Physician networks, formularies now viewable on healthcare.gov

Visitors to healthcare.gov now can view physician networks, deductibles, copayments, and formularies as "window shoppers" before they sign up for a health insurance plan – information that both doctors and patients have been seeking.

The new functionality was announced Dec. 2 by the Centers for Medicare and Medicaid Services.

At a Nov. 26 White House meeting on Affordable Care Act concerns, representatives of several physician organizations voiced concern that patients could not see whether their physician or preferred hospital was in a plan’s network during the shopping process, according to Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians.

Mr. Doherty, who attended the White House meeting, said that physician groups also told administration officials that patients and physicians needed information on formularies. Pharmaceuticals – at least one medication from each therapeutic class – must be covered by health exchange plans as an essential health benefit.

"But that doesn’t mean necessarily that your own particular drugs are on that plan’s formulary," Mr. Doherty said. The physician groups argued that more transparency was needed.

The same is true for provider networks. "From a consumer point of view, you may decide that if you can get a plan with lower premium and a deductible you can afford, you may choose to forgo your doctor or hospital," Mr. Doherty said. "That’s okay as long as you make an informed choice," he said, adding that without the ability to see networks, it was impossible to make such a choice.

Now, the networks are visible, but the question is whether the lists are up-to-date, he said. Physician groups also want "more transparency from the insurance industry, disclosing decisions on why they include or don’t include doctors in their networks and why they delist" physicians, Mr. Doherty said.

Physicians are getting help from Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee. Rep. Issa sent a letter to 15 insurance companies on Nov. 29, asking for documents "related to the reevaluation of provider networks and payment rates, as well as communications with the administration about potential changes to health plans limiting or changing health care access," according to a statement.

"Even among the individuals fortunate enough to keep their plans, many Americans are finding that access to their preferred doctor(s) is being abruptly terminated," wrote Rep. Issa, adding, "Some health insurers have acknowledged that they are slashing provider payment rates for plans offered on Obamacare exchanges."

The letter requested a response from the insurers by Dec. 13.

[email protected]

On Twitter @aliciaault

Visitors to healthcare.gov now can view physician networks, deductibles, copayments, and formularies as "window shoppers" before they sign up for a health insurance plan – information that both doctors and patients have been seeking.

The new functionality was announced Dec. 2 by the Centers for Medicare and Medicaid Services.

At a Nov. 26 White House meeting on Affordable Care Act concerns, representatives of several physician organizations voiced concern that patients could not see whether their physician or preferred hospital was in a plan’s network during the shopping process, according to Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians.

Mr. Doherty, who attended the White House meeting, said that physician groups also told administration officials that patients and physicians needed information on formularies. Pharmaceuticals – at least one medication from each therapeutic class – must be covered by health exchange plans as an essential health benefit.

"But that doesn’t mean necessarily that your own particular drugs are on that plan’s formulary," Mr. Doherty said. The physician groups argued that more transparency was needed.

The same is true for provider networks. "From a consumer point of view, you may decide that if you can get a plan with lower premium and a deductible you can afford, you may choose to forgo your doctor or hospital," Mr. Doherty said. "That’s okay as long as you make an informed choice," he said, adding that without the ability to see networks, it was impossible to make such a choice.

Now, the networks are visible, but the question is whether the lists are up-to-date, he said. Physician groups also want "more transparency from the insurance industry, disclosing decisions on why they include or don’t include doctors in their networks and why they delist" physicians, Mr. Doherty said.

Physicians are getting help from Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee. Rep. Issa sent a letter to 15 insurance companies on Nov. 29, asking for documents "related to the reevaluation of provider networks and payment rates, as well as communications with the administration about potential changes to health plans limiting or changing health care access," according to a statement.

"Even among the individuals fortunate enough to keep their plans, many Americans are finding that access to their preferred doctor(s) is being abruptly terminated," wrote Rep. Issa, adding, "Some health insurers have acknowledged that they are slashing provider payment rates for plans offered on Obamacare exchanges."

The letter requested a response from the insurers by Dec. 13.

[email protected]

On Twitter @aliciaault

Visitors to healthcare.gov now can view physician networks, deductibles, copayments, and formularies as "window shoppers" before they sign up for a health insurance plan – information that both doctors and patients have been seeking.

The new functionality was announced Dec. 2 by the Centers for Medicare and Medicaid Services.

At a Nov. 26 White House meeting on Affordable Care Act concerns, representatives of several physician organizations voiced concern that patients could not see whether their physician or preferred hospital was in a plan’s network during the shopping process, according to Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians.

Mr. Doherty, who attended the White House meeting, said that physician groups also told administration officials that patients and physicians needed information on formularies. Pharmaceuticals – at least one medication from each therapeutic class – must be covered by health exchange plans as an essential health benefit.

"But that doesn’t mean necessarily that your own particular drugs are on that plan’s formulary," Mr. Doherty said. The physician groups argued that more transparency was needed.

The same is true for provider networks. "From a consumer point of view, you may decide that if you can get a plan with lower premium and a deductible you can afford, you may choose to forgo your doctor or hospital," Mr. Doherty said. "That’s okay as long as you make an informed choice," he said, adding that without the ability to see networks, it was impossible to make such a choice.

Now, the networks are visible, but the question is whether the lists are up-to-date, he said. Physician groups also want "more transparency from the insurance industry, disclosing decisions on why they include or don’t include doctors in their networks and why they delist" physicians, Mr. Doherty said.

Physicians are getting help from Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee. Rep. Issa sent a letter to 15 insurance companies on Nov. 29, asking for documents "related to the reevaluation of provider networks and payment rates, as well as communications with the administration about potential changes to health plans limiting or changing health care access," according to a statement.

"Even among the individuals fortunate enough to keep their plans, many Americans are finding that access to their preferred doctor(s) is being abruptly terminated," wrote Rep. Issa, adding, "Some health insurers have acknowledged that they are slashing provider payment rates for plans offered on Obamacare exchanges."

The letter requested a response from the insurers by Dec. 13.

[email protected]

On Twitter @aliciaault