Narrow networks: “Enjoy”

More Insured, but the Choices Are Narrowing – NYTimes.com.

In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.

In Colorado, all exchange plans except Rocky Mountain Health Plans PPO, have state based networks if not more restrictive. Off exchange, nationwide networks are available from Assurant Health, Humana and Rocky Mountain Health Plans.

Narrow networks are great until they’re not. In general, if you’re looking to go out of network, there are serious issues that require and access to a specialist. The insurance company won’t pay because the specialist is either out of state or out of network. The solution to the above problems is cash…. or access to cash. Believe me, the specialist and his facility will be glad to accept your cash, what do you think the insurance company pays them?

How do you get “cash”, through an insurance policy that will be triggered by some of these serious issues. Potential policies include:

  • Critical Illness
  • Cancer/Heart Attack/Stroke
  • Accident coverage
  • Hospital indemnity coverage

Critical Illness may not be a coverage you are familiar with. Basically it is expanded Cancer/Heart Attack/Stroke. Expanded coverage vary from provider to provider, but typical additional coverages include: major organ transplant, coma, end stage renal failure, paralysis, blindness and severe burns.

Critical Illness and Cancer/Heart Attack/Stroke pay out the selected benefit upon diagnosis. Supplemental accident coverage usually cover the cost of treatment up to the limit of the policy (some accident plans work differently), Hospital indemnity pay specified amounts, such as $2000/day in the hospital.

Share

Leave a Reply

Your email address will not be published. Required fields are marked *