Georgia had the highest percentage of "narrow'' medical provider networks in the 2014 Affordable Care Act health insurance exchanges, a new report shows.
Five of six Georgia silver exchange plans last year had medical provider networks with a limited choice of doctors, according to the report from University of Pennsylvania researchers. The exchanges have a variety of plans with varying levels of coverage, including bronze, gold, silver and platinum. Silver is the most common
The 83 percent of Georgia plans having narrow networks surpassed that of all other states, the researchers found.
Health insurers are using narrow networks to keep premiums down as consumers shop for coverage on the exchanges. Under the narrow network format, doctors, hospitals and other providers agree to accept lower payments in exchange for a larger number of patients.
Narrow networks were on the rise before Obamacare but have become more prevalent under the health care law.
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, according to the report, which was funded by the Robert Wood Johnson Foundation. In contrast, 12 states, including Alabama, had no health plans that narrowly limited the physicians available to consumers.
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.
“More employers and more consumers are choosing these plans because cost is their No. 1 concern, ’’ said Graham Thompson, executive director of the Georgia Association of Health Plans.
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 also 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 The report said insurers’ directories of doctors “are notoriously out of date.”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.
It’s true that some consumers are willing to make the trade off of a lower premium for a smaller network, but that’s not the whole story, Zeldin said.
“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.”
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 Palmisano, the association’s executive director.
“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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