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You are here: Home / Anderson On Health Insurance / Network Shock as a minimal issue

Network Shock as a minimal issue

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Kevin Drum raises a good question this weekend on different challenges (actual and political) that Obamacare faces in the next six to nine months:

network shock might actually be a bigger issue. It’s one thing to get a rate increase. That’s bad, but it’s often tolerable, and everyone in the individual market is pretty used to big annual premium increases anyway. But a lot of plans on the exchange restrict doctor networks fairly severely, and this could be a big problem for people who are loyal to their current physicians.

In most markets where there are multiple insurers offering plans, the insurers aren’t offering just one plan per metal band.

Mayhew Insurance is not just offering Mayhew Catastrophic, Bronze, Silver, Gold.  Mayhew Insurance is offering Mayhew Silver Basic, Mayhew Silver Premium, Mayhew Silver Enhanced Premium, Mayhew Silver Superb.  The same is with the local Blue Cross affiliate as well as the major national players.

Each of those plans are Silver plans (70% actuarial value).  Mayhew Silver Basic is the cheapest, and Mayhew Silver Superby is the most expensive.  There are probably a few significant differences that drive the prices.  The first is the higher cost plans probably have a more expansive and expensive prescription drug formulary.  The second is the network is wider. 

In most markets where there is a decent number of companies offering plans, Dr. X will be available in at least a couple of plans on the market at a given metal level. It is just unlikely that Dr. X will be available in all of the low price (for the metal band) plans.

Reader Interactions

68Comments

  1. 1.

    piratedan

    but what happens if my Doc is more into R&B than metal?

    I guess it also matters if he’s more of a Judas Priest fan than Metallica too… damn health care is so complicated these days.

  2. 2.

    Xecky Gilchrist

    Thank you as always for your insights, Richard – this series has been a joy to read and I’m sure will continue to be.

    And am I the only one who thinks that if we’re going to call the classifications of insurance as “metal bands” they should have names with more umlauts in, like Göld and Plätïnüm?

  3. 3.

    TrexPushups

    My wife and I noticed it when we signed up.

    650 per month plat plan didn’t have our doctors so we went with 720 per month

  7. 7.

    NotMax

    How many of the currently uninsured already have a regular preferred physician? Not a great percentage, I’d wager.

  8. 8.

    the antibob

    This is a huge problem in NH. Anthem Blue Cross is the only insurer on the exchange. Our individual plan used to have access to the Blue Cross Network in and out of state. Now all plans on or off exchange are switching to a NH only (Path) network which excludes over half the hospitals and doctors in the state. Obviously the game is to limit access to healthcare via the network restrictions.

  11. 11.

    Richard Mayhew

    @NotMax: actually a decent number of people who are uninsured today and over age 25 has someone that they consider a PCP. Uninsured status is not a permanent condition. People can bounce between Medicaid, CHIP, group insurance in the commercial market and individual insurance plus local clinics. If a person has bumped around and has any health issues, they probably have a doc they like/want even if they don’t have insurance today.

  13. 13.

    Jennifer

    Oh, and it’s even worse for pregnant women on Medicare, according to Elizabeth Hasselbeck. It seems that some insurer is dropping a lot of doctors from their Medicare part B network, and this is all the fault of Obamacare that this private company is reshuffling its provider network, something that had never ever before occurred until this law that has nothing to do with Medicare was passed.

    But seriously…Hasselbeck’s concern was that all the pregnant women on Medicare would have to go find new doctors at a time in their lives where they’re already feeling vulnerable.

    It was the last bit that really threw me, because I’m thinking that your average 65 year old or older woman would be thinking “WTF? What the fucking FUCK?” upon learning she was pregnant, rather than be feeling vulnerable.

  15. 15.

    Ella in New Mexico

    From what I’ve been able to ascertain, every single thing that is wrong with Obama care can be traced back to:

    A) tricky little poison pill rules, including lack of enough funding for implementation, which were inserted into the legislation as attempts to placate R’s and Dem Con’s into voting to pass it

    B) the ability of rat-fucking insurance companies (based on decades of previous experience) to find an endless number of “creative” ways to avoid having to spend their customer’s premiums on actual care, and

    C) the simple fact that the healthcare for-profit industrial complex in America should essentially be outlawed because we will never, EVER get around the greed of American companies. At a minimum, all health-care related business should be non-profit, at best, we need a single government payer program.

