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May 01, 2014 at 07:53 AM
The head of a provider network company argues that plans offering smaller directories in exchange for lower premiums are here to stay.
Joseph Berardo Jr., chief executive officer of MagnaCare, talked about the new “narrow network” plans in a telephone interview.
MagnaCare runs a network that contracts with 70,000 providers in New York and New Jersey, and arrangements offering patients access to a total of 510,000 providers throughout the country.
The company markets provider networks to self-insured employers, unions, benefit plan administrators, workers’ comp insurers, and even commercial carriers. New York’s new nonprofit, member-owned co-op – Health Republic Insurance of New York – used a MagnaCare network to get up and running quickly.
Some enrollees in the new Patient Protection and Affordable Care Act plans have complained about inaccurate plan provider directories, and problems with getting the providers who, at least technically, agreed to be in the directories to accept reimbursement from the plans.
Insurance regulators in Washington have come out with new network adequacy rules. Regulators in other states and at the U.S. Department of Health and Human Services are considering setting new network adequacy rules of their own.
But more than 8 million people have selected plan coverage through the exchanges.
Berardo said he thinks the success narrow-network plans have had with attracting enrollees speaks for itself.
Millions of people voluntarily signed up for the narrow-network plans, Berardo said.
“The push back comes from the press, or people who don’t understand the situation,” Berardo said.
Offering a combination of reasonable coverage prices, easy access to medical services, and unfettered access to providers is impossible, Berardo said.
