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Limited Networks for PPACA Policies
Old 11-25-2014, 10:27 AM   #1
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Limited Networks for PPACA Policies

In my neck of the woods we had 2 companies on the exchange last year, and 3 this year, the new one being UnitedHealthcare.

Last year I noticed that BlueCross BlueShield of NC had the same network for policies sold on the exchange as for those sold directly. I think that also holds true for offerings in 2015.

But when I check UnitedHealthcare, if you buy a policy from the exchange, it is called United Healthcare Compass, and has a much smaller network. There are two competing healthcare chains in my area, Carolinas Healthcare and Novant. When I checked the exchange-based policy from UnitedHealthcare, I saw that the only Novant stuff in there were imaging centers....there were no doctors. But if I check the non-exchange policy, all the Novant docs are in there.

Has anyone else noticed this trend? I'm thinking if this trend continues, we, who buy on the exchange, could end-up second-class citizens when it comes to medical services.
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Old 11-25-2014, 10:46 AM   #2
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Our Anthem group plan has a name that's similar to the exchange plan and I had a provider turn me away before they realized I wasn't on the Covered California plan.
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Old 11-25-2014, 10:53 AM   #3
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The HI I deal with has 2 networks one very limited, the other covers most every provider in the metro area. Of course you pay up for the better one.

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Old 11-25-2014, 11:02 AM   #4
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One of the big local insurers here had 2 identical looking Bronze HSA policies. I called to ask what the difference was and found that the less expensive one had a smaller network. All of our doctors were included in the smaller network but not the hospital around the corner, instead we'd have to use the city hospital about 10 minutes away, which is fine.

The lab, radiology and mammography at the hospital campus around the corner are all included but not the hospital itself. Need to pay attention to every detail with some of these policies!

The price difference between the 2 policies is $50/mo for each of us. For that amount of difference I can remember to check the provider directory before seeing a new doctor or using a new facility.
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Old 11-25-2014, 11:20 AM   #5
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Has anyone else noticed this trend? I'm thinking if this trend continues, we, who buy on the exchange, could end-up second-class citizens when it comes to medical services.
This is not new. For years, perhaps even decades, insurance companies have offered policies with networks designed around a specific price point. This is the first time these networks are subject to public inspection. large national insurers have hundreds of different network groups, each built to a specific purpose.

There is a clear trend for insurers to offer policies that fall into three groups; HMO (closed), restricted network, and broad network. They are also required to allow the public to search the network and offer mostly rudimentary tools to do so.
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Old 11-25-2014, 11:21 AM   #6
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I have nine United Healthcare Compass plans offered to me on ACA. When I checked the United Healthcare website I get the same exact same plans that are offered to me on ACA.
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Old 11-25-2014, 04:28 PM   #7
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I have nine United Healthcare Compass plans offered to me on ACA. When I checked the United Healthcare website I get the same exact same plans that are offered to me on ACA.
When I went to the UnitedHealthcare site a few weeks ago and acted like I was going to buy a policy, it offered me the non-Compass product that had the "good" network. But I went just now, and, as you say, it's offering the Compass product only. Hmmmm. I'd bet if I called them, they'd sell me a policy with the big network! Why have a big network if you are not going to sell a policy that uses it?

I probably didn't make myself clear in the OP. I don't have a problem with various different networks. That's mostly how they differentiate themselves now that they have the rules that make the policies more uniform. The problem I saw was that they only offered limited network policies on the exchange. So maybe it's worth $20 a month for me to get the expanded network, but I can't get the expanded network AND the subsidy since the exchange lacks the expanded network policies.

EDIT: Called UHC and they did offer to sell me a non-Compass product with the big network.
EDIT2: Found out you need to go to www.uhone.com to get the non-PPACA policies.
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Old 11-25-2014, 05:24 PM   #8
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It's actually $11 more to get the big network, but the big network is not offered on the exchange.

