To Curb Costs, New California Health Plans Trim Care Choices : Shots - Health News Insurers are holding down prices by including fewer doctors and hospitals in their health plans. Consumers may save money, but at the cost of more restrictions on where they can get medical care that is covered.
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To Curb Costs, New California Health Plans Trim Care Choices

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To Curb Costs, New California Health Plans Trim Care Choices

To Curb Costs, New California Health Plans Trim Care Choices

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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As people shop for new insurance under the federal health law, they're faced with many choices at a range of prices. The plans they can choose from may also come with different combinations of doctors and hospitals. And that has some people confused and frustrated. Pauline Bartolone from Capital Public Radio in Sacramento reports.

PAULINE BARTOLONE, BYLINE: Diane Shore of Mill Valley has been buying her own health coverage for over 10 years. But recently, Blue Shield of California canceled her plan and suggested a new one. It would involve a small premium increase but that's not what bothers her.

DIANE SHORE: My physicians will no longer be in this network of physicians or the hospital won't be, as well.

BARTOLONE: Shore says leaving the care of her doctors is not an option. She's been seeing the same group since she had breast cancer in 1998.

SHORE: I want to keep with a surgeon that I know, if this ever reoccurred, that I have full confidence in her. And my primary care doctor has been my primary care doctor for 20 years.

BARTOLONE: If Shore chooses that Blue Shield plan, the doctors and hospitals available to her will be limited to certain geographic areas, like the county where she lives. But she crosses county borders for health care.

SHORE: All my doctors are in San Francisco, and I live 20 minutes from San Francisco. In fact, it's more convenient for me to go to San Francisco than to the hospital here in Marin County.

BARTOLONE: So she says she's looking at other options and she's fortunate enough to have help from Susan Shargel, an insurance broker in San Francisco.

SUSAN SHARGEL: It's enough to give you a migraine, truly.

BARTOLONE: Shargel says she's trying to sort out all the new ways insurers are contracting with doctors. Some health plans will have fewer doctors in hospitals. Blue Shield, for example, will have half the doctors in three-quarters of the hospitals they have in the individual market this year. Shargel says she's never seen such restrictions to the provider's health plans cover.

SHARGEL: There isn't something that says, alert, be aware, take action now to be sure this works for you. There needs to be a red alert.

BARTOLONE: Health insurers say it's true, some plans will have fewer providers next year. Patrick Johnston is from the California Association of Health Plans. He says the Affordable Care Act requires insurers to offer greater benefits. So one of the few ways to keep costs down is through doctor contracts.

PATRICK JOHNSTON: What's left to control costs is the network. And in areas where there are a lot of hospitals, some more expensive than others, and a lot of doctors, it's only natural that a health plan will sign up some but maybe not all.

BARTOLONE: So, Johnston says if you're buying your own health insurance next year and want to keep your doctors, you may have to shop around.

JOHNSTON: Transitioning might mean looking or having difficulty signing up exactly the same doctors. But the benefits are rather enormous.

BARTOLONE: Benefits such as free preventive care and limits on out-of-pocket expenses. Gerry Kominski is with the UCLA Center for Health Policy Research. He says insurers are negotiating for their bottom line.

GERALD KOMINSKI: We're willing to pay you $50 a visit, just for example. If you're not willing to do that, we know a doctors group across the street that will accept that.

BARTOLONE: Kominski says the trend of narrowing provider networks to keep costs down is not new but it's been accelerating under the Affordable Care Act. It happens for people who get insurance through work as well.

KOMINSKI: If we want to keep health care from becoming completely unaffordable for everyone, at some point, something has to give. And in this case, what's giving is the ability to choose any doctor and any hospital.

BARTOLONE: Kominski and insurers say if plans offer a wide variety of doctors and hospitals, you may pay more for that choice. For NPR News, I'm Pauline Bartolone in Sacramento.

CORNISH: This story is part of a collaboration with NPR, Capital Public Radio and Kaiser Health News.

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