health care costs and providing reasonable access.

Panelists Anne Price, director of the Plan Management Division of Covered California; journalist and “Ask Emily” columnist Emily Bazar of California HealthCare Foundation’s Center for Health Reporting; Larry Levitt of Kaiser Family Foundation; and Betsy Imholz of Consumers Union addressed narrow networks’ impact on consumers, insurers, and providers, as well as proposed government regulation. Marilyn Serafini of nonpartisan Alliance for Health Reform, the panel’s cohost, moderated the briefing.

Narrow networks predate the Affordable Care Act to the controlled HMOs of the 1980s and 1990s, Levitt explained. The ACA accelerated the trend as insurers sought new ways to cut costs under a law that capped deductibles, banned pre-existing condition denials and mandated certain preventative care benefits. Continue reading

Love ‘em or hate ‘em, narrow networks are drawing scrutiny

Health insurers’ efforts to keep costs low by using narrow networks are drawing increased scrutiny.

Such oversight may be inevitable given that hospitals and physicians often complain if they are excluded from narrow networks, and sometimes consumers complain as well if their doctors or preferred hospitals are suddenly deemed to be out of network. The problem is that increased scrutiny could lead to increased regulation that limits the ability of insurers to control costs.

Earlier this month, the federal Centers for Medicare & Medicaid Services (CMS) said it would review all networks to ensure that they meet patients’ needs. Writing in The New York Times, Robert Pear reported that insurers will be required to have contracts with at least 30 percent of “essential community providers” in their service areas and that insurers must not discriminate against people with significant health needs.

The CMS action came in a letter to health plans using the federal marketplaces. In its 2015 Letter to Insurers in the Federally-facilitated Marketplaces, CMS said it wants to ensure that networks have adequate participation from hospital systems, mental health providers, oncologists, and primary care physicians. Continue reading