This is like the high-priced, low-quality grocery store in the bad neighborhood; it's what you are offered, so you have to take it.
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Old 11-25-2014, 05:39 PM   #9
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I probably didn't make myself clear in the OP. I don't have a problem with various different networks. That's mostly how they differentiate themselves now that they have the rules that make the policies more uniform. The problem I saw was that they only offered limited network policies on the exchange. So maybe it's worth $20 a month for me to get the expanded network, but I can't get the expanded network AND the subsidy since the exchange lacks the expanded network policies.

EDIT: Called UHC and they did offer to sell me a non-Compass product with the big network.
EDIT2: Found out you need to go to www.uhone.com to get the non-PPACA policies.
I'm pretty sure the UHC policies are ACA compliant. They just aren't available on the health exchange. Most other national insurers are doing the same thing.

Insurers offer national networks in some states and not others. This is not an ACA issue, and it is a PITA for consumers, but it's up to each state to get insurers to offer broader coverage.
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Old 11-25-2014, 06:14 PM   #10
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It's actually $11 more to get the big network, but the big network is not offered on the exchange.

This is like the high-priced, low-quality grocery store in the bad neighborhood; it's what you are offered, so you have to take it.
UHC is offering that same product in Florida. We still have other offerings that I prefer, but I do agree it's better than the plans with local or regional networks. The price I see for Fl isn't that bad. That is, it's in the same ballpark as the others.

The exchange availability is an issue if you want or expect premium assistance. If not, no issue.

You might want to check Humana, Assurant and Blue Cross - they all have additional non-exchange plans on their website.
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Old 11-25-2014, 07:30 PM   #11
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We have a similar dilemma and are in analysis / paralysis mode with two different Horizon BCBS bronze plans offered on the exchange. One of the two plans we already have in 2014 which has the full Horizon managed care network available to us and requires no PCP referrals. Our initial perspective prior to signing into healthcare.gov this year was just to renew this policy.

Upon reviewing the 2015 ACA offerings, however, we saw that Horizon BCBS came out with a significantly less costly bronze plan ($321 less per month for a family of four) which though requires PCP referrals and has a smaller network. The ind/fam deductibles and max OOP costs for both plans are relatively close so the decision comes down cost versus network size and level of flexibility in not having to go to a PCP for any specialist referrals.

We reviewed the provider listing in the less costly bronze plan and every one of our current potential physicians/specialists (roughly 10 or so including PCP) are in the network but upon detailed review there are a number of doctors who do not participate (40% or so of full managed care network). All of the hospitals and other facilities are the same in both plans.

As such, we are struggling with whether it is worth $321 more per month premium for the added flexibility of no referrals and the "potential" need for in-network access to healthcare physicians or specialists who are not in the reduced network in the likely event of something major happening throughout the course of 2015. Any perspectives in helping us solve our dilemma?
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Old 11-25-2014, 10:15 PM   #12
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...... I'm thinking if this trend continues, we, who buy on the exchange, could end-up second-class citizens when it comes to medical services.
In some regions it is happening already according to some reports here and on other forums. IMHO- This may be a big reason to buy outside the Exchange if certain you will not qualify for a subsidy. Or even get a j#b to qualify for access to decent employer-sponsored HI plan
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Old 11-26-2014, 10:09 AM   #13
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When going through the pain of being forced into an ACA-compliant plan (and seeing my premium increase by 118%), I did pretty exhaustive comparisons of many plans. In discussing all this with my agent, he mentioned that many companies are not putting their "better" plans on the exchange because they are afraid of getting overloaded with people who have been uninsured in the past and/or have serious health issues. Not sure how the logic flows, but that is his observation.
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Old 11-26-2014, 11:01 AM   #14
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When going through the pain of being forced into an ACA-compliant plan (and seeing my premium increase by 118%), I did pretty exhaustive comparisons of many plans. In discussing all this with my agent, he mentioned that many companies are not putting their "better" plans on the exchange because they are afraid of getting overloaded with people who have been uninsured in the past and/or have serious health issues. Not sure how the logic flows, but that is his observation.
That could be taken as "good news"; if this is a sign of the insurance companies sticking their toe in the water, maybe in a few years, they'll jump in!
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Old 11-26-2014, 11:16 AM   #15
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In discussing all this with my agent, he mentioned that many companies are not putting their "better" plans on the exchange because they are afraid of getting overloaded with people who have been uninsured in the past and/or have serious health issues. Not sure how the logic flows, but that is his observation.
I don't see why they wouldn't just list both plans on the exchange. In fact I see this for some providers as they have a cheaper HMO and more expensive EPO/PPO.

