Georgia had the highest percentage of “narrow’’ insurance networks in the 2014 health exchanges, a new report says. Five of six Georgia “Silver” exchange...

Georgia had the highest percentage of “narrow’’ insurance networks in the 2014 health exchanges, a new report says.

Healthcare CostFive of six Georgia “Silver” exchange plans last year had medical provider networks with a limited choice of doctors, the report said.

The 83 percent of Georgia plans having narrow networks surpassed that of all other states, according to University of Pennsylvania researchers.

The report, released Monday, said health insurers are using narrow networks to keep premiums down as consumers shop for coverage on the exchanges, created under the Affordable Care Act.

Georgia’s narrow network rate was followed by Florida’s 79 percent; Oklahoma, with 78 percent; California, with 75 percent; and Arizona and Texas, each with 73 percent.

In contrast, 12 states, including Alabama, had no health plans that narrowly limited the physicians available to consumers, said the report, produced by Penn’s Leonard Davis Institute and funded by the Robert Wood Johnson Foundation.

Narrow networks were on the increase before the ACA was enacted, but they have become more prevalent under the health reform law.

The report’s findings will undoubtedly be a topic when a Georgia legislative study committee meets in September to discuss insurance networks.

From a consumer standpoint, the argument for such plans is that limited choices come with a lower cost.

Graham Thompson

Graham Thompson

“More employers and more consumers are choosing these plans because cost is their No. 1 concern, ’’ Graham Thompson, executive director of the Georgia Association of Health Plans, said Tuesday.

Many of these health plans offer incentives for providers to meet quality-of-care standards, Thompson added. “We’re trying to partner with providers to get the best outcomes and lower costs.”

But these plans have drawn complaints about a lack of information on which providers are part of a network. The report said insurers’ directories of doctors “are notoriously out of date.”

Cindy Zeldin of the consumer group Georgians for a Healthy Future agreed that directories are “routinely inaccurate.”

“Right now, provider networks are a bit of a black box for consumers, preventing them from choosing the plan that best meets their needs and potentially limiting access to care,’’ she said.

Zeldin said it’s true that some consumers are willing to make the tradeoff of a lower premium for a smaller network. But that’s not the whole story, she added.

“Others need a broader network to meet their health needs,’’ she said. “And everyone deserves the tools and information to make that choice and to know that they can access services for all covered benefits.”

Donald J. Palmisano Jr.

Donald J. Palmisano Jr.

The Medical Association of Georgia said that when insurers limit their networks, it often means that patients lose access to their physicians.

“MAG believes that the proliferation of narrow health insurance networks will exacerbate the shortage of physicians in Georgia,” said Donald J. Palmisano Jr., executive director of the Medical Association of Georgia.

“MAG believes that individual patients should have the freedom to see the physician of their choice as long as that physician is willing to participate in the patient’s health insurance network,’’ he added.

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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