The problems with inadequate health insurance networks
The uninsured rate in the United States is at its lowest level in history, and that is something to applaud. However, while consumers are doing what they’re being asked — purchasing policies — insurers have taken advantage of them by selling healthcare plans so limited that finding covered doctors and services can be a nearly impossible challenge. For Americans stuck with these scanty plans, they might as well not be insured at all.
Health insurance company Centene’s decision to sell inadequate, bare-bones policies under a false pretense through its subsidiary company Ambetter exemplifies the problem with these “narrow network” plans. Consumers in at least 15 states bought Ambetter insurance plans with the expectation that they and their families would be covered, only to find out all too late that their policies are not what they seemed.
According to a recent lawsuit, Centene misled customers about the number of doctors covered under its Ambetter plans – sometimes outright lying about the provider networks available to policyholders. If that weren’t enough, the company allegedly listed doctors who had specifically asked to be removed and students who weren’t licensed to practice medicine in its provider network. In one instance, the lawsuit claims, Centene even assigned an obstetrician-gynecologist to a man as a primary-care provider, even though the physician does not provide care to men.
Centene saw its national profile increase in the years following the implementation of the Affordable Care Act, expanding its reach as other insurers retreated from the exchanges. Through its Ambetter brand, Centene positioned itself as the insurer of choice for lower-income Americans. While this may seem like a noble pursuit on the surface, the company is taking advantage of vulnerable Americans, falsely touting an adequate provider network when the actual plans are so skimpy that many critics question whether they even meet minimum coverage requirements.
This practice completely violates consumers’ rights. What’s worse, it isn’t the first time Centene has been in trouble for this very practice. In December 2017, Washington State fined the company $1.5 million for having an inadequate network.
Unfortunately, Centene’s situation is not unique. Narrow-network plans are becoming increasingly common, and a growing number of consumers are unable to find affordable plans that cover the doctors, specialists, treatments, services, and hospitals they need. With limited doctors and services, patients are forced to choose between traveling hundreds — sometimes thousands — of miles to get the care they need or risk being hit with massive surprise bills later. It is a dangerous barrier to high quality healthcare, oftentimes compelling consumers to forgo care entirely.
While these plans were created to help reduce costs, they are often riddled with overwhelming small print that can deny care or result in exorbitant, unexpected bills. Consumers are then left paying for plans they cannot use or finding out, too late, the services they need are not covered.
Consumers for Quality Care, the patient advocacy group on whose board I sit, urges Centene and all insurers to examine their plans to ensure they truly offer comprehensive, accessible coverage that meets the needs of patients. Consumers have faced inadequate plans that can bankrupt families for far too long.
Donna M. Christensen, D-Virgin Islands, served nine terms in the U.S. House of Representatives and was the first female physician elected to serve as a House member. She now serves on the board of directors of Consumers for Quality Care.
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