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Making it costlier to choose your own doctor from outside a health plan

Insurer does its own health care reform -- adding 50% to certain charges

ASK THIS | May 11, 2011

Oxford Health subscribers who go 'out-of-network' find it costs a lot more than it used to. Is it only one company that has lit up a new revenue enhancer, or are other health insurers doing it as well? And at what point will these new charges force patients to use a plan's doctors instead of their own?

By Craig Gurian

Remapping Debate, my online news journal, recently reported on a decision by Oxford Health Plans, a UnitedHealthcare company, to change the reimbursement schedules on at least some of its "Freedom Plans" so that patients have to pay 50 percent more than previously for an out-of-network doctor visit or procedure. The idea is to discourage enrollees from using out-of-network services. (Editor's note: Unitedhealthcare has close ties to AARP, so that, for example, AARP advertises its Medigap policies as being insured through Unitedhealthcare.)

Q. Is Oxford an outlier, or are other private health insurance providers taking plans marketed as giving out-of-network choice and effectively limiting the ability of enrollees to use the out-of-network component?
Q. What kinds of medical services become more difficult to obtain with out-of-network services out of reach for many enrollees?
Q.  Much of the polltical debate on health care is marked by rhetoric that the current system provides "choice" and that options  — whether those contemplated under the Affordable Care Act, or a single-payer system — would restrict choice. What do those who champion choice say about private health insurers taking that choice away?
Q. Are moves to restrict out-of-network availability consistent or inconsistent with the Obama Administration's vision of health care reform?
Q.  What, if anything, would be the impact on the ability of citizens to get out-of-network care with reimbursement better than that now being provided under Oxford's new system?

Q.  What does it say about the efficiency or effectiveness of private health insurers that actual reimbursement of out-of-network doctor care appears to be slightly lower than that available to Medicare beneficiaries?
Q. In the course of reporting the story, we saw that Oxford uses a method of counting "providers" that includes multiple types of practitioners, and that counts doctors who have more than one certification (for example, primary care and a speciality) as multiple providers. Is this method common in the industry? And why isn't there more transparency in terms of simply setting forth the actual numbers of doctors?

Click here for Remapping Debate's full story.


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