About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

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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 →