Enable consumer choice when offering narrow networks


It's always refreshing when I come upon a story that makes me feel like there's hope for the health insurance industry. This hope came last week when Washington Insurance Commissioner Mike Kreidler adopted a new rule requiring insurers incorporate certain adequacy standards in their provider networks.

Under the rule, insurers in Washington will have to include enough doctors and facilities in their networks to avoid unreasonable delays in care, plus some essential community providers. The changes effectively require insurers broaden their networks.

Insurers, however, pushed back against these changes--and, in some cases, for good reason. One of their bones of contention was the short timeline they were given to comply with the rule, which takes effect for the 2015 plans.

I understand how challenging it must be for insurers to go out, find and recruit certain providers to their networks only a few months before setting rates and offering plans. That's not a small task.

But Kreidler said the rule change was prompted by consumers complaining they weren't prepared for the narrow networks offered on most of the plans sold on the state's health insurance exchange. Some Washington state insurers offered exchange plans that excluded the most prestigious hospitals and medical centers in the region, including Seattle Children's hospital.

In announcing his new rule, Kreidler said he was attempting to provide consumers with as many tools and transparency as possible to successfully shop for health insurance.

And that's where I rejoice. The problem so far with insurers' narrow networks hasn't been that they're restricting choices. It's been an overall lack of transparency about which providers and medical facilities they actually include. One of the biggest complaints Kreidler heard from consumers throughout open enrollment for the exchange was that they learned their doctor was excluded from their plan after they had enrolled.

In many cases, consumers would likely choose a limited provider network for lower costs. And they should have the option to make that decision. A survey released earlier this year showed people are willing to accept a narrow network if they can save up to 25 percent on their healthcare costs. However, they should know that's the choice they're making, which is what Kreidler is trying to guarantee.

Insurers also could benefit consumers by disclosing what factors make a provider "high performing" or "efficient," Ezekiel Emanuel, a former White House health adviser, said in a New York Times opinion piece.

It would be lovely if insurers one day would implement network transparency without rules and regulations requiring it; but until then, I'm thankful there are regulators who will apply consumer protections to enable as much choice as possible. - Dina (@HealthPayer)