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Life Health > Health Insurance > Health Insurance

Do small health provider networks cause billing problems?

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Analysts at the Commonwealth Fund say they have survey evidence confirming that typical Affordable Care Act exchange users care more about cost than about big provider networks.

Sixty-two percent of ACA exchange plan purchasers surveyed said either the premium amount or the out-of-pocket cost level was the most important consideration when they picked their plans, Munira Gunja and three colleagues at the New York City-based health policy center write in a new report.

Just 28 percent said having their preferred providers be in the plan network was the most important consideration.

When survey workers asked plan switchers why they switched plans, 40 percent said they were looking for lower premiums. Thirty percent said the new plan has more of the doctors and hospitals they want to use.

The analysts used Commonwealth Fund telephone survey data for 432 adults ages 19 through 64 who have ACA exchange plan coverage, and 2,237 adults in that age group who have employer-sponsored coverage.

In June, Andy Slavitt, acting director of the Centers for Medicare & Medicaid Services (CMS), said at a meeting with exchange plan issuers that CMS believes consumers have been saying loudly and clearly that coverage affordability is their most important concern.

Related: Slavitt says consumers want low health premiums

One obstacle to interpreting insurance buyer survey data is that the healthy people in a sample may not know much about their provider networks.

The Commonwealth Fund asked exchange plan users and enrollees in employer-sponsored health plans a question that applied mainly to the people in each group who have had health problems: “Have you or a family member ever received care at a hospital that you thought was covered by your insurance, but you received a bill from a doctor who was not covered by your plan?”

The survey question referred to “balance billing,” or efforts by providers to collect on the difference between the full amount they billed and the amount the health insurer wants to pay. 

The survey team assumed when it drafted the question that the exchange plan users were much more likely to have plans with narrow provider networks than the survey participants with employer plan coverage were.

About 23 percent of the exchange plan users said they have had problems with balance billing, compared with 19 percent of the employer plan enrollees.

The gap is small enough to suggest that users of narrow-network plans are only about as likely to get “surprise bills” as enrollees in big-network employer plans are, the analysts say.


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