Teaching hospitals left out of narrow networks in push to cut insurance costs

Facilities left out to make plans more affordable for consumers

Academic medical centers increasingly find themselves on the outside of many insurers' provider networks, the St. Louis Post-Dispatch reported.

Facilities such as the St. Louis University Hospital and New York's Memorial Sloan-Kettering Cancer Center rank among the most prestigious in the country. An affiliation with a medical school, coupled with a robust residency program, helps these institutions provide a high level of patient care, especially when it comes to complicated cases.

Teaching hospitals are typically covered on employer-sponsored and private-market insurance plans. However, the cost of receiving care at these facilities can be high--and consumers increasingly discover that they are not covered on Affordable Care Act (ACA) plans or on narrow networks.

These types of plans aims to make health insurance more affordable--but, in doing so, they limit access to the best care. On top of that, narrow networks don't always mean lower premiums, FierceHealthPayer previously reported, though consumers may not know that.

Insurers have introduced narrow networks partly to appeal to shoppers on the ACA marketplaces and partly to spread their risk pool, as the ACA no longer allows insurers to set premiums based on an individual's medical risk, a hospital executive told the Post-Dispatch. Meanwhile, a representative of Anthem said that decisions about which doctors and facilities to cover come down to "affordability and quality on a sustainable basis."

Nonetheless, some narrow network and ACA plan enrollees struggle to find doctors. That has caught the attention of the Association of American Medical Colleges, which issues accreditation to teaching hospitals. The group is lobbying Capitol Hill to compel insurers to include more health systems in their plans, the article said.

For more:
- read the Post-Dispatch article

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