    But we won’t learn any of that from Obama care. Instead the Fauxer’s will be brainwashed that we need more of a return to the Wild West of unregulated health care in this country, not less.

  16. 16.

    PeakVT

    and this could be a big problem for people who are loyal to their current physicians.

    Somewhat tangential: switching physicians obviously is obviously problem for someone who is undergoing some kind of intensive treatment. But does it matter much for most people, who just go in for a checkup, and maybe get a prescription for something that is very commonplace at this point (high blood pressure, for instance)? People may “like” their doctor, but does keeping the same one make a difference in terms of health outcomes?

  17. 17.

    Yatsuno

    @Jennifer: Medicare does cover obstetrics and gynecology because of the disability/end-stage renal failure patients. Plus it was the original plan to have Medicare be our single-payer system but Johnson could only get it for the olds at first. It probably would have expanded in age if not for Nixon.

    Oh and Hasselsack is just an idiot.

  18. 18.

    Ella in New Mexico

    @Jennifer:

    LO freaking L!!!

    I don’t know what is more pathetic about Elizabeth Hasselbeck, the fact that she is too stupid and lazy to even try to get her facts straight, or that she is pretty much the “Everyman” of right wing America, who also, too, cannot get their facts straight. And who proceeds to vote based on those incorrect facts.

  19. 19.

    ? Martin

    In most markets where there is a decent number of companies offering plans, Dr. X will be available in at least a couple of plans on the market at a given metal level. It is just unlikely that Dr. X will be available in all of the low price (for the metal band) plans.

    Many of the components of ACA are designed to encourage changes in the marketplace. By flattening the marketplace through regulation, the goal is that over time doctors will expand what insurance they take. Not all of the network shock will happen on the consumer side – much of it will happen on the provider side as well.

  22. 22.

    Emerald

    I found out about these network restrictions while I was trying to decide which plan to choose. Because I learned that Blue Shield was reducing their network by 50%, I chose to go with Kaiser, which is using their full network.

    I’ll have to give up my wonderful doctor for the next two years until I’m eligible for Medicare (hoping I don’t get pregnant!!), but he’ll understand.

    I’m safer with Kaiser. Step one toe outside the verdamten Blue Shield network and you’re on your own.

  23. 23.

    agrippa

    “unarguably been a fiasco”

    Another example of overheated rhetoric. What is this preaching of gloom and doom all about?
    Theatrics? Playing copy cat?

    Those people need to calm down.

  27. 27.

    ? Martin

    This story about the food drive for Walmart is kind of awesome. Does Walmart not get that it looks like they’re requesting that the public volunteer to pay their employee salaries?

  29. 29.

    scav

    @JPL: I saw it at NYT. Round 8 gazillion is it for the posterboy of the correct, legal and sactified use of violence?

  32. 32.

    JPL

    @? Martin: I thought it was an employee only bin which makes it better. You can barely get by on your salary but you feel you have to help those employees not makin it. It would be an interesting reality series. Do they have to buy the food at Walmart?

  33. 33.

    lumpkin

    So, Obama has 1 to 1.5 Friedman units after which things will be better, except that they could get even worse. Better bring a shovel – maybe two or three.

  36. 36.

    MikeJ

    @Southern Beale:

    Unrelated but George Zimmerman has been arrested for domestic violence. The victim is his girlfriend.

    He would have beaten his wife except her relatives made it clear they’d stand their ground. So of course he moved on to beating his gf.

  37. 37.

    NobodySpecial

    May not be the norm, but in my market there’s exactly one hospital that’s in all the networks. The other two aren’t bothering.

  41. 41.

    Mnemosyne

    @? Martin:

    Not all of the network shock will happen on the consumer side – much of it will happen on the provider side as well.

    Yep. I keep trying to point out to people that for-profit insurers are only part of the problem. Now we have to deal with the much thornier issue of for-profit hospitals and medical groups being upset at not making the massive profits they had been making.

