How many private health insurers are squeezing out-of-network care?

Leads | By Remapping Debate |

May 11, 2011 — Last week, Remapping Debate reported on the 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.

  • 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?


  • What kinds of medical services become more difficult to obtain with out-of-network services out of reach for many enrollees?


  • 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?


  • Are moves to restrict out-of-network availability consistent or inconsistent with the Obama Administration’s vision of health care reform?


  • 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?


  • 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?


  • 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?
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