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More than a month after HealthCare.gov and 15 state-based exchanges opened for business, consumers and even physicians are finding it isn’t easy or even possible sometimes to find out which doctors and hospitals are in the plans’ provider networks.
“Some states, they have it and for some it isn’t available. It’s a big unknown for the patient,” says Anders Gilberg, head of government affairs for the Medical Group Management Association, whose members manage doctors’ practices.
That means insurance shoppers often can’t choose plans that their doctors participate in — or that include doctors near them. It also means doctors may not be able to confirm they’re in a plan when consumers ask them. While consumers may now occasionally find a doctor listed on their commercial insurance plan isn’t accepting patients or is no longer on the network, at least they can reliably find provider lists, and doctors at least know what plans they currently participate in.
Gilberg says he wouldn’t buy a plan “if I didn’t know if my physicians were in the network or the hospital was in the network.”