    Pretty much our whole system, top to bottom, has gone to being for-profit over the last couple of decades (IIRC, in the early 90s when Clinton attempted his reforms, the majority of the industry was still non-profit or not-for-profit). We’re going to have to reverse that spiral before we can make significant strides towards a real universal healthcare system. And those for-profit hospitals and medical groups are going to fight any changes every step of the way.

  42. 42.

    bemused

    @Jennifer:

    Watching earnest, concerned Hasselbeck on that video clip is just hilarious. Did she miss the word Medicare completely or is she that dumb?…never mind.

  45. 45.

    Elizabelle

    I hope those dumbass gun-loving jurors from the Trayvon Martin case feel lousy today after hearing about Zimmerman’s latest arrest.

  46. 46.

    goblue72

    At what point do we accept that we may need to move to much more of a managed-care model that we have even currently? (My understanding of the failed “HillaryCare” from the 90s was that it would have made U.S. healthcare primarily an HMO driven model)

    This whole system of decentralized, atomized single or small group practice PCPs seems so antiquated – and really inefficient. I’ve been in an HMO system my entire adult working life (Harvard Pilgrim, Kaiser, and GroupHealth). No complaints. Whenever I needed to go to the “doctor” for something, I’d just call up the helpline nurse and if it warranted a live visit, they’d schedule me with whomever was available at the HMO’s closest medical center. One doc was as good as the next for the most part.

    I’ve technically had an assigned PCP at each, but it was often just a rotating cast of characters – most of whom were on the younger side who eventually would leave to go into private small group practice – presumably to make more money. (which tells me that the HMO was doing a good job of holding down costs while the PPO market was less efficient/more costly) So I’d rarely see my actual PCP unless it was for planned for in advance visits – which for the average “I’m sick” or “I think I pulled a muscle” or “I got this weird rash”, I didn’t really care who I saw as long as the appointment was convenient for me.

    Sometimes I wonder how much of this is driven by stubborn olds like my parents who can’t get over the fact that “their” doctor isn’t actually materially better in skill than the doctor across the street. I’m sure there are superstar doctors out there – but they aren’t available to the 99%, so who cares anyway.

  48. 48.

    Elizabelle

    @j:

    He’s getting to be rather familiar with booking photos, no?

    And no bail. That is the best part.

  49. 49.

    Yatsuno

    @MikeJ: Plus he never paid his lawyer all that sweet sweet wingnut welfare he got. So getting legal representation might be a dicey proposition, especially since he won’t qualify for a public defender.

  51. 51.

    cckids

    @Elizabelle:

    I hope those dumbass gun-loving jurors from the Trayvon Martin case feel lousy today after hearing about Zimmerman’s latest arrest.

    There is exactly a snowball’s chance in hell that this will happen.

  52. 52.

    StringOnAStick

    @goblue72: I’m with you on that one, though I suspect it has something to do with neither of us currently having any long term, chronic condition that requires constant management, plus it seems to be generational. My folks are of the “my doc and ONLY my doc” ilk, and like most of the people in their cohort, they just blindly trust that their doc knows all, sees all, they question nothing and do exactly what he says (well, not exactly; they are both type 2 diabetics who still drink way too much alcohol). I do find it interesting that they are in an HMO and they were taken off statins a few years ago; seems like the only way to back off the statins for everyone hysteria is when it hits the HMO’s bottom line.

  53. 53.

    Elizabelle

    Betty Cracker, expert on all things Florida, has a fresh Zimmerman thread up.

    And maybe his latest arrest will give our fine professional media something new to flap their lips about. You’d think they’d be getting tired of piling on Obamacare.

  54. 54.

    Just Some Fuckhead, Thought Leader

    @StringOnAStick: Not me! When I go in to have my colon checked, I want to meet as many new people as possible with my butt. I’ll usually start outside the hospital or clinic and ask everyone all the way in if they want to see the insides of my delightful ass. My wife is the same way with her cooter. Last time she had cooter surgery, she was showing her cooter surgery pics to everyone. It makes her feel special to have everyone oohing and aahing over her cooter.

    I guess that’s just how we roll.

  56. 56.

