WA: Exchange Players Trying to Hide How Bad Networks Really Are

Comment: Washington State hospitals and insurers are opposing State Insurance Commissioner Mike Kreidler’s new rule requiring them to tell consumers exactly what doctors and hospitals their plans cover.

“Health insurers and hospitals [...] lined up together Tuesday to give Insurance Commissioner Mike Kreidler an earful about his proposed new rule for insurance-provider networks.”

“Kreidler proposed the rule after complaints that consumers have been taken by surprise about narrower networks in insurance plans offered in the Affordable Care Act. Those networks exclude some of the region’s prominent hospitals and medical centers, meaning some consumers don’t have access to providers they expected to use.”

“For example, only one insurer offering plans through the Washington Healthplanfinder online exchange includes Seattle Cancer Care Alliance in Seattle; only three include Seattle Children’s, which has filed a lawsuit over the issue.”

“Kreidler says his new rule is designed to make it easier for consumers to discover which hospitals and providers are in the network for a plan they are considering buying.”

Comment: Apparently insurers don’t want Obamacare enrollees i.e., “suckers”) to know exactly how bad their government-designed coverage is:

“Katie Rogers, representing Coordinated Care, with one of the tightest networks and more than 26,000 enrollees through the Washington Health Benefit Exchange’s Healthplanfinder, said the majority of enrollees are subsidized and very likely were previously uninsured. ”

Comment: Meanwhile, hospitals are apparently happier with you not knowing they’re “out of network” — that way they can still get your business, and make the insurers pay later through an appeals process:

“Mark Del Beccaro, of Seattle Children’s, said the hospital has had to spend an inordinate amount of time appealing on behalf of children whose insurer denied coverage for care at Children’s. More than 70 percent of those reviews are ultimately decided in favor of the patient, he said, simply adding time and costs.”

““The narrow networks are threatening the access to care at both Seattle Children’s and Mary Bridge [Children’s Hospital in Tacoma],” he said. “In our view it is unacceptable for an insurer to have no qualified pediatric surgeons in network.” ”

Insurers, hospitals complain to Kreidler about new rules
April 22, 2014, By Carol M. Ostrom

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