Are thousands of health insurance plans that allegedly meet the standards set by the Patient Protection and Affordable Care Act falling short in at least one key area?
A study by researchers from Harvard suggests that is very much the case.
The study, published in JAMA, the journal of the American Medical Association, found that 14 percent of plans in the research group do not include covered access to practitioners in at least one common practice area. Among the missing links in these plans: Endocrinologists, psychiatrists and rheumatologists.
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Researchers analyzed the networks of 135 health plans in the 34 states that sell health insurance through the federal marketplace, concluding that 19 failed to meet this basic coverage test.
That, they said, suggests that these plans do not meet the basic minimum requirements of the act, since one of them dictates that plans must offer reasonable coverage within their network.
"If somebody needed to access a psychiatrist or a rheumatologist, or they had a thyroid disorder and needed an endocrinologist, they would not be able to find an in-network specialist to care for them," says Stephen Dorner, a medical student and an author of the study. "From where we were sitting, in our analysis, having no access to an in-network specialist didn't seem like sufficient access to us."
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
