This is a continuation of the quasi-series of open-enrollment advice posts. A valued commenter and reader e-mailed me with a very interesting question:
I’m changing jobs, and have a choice between a PPO, an HMO, and Kaiser. (Kaiser is listed separately, and one has to ask about it; for whatever reason, it is discouraged by HR.) the cost difference between the PPO and the HMO are nominal – the difference in my cost is about $6/mo for just me.
Thanks to your blogging, I’m trying to pay attention to the depth of the networks, but it is hard to tell what is going on. The online directory they have (this is UnitedHealthCare) lists a bunch of doctors. Is there any reasonable way a mostly clueless-about-this-stuff person can get an idea of how sizable their network is?
This is a two layered process. The first layer is to make sure that if you value to keep seeing your doctors and facility services is to make sure that they are in the directory. If you want Dr. Brown to continue to treat you, you should be checking to see if Dr. Brown is in network. If he appears in the directory, then you’re good on this stage.
The second check is a cheat for narrow networks and gives you a good sense of the net that was cast.
Most narrow networks are primarily concerned about controlling what hospitals are being used as hospitals have high costs and more importantly, high variance in costs. There will be exceptions as some networks will actively seek to exclude specific doctors but most narrow networks are premised on controlling hospital costs.
There are two basic flavors of narrow networks. The first flavor is the simple version of cost control. An insurer will offer X, and any hospital that will accept X or less is in network, while everyone else is out. A good check here is to see if the major academic medical centers in the central urban area of the region is in the network. If it is, the network is probably fairly broad.
If the major academic medical center has a split hospital structure where there are a few high end specialty hospitals (pediatrics, ob/gyn, trauma etc) and also general purpose hospitals, look at the general purpose hospitals.
The other type of narrow network is a business buggering thy competitors strategy. This is more common when a region has an integrated payer provider system (like Geissenger, Steward, Sutter, Meridian etc) . If you are buying insurance through an integrated payer-provider, see if major hospital chains not owned by the insurance company are in the network. Outlying community hospitals that are independent or part of small local chains will probably be included in modestly narrow networks solely to give coverage, but chains have negoatiating power. If the non-owned chain is in, the network is probably fairly broad.
These are not perfect cheats, but they are 20 second checks as doctors usually follow hospitals when narrow networks are created.