    Mnemosyne

    @StringOnAStick:

    I remember one of my last visits to my pediatrician (when I was probably 16 or even 17) and he showed me the very first page of my file where he had noted my birth. He and his brother had parallel practices — he was the pediatrician and his brother was an OB/GYN — so he was in the loop literally from day one.

    With the way today’s health insurance is structured, I seriously doubt if there are many kids who can say the same thing, but many older people are convinced that’s still the way the world works.

  58. 58.

    pseudonymous in nc

    @Mnemosyne:

    Now we have to deal with the much thornier issue of for-profit hospitals and medical groups being upset at not making the massive profits they had been making.

    And in this context “for-profit” basically means “not-for-profit”, because the difference between how not-for-profit hospitals and for-profit hospitals behave as corporate entities is generally nothing.

  59. 59.

    Mnemosyne

    @pseudonymous in nc:

    And in this context “for-profit” basically means “not-for-profit”

    I think you’ve got that backwards — you’re saying that ostensibly “not-for-profit” hospitals act the same way as for-profit hospitals, correct? Not saying that for-profit hospital chains are actually not-for-profit and that the massive payouts to their executives are just rumors meant to malign them?

    Non-profit does still mean non-profit, but it’s true that “not-for-profit” hospitals and medical groups play a lot of games that make them more similar to the for-profits.

  60. 60.

    rikyrah

    ALEC Mulls Assault On Constitution’s 17th Amendment — The Direct Election Of Senators

    [….] In an agenda for a December meeting posted on ALEC’s website, one of the items up for review is language for a bill, called the Equal State’s Enfranchisement Act, that would allow state legislatures to add a candidate’s name to the ballot for a U.S. senate seat, along with the names of those nominated by voters.[….] If ALEC’s members decide to further pursue this act and manage to get it passed in any state, it would be an assault to the 17th Amendment of the Constitution.

    For over a century, Senators were elected by state legislatures. This often led to stalemates, leaving Senate seats open for months at a time. But in 1913, the country ratified the 17th Amendment, which stipulates that Americans are to directly elect their senators[….]

    http://thinkprogress.org/justice/2013/11/18/2957291/alec-17th-amendment/

  61. 61.

    superfly

    Cedars Sinai and all its affiliated doctors in Los Angeles are included in one bronze level plan on the CA exchange, how is that even possible?

    My insurer has eliminated them from their individual plans, but they remain in all the group plans, so I don’t see any rhyme or reason for the exclusion.

  64. 64.

    Bill Arnold

    @goblue72:

    Sometimes I wonder how much of this is driven by stubborn olds like my parents who can’t get over the fact that “their” doctor isn’t actually materially better in skill than the doctor across the street.

    The reason I keep my primary care guy (even though he’s not local) is that he will sometimes draw the diagnostic tree on the examining table paper, and will answer questions with technical answers (if asked to), including rough probabilities.
    That’s a rare in my experience, though it can and probably should be taught. [edit FWIW, I first used him as part of a HMO, then that plan was dropped by my employer.]

  66. 66.

    fuckwit

    But those of us who demanded single payer, Medcare for All, in 2009, were just irrational, unrealistic dreamers.

    Nevermind that single payer eliminates all these fucking problems. All doctors are in the program. There’s no such thing as “out of network”. There’s no bewildering complexity and shell-games being foisted by insurance companies. There’s just, FREE FUCKING MEDICAL CARE.

    The Canadians, the British, and the French have got this right.

    Those of us who now qualify for Medicaid can thank our lucky stars for Obamacare. The rest of the country should be as lucky.

  67. 67.

    FlipYrWhig

    @fuckwit: Sounds like a great plan, apart from the fact that it was the threat of everyone having to change their insurance to something else, and the resulting opposition of doctors, hospitals, etc. to “socialized medicine” that, you know, destroyed every previous attempt to do anything about health care in America. American doctors would have the shitfit to end all shitfits if we moved in that direction, and people love doctors and do what they say.

  68. 68.

    Bubba Dave

    @fuckwit:
    Nobody said single-payer was a bad idea. We just pointed out that in a Senate that depended on Joe Lieberman and the Red State DemoCowards, there was no way to pass it, period. (Hell, I have my doubts that even Nancy SMASH! could have gotten it through the House.)

    So yeah, unrealistic dreamer fits pretty well.

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