Imagine yourself or a loved one receiving medical treatment from a specialist on a monthly basis. Then, one day, you arrive at your next appointment to discover that your doctor is no longer in your network, requiring you to seek for a new specialist. Doesn’t it seem upsetting to be in that situation, with the burdensome task of finding a new specialist and having them learn everything about your medical history and treatment plan?
That situation happened to some cancer patients in Houston, who discovered that M.DAndersonCancerCenter no longer would be in-network, obligating them to pay out-of-pocket or seek in-network care. Cancer is a life-threatening situation that is difficult enough and to have the added stress of not knowing how you will pay can be overwhelming, because your health insurance just decided that a specific hospital no longer would be in-network, making access to health care that much harder.
The Patient Protection and Affordable Care Act of 2010 was a comprehensive national healthcare reform aimed at expanding health insurance coverage and improving access to care in the United States. However, when trying to promote more affordable costs, plan network providers have had to narrow the providers in their networks, limiting the accessibility of care providers. According to Kaiser Health News, this sometimes caused consumers to drive long distances for care, impeded their access to providers, or resulted in high out-of-pocket costs for necessary care because the provider was out of network.
Following proposed regulations would promote network adequacy, but a pro-provider stance may not be inherently pro-consumer or even pro-patient.
The Latino community suffers from poorer health on many measures; consequently, it has less access to high-quality care. One in two Latinos will develop diabetes over their lifetime and are at a 66% greater risk of developing type 2 diabetes, and once diagnosed, have worse outcomes than non-Hispanic whites. Diabetes often brings mental health problems in its wake: One in five diabetics have depressive symptoms. However, Latinos are also less likely to receive treatment for depression, anxiety and other behavioral issues than their white counterparts
Therefore, making health care accessible is essential for the Latino community.
When looking at possible solutions, one can look at companies like Oscar, which found ways to simplify health care and make it more digital, making it more accessible and affordable by offering services like free telemedicine for incidents like bumps, bruises, coughs and fevers. If more health insurance companies offered more accessible health care like telemedicine, minimizing the need to go into the office for refills or common diagnosis, they could save money on in-office visits, allowing customers more flexibility in choosing providers and not having to narrow the networks so much.
Another way plans could control costs while diminishing consumer concerns about the limited choice are by making greater use of tiered networks. Tiered networks allow patients to receive care from a broader set of providers but require patients to pay higher out-of-pocket costs if they go outside the core network.
Utilizing tiered providers could help with narrowing networks, providing consumers a choice in providers.
In the social work profession, advocating and raising awareness is a fundamental aspect of achieving the primary goals of social justice, equality and the promotion of human dignity. Social workers commonly engage and understand the people within their communities, and they are trained to navigate the service systems that can provide resources to clients to promote their health, allowing the social workers to be key voices in advocacy for policies and how they are contributing to the community.
So why should you care? Because the federal marketplace plans are making narrower networks, fewer options and higher rates. The Robert Wood Johnson Foundation found that of the 131 carriers that offered preferred provider organization silver plans in 2015, just one-third remained unchanged; the rest were either diminished or done away with.
Having more narrow networks restricts consumers’ choice of providers, which sometimes causes consumers to drive longer distances for care, impedes their access to providers, or results in high out-of-pocket costs for necessary care because the provider is out of network.
This is a call to action for health insurance companies to explore better and more cost-effective methods to serve consumers rather than keep narrowing health care options.
Vanessa Tirado of McAllen is a master of social work student at Our Lady of the LakeUniversity.
