Dive Brief:
- Numerous health plans offered under the Affordable Care Act in 2015 have failed to include access to medical specialists including endocrinologists, rheumatologists and psychiatrists, according to a new JAMA study.
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Some of these overly-limited provider networks are likely forcing consumers to pay for out-of-network care by specialists, resulting in "huge cost burdens for patients,” Stephen Dorner, lead author of the study, told the Los Angeles Times.
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The study by researchers at the Harvard T.H. Chan School of Public Health followed increasing criticism of narrow networks from patient advocates.
Dive Insight:
The researchers examined provider directories for 135 “silver” health plans in the 34 states that used the HealthCare.gov marketplace in 2015. While they expected to find some plans with only a few options in certain specialties, they actually found nearly 15% of the plans failed to include even a single physician for at least one specialty.
The researchers said the deficient plans occur in both rural and primarily urban states around the U.S.
Dorner suggests the findings indicate better state and federal standards are needed to ensure network adequacy.
“Down the road, we likely will have to make sure [regulations] are sufficient and that we are guaranteeing patients access to affordable in access care,” he told The Los Angeles Times. The Times adds that The National Association of Insurance Commissioners is currently updating its suggested regulations for network adequacy.