Consumers Faced with Choice on Health Providers

Consumers Faced with Choice on Health ProvidersAlthough unfavorable opinions of the Affordable Care Act (ACA) have increased to 53 percent in the Kaiser Family Foundation’s July Health Tracking Poll, the majority still want Congress to continue to improve upon the law rather than repeal and replace it.

Although there have been many good changes to come from the ACA, such as an insurer no longer being able to drop coverage or increase premiums when a person becomes ill, there are still many hurtles and challenges that need to be overcome.

For instance, consumers are finding that they have two options when faced with choosing a health plan through the exchange: more expensive plans with broader networks, or less expensive plans with narrow networks. Narrow network health insurance plans limit the range of doctors and hospitals their customers can visit, or sometimes even charge more for visiting providers outside of the network.

The key thing for consumers is to stay educated and informed when choosing a health care plan, either through their employer or the exchange system. Follow these 5 tips to ensure you avoid an unexpected medical billing situation:

  1. Read the benefits summary. Know what the deductibles and co-payments are for your in-network and out-of-network providers.
  2. Verify that a provider is in your network. Although a provider may be listed on the plan directory, they may no longer be in the network where you seek care.
  3. Stay in your network. If your doctor is no longer in your network, seek out another that is.
  4. Check if top-notch specialty providers are in your network. Federal rules require networks to include essential providers, but that does not mean they are required to include the most prestigious facility. If your plan does not include specialists to treat a particular condition, speak with your insurer about visiting an out-of-network specialist that will be treated like an in-network provider.
  5. Appeal a plan’s decision. Under the Affordable Care Act, if you disagree with your plan’s refusal to pay for care, your insurer must review its decision.

For more information on the Affordable Care Act, contact McGrath Insurance Group at 800-342-3859 or visit our website at

*This article is written for informational purposes only and should not be construed as providing legal advice.