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Doctor Networks and Health Plan Reviews

Hoodles Doctor Networks

 

The third criteria in reviewing health plans behind benefits and cost is Doctor Network and you can expect this category to become more important as time goes forward into the new world of Health Refrom which we’ll explain later.  First, what exactly does Doctor Network mean and how do we compare and review it?

 

HMO versus PPO primer

First, a quick lay of the land to help guide expectations when it comes to health plan doctor networks.  There are two primary models out there right now…PPO and HMO health plans.  We’ll go into each one with more detail but a here’s a quick and dirty comparison.  PPO’s are more flexible in how you access care with more doctors/hospitals available to you but with more cost sharing (deductibles, etcs).  THe HMO’s are stricter in terms of how you access health care, offer fewer doctors/hospitals but generally offer richer benefits albeit at higher costs.    Most of the individual family market plans are PPO these days while HMO’s still reside in the group health market and in the senior market under the Advantage plan umbrella.  So back to expectations…you should know up front that with an HMO plan, you’re going to have fewer providers available, more rules regarding access, and the like.  Don’t buy an orange tree expecting apples.

 

I can’t find any doctors in this health plan

So how do we review or compare plans when discussing doctor networks?   Again, this is expectation.  If you find very few doctors in a given network or if doctors are leaving the network, that’s an issue and should be noted or reflected in the scoring.  Keep in mind that rural areas will have fewer doctors than more populous areas.  HMO plans may not even be available in rural areas reflecting the extreme of this trend.  In Hoodles, we review health plans on a scale of 1 to 5 with 5 being the best.  If you find that your doctors have all been in-network, that speaks pretty highly of the plan’s network.  If you find the only doctors in the network are marginal (we all know what that means), you should reflect it.  The health plan reviews will ultimately look at the average of all reviews and scoring so the one-off’s will fade away from view.    So why is it important to look at doctor network when comparing health plans?

 

The Big Squeeze in doctor networks is coming

It started a few years back.  Each year, health plan rates were spiraling with unceasing vigor.  We had already seen deductibles rise to levels that make health insurance itself seem impractical at best.  If benefits can’t get worse and rates can’t go higher, what is a carrier to do?  Squeeze the doctor networks.  First, they came out with limited network plans.  These are essentially health plans with comparable benefits but with doctors and hospitals that agree to much less reimbursement for care.  Fewer doctors and hospitals are willing to accept this discounted reimbursement so you end up with a much smaller network.  On the surface, the plans looks identical (although much cheaper) than other plans and most people don’t realize the difference until they actually need care (and a doctor).  The health plan review through Hoodles should help to clarify this difference and allow shoppers to compare apples and apples.

You can actually access any listed carrier’s doctor networks through the free quote available when you click the “Quote” button next to your plan along with brochures, exclusions, and of course rates.

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