Also given that ACA limits the MLR to 85% (and I assume the companies have good enough actuaries that they can actually get it to the limit) does it really make a difference? maybe my assumption is wrong.
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Old 11-26-2014, 11:51 AM   #16
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There are three programs to help insurers manage the risk of averse selection. Two apply to all insurance policies, the third only applies to policies sold on the exchange. One reason an insurer chooses to offer a policy off exchange only might be because they don't want the policy subject to "risk corridors" regulations. Under that system, groups that pay out fewer claims than planned pay into a pot and groups that pay out more than planned collect from the pot. It a risk stabilizing measure, perhaps the insurer is pushing the riskier policy groups onto the exchange and keeping the safer one. Pure speculation...

This KFF analysis explains the risk management aspect of the ACA Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors | The Henry J. Kaiser Family Foundation
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Old 11-26-2014, 12:35 PM   #17
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In my neck of the woods we had 2 companies on the exchange last year, and 3 this year, the new one being UnitedHealthcare.

Last year I noticed that BlueCross BlueShield of NC had the same network for policies sold on the exchange as for those sold directly. I think that also holds true for offerings in 2015.

But when I check UnitedHealthcare, if you buy a policy from the exchange, it is called United Healthcare Compass, and has a much smaller network. There are two competing healthcare chains in my area, Carolinas Healthcare and Novant. When I checked the exchange-based policy from UnitedHealthcare, I saw that the only Novant stuff in there were imaging centers....there were no doctors. But if I check the non-exchange policy, all the Novant docs are in there.

Has anyone else noticed this trend? I'm thinking if this trend continues, we, who buy on the exchange, could end-up second-class citizens when it comes to medical services.
South Carolina has four companies on the exchange for 2014 and 2015. BCBSSC and BlueChoice offer the same large networks on the exchange that I could access through my employer's plan before retiring earlier this year.

Coventry has a small exchange network that only includes the smaller of the two hospitals in my town. Coventry's non-exchange plans include both hospitals.

Consumer's CO-OP was created specifically for the exchange and has a small network similar to Coventry. They don't offer non-exchange plans.
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Old 11-26-2014, 04:08 PM   #18
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South Carolina has four companies on the exchange for 2014 and 2015. BCBSSC and BlueChoice offer the same large networks on the exchange that I could access through my employer's plan before retiring earlier this year.

Coventry has a small exchange network that only includes the smaller of the two hospitals in my town. Coventry's non-exchange plans include both hospitals.

Consumer's CO-OP was created specifically for the exchange and has a small network similar to Coventry. They don't offer non-exchange plans.

I am just hoping to actually get a look at all Coventry plans. Their website in my area is all screwed up and reports no plans are available in my area despite having a host of them on government website. Calling them is useless too, and they have assured me it will be fixed soon. They had no problem sliding me into an expensive off exchange plan for my convenience already though.


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Old 11-27-2014, 08:59 AM   #19
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There are three programs to help insurers manage the risk of averse selection. Two apply to all insurance policies, the third only applies to policies sold on the exchange.
Thanks for the explanation and link. The table 1 in the article was very helpful -- it's interesting that two of the three methods (reinsurance and risk corridors) are only temporary and designed to last only 3 years. I guess they expect the system to stabilize by then.
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