Elisabeth Rosenthal recently wrote a nice feature article for The New York Times about how health plan enrollees are having a harder time getting in-network care these days.
She said three of the culprits include:
- The narrower provider networks insurers are using in an effort to hold down premiums;
- Some providers’ reluctance to participate in the networks of the plans sold through the Patient Protection and Affordable Care Act (PPACA) public exchange system, and;
- Plans’ misleading provider directories.
She was even-handed to acknowledge that some consumers may gladly accept a narrower network if that helps keep their premiums down.
She didn’t say anything about consumers’ access to, or lack of access to, live-human help.
On the one hand, of course, live humans vary tremendously in terms of their intelligence, experience and level of enthusiasm. PPACA rules prohibit navigators and other nonprofit exchange assisters from helping consumers decide which exchange plan is the right plan. Some of the agents who are still selling public exchange plans may be unwilling to spend much time to learn about the plan networks, given how little insurers are paying them.
On the other hand, even the most burned-out agents and nonprofit assisters could encourage consumers to call a few of the providers listed in a plan’s provider directory, to see if the providers are really in the plan’s network and taking new patients.
Agents with just a little more energy could team up to hold provider directory checker parties. Maybe they could get the blessing from an antitrust attorney, converge on one agency’s office, order delivery food, and take turns calling three providers in a plan’s directory each to see what percentage of the providers are actually taking new patients. Or, they could set up a private Yahoo, LinkedIn or Google+ group to share reports from their clients about which plans seem to have reasonably good provider networks or which don’t.
Many of the most successful agents don’t even need directory checker parties or Web forums. They already have an encyclopedic knowledge of what’s going on with plan provider networks.
On the third hand, it’s interesting that a New York Times reporter doesn’t even think of advice from either nonprofit exchange helpers or licensed agents and brokers as one possible remedy for consumer disappointment with provider networkers.