Networks are one of the major product differentiators. If I needed to buy on Exchange, the Blue Cross and Blue Shield of North Carolina network is different than the Cigna network which is different than the Ambetter/Centene network. Right now, my family is relatively healthy and low touch with the medical system so we would be fairly network agnostic once other factors such as premiums and cost sharing are involved. However if one of my family members had the medical history that required continual relationships and specialized care, network would become very important in our decision making process.
We would be relying on directories to make choices. Our purchase choice would be locked in for a year while the directory may or may not be pragmatically accurate at the moment of the decision. Today’s directory is guaranteed to be inaccurate six months from now. The question is whether or not it will be materially inaccurate or just “normally” inaccurate.
Wesley Sanders notes that there are few reasons for Exchange insurers to care strongly about their directories:
An inaccurate m provider directory does not qualify as a special enrollment period. An Insurer can lie to you about who will be in network when you buy your plan, and you’re still stuck with them for the whole year
— Wesley Sanders (@wcsanders) December 4, 2018
People are locked into their contracts for a year. They can’t leave even if they had strong reason to believe that they were buying a policy with a critical provider set in it and then discover in January or February that those providers are actually not in network. If they made the buy/no buy decision partially on the basis of a particular specialist/hospital set being in the network and then find out that either those providers never were in the network OR their contracts expire early in the policy year, then the actual policy that is bought is materially different than the policy that the buyer reasonably thought they were buying.
As long as we count on individual decision making as a means of unleashing market discipline, then we need to make sure that the variance between what people are thinking that they are buying and what they actually are buying is as small as possible.