While the press appears to have missed the lack of out-of-network benefits, exchange shoppers have not, and some are unhappy. One Manhattan hairdresser told me she probably wouldn’t buy an exchange policy and would instead keep her existing insurance because, “I’m not clear who the doctors are and who the hospitals are.”
Courtney Lee Adams, a New York freelance writer and editor—and avid CJR reader—contacted me to talk about her shopping experience in the New York exchange. Once she managed to create an account with what she described as a confusing and not very helpful website, she discovered her primary care doc of 15 years would not accept insurance from any plan on the exchange. It came down to reimbursement, she said. No out-of-network benefits meant she’d have to find a new doctor or pay on her own and made peace with those options. Then she faced a new obstacle. She found a hospital network in lower Manhattan she liked and trusted to deliver good care. But who were the doctors in the network? Each call to find out brought different answers. “As I get down to the deadline to purchase coverage effective January 1, I find comparison shopping among plans nearly impossible, mostly because of conflicting information about provider participation in plan networks,” Adams said. She added that many providers listed on carriers’ sites as being in-network have told her that they are not even accepting the plans.
There’s plenty of material here to move the insurance exchange story along beyond cheap premiums and technical glitches that continue to plague some states. Shoppers could use more stories like Siegel Bernard’s for the Times—advice via anecdote. But there’s also an important and larger story here about the ongoing payment wars between medical providers and insurers over which party can extract the best price for its bottom line. As Adams, the freelancer shopping for insurance in New York, told me: “This is not just a consumer shopping story. It’s something deeper. They’re wrangling over money. It’s not just about consumer choice.”
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