As readers know, the great winnowing is beginning. Health plans are beginning to cut apart their networks, dumping hospitals and clinics in an effort to save money.
Not surprisingly, the hospitals and physicians involved in this network-narrowing exercise are not too pleased. In fact, there are at least two high-profile cases in motion in which providers are fighting exclusion from a network by legal means:
- Rochester, N.H.-based Frisbie Memorial Hospital, one of 10 hospitals booted from the newly narrow network run by Anthem Blue Cross and Blue Shield, has taken its fight against being excluded to the state Department of Insurance.
- Doctors with two Connecticut groups, the Fairfield County Medical Association and the Hartford County Medical Association, continue to fight their exclusion from UnitedHealthcare's Medicare Advantage networks in the state.
While these may be among the first battles of this kind, it's certain they won't be the last as long as health plans are given largely free discretion as to which providers they cut and why. Yes, state Departments of Insurance are overseeing the transformation of health plans networks, but that doesn't mean we're going to get results we're happy with across the U.S.
I submit that this is one of the situations in which the patchwork of local decisions made by local Departments of Insurance should be superseded by federal law. Filing and passing federal law which better defines what cuts can be made would save on litigation and heartache for both sides. Also, a federal law which takes narrow networks in hand protects consumers, who won't always be on the right side of things when health plans decide to start chopping.
Of course, the health plans will scream bloody murder if such a measure is filed in Congress or proposed as a regulation by HHS. But look at it this way, health plan folks. If the definition of a narrow network is standardized nationwide, it probably won't be necessary to go to court as often to defend your decisions. And on the flip side of the same coin, providers will have clear-cut regulations or legislation to point to if they feel they've been treated unfairly. In other words, the way I see it, both sides win.
Readers, what do you think should be done to address the turmoil around narrowing of networks? Write to me at [email protected], and if you disagree with me, don't be afraid to let me have it.