Dive Brief:
- As ACA plans roll out, hospitals are increasingly facing the prospect that they may be left out of "narrow networks" designed to accommodate low-cost health policies.
- Health plans can narrow their networks up to a point, but in some cases -- such as when a given hospital has the only level one trauma center in the region -- the hospital is a must-have even if it isn't the lowest cost provider.
- When markets have a single dominant player in a given niche, narrow networks can be problematic. For example, in Seattle, Seattle Children's Hospital is now out of network for many of the new plans offered on the Washington state health benefit exchange. Seattle Children's has now filed suit against the state insurance commissioner's office, arguing that its approval of the narrow ACA networks don't meet requirements for adequate access to care.
Dive Insight:
The narrow networks insurers are devising for use with their health exchange plans are precarious innovations indeed. As the case of Seattle Children's illustrates, payers can't just gut their networks for their own benefit if it leaves patients without sufficient access to care. It will be very interesting to see how Washington's insurance commissioner handles this issue.