Introduction: The main objective of the Affordable Care Act (ACA) was to make health insurance affordable to all Americans while addressing the lack of coverage for 48 million people. In the face of rapidly increasing enrollment and rising demand for inexpensive plans, insurance providers are limiting in-network physicians. Provider networks offering plans with limited in-network physicians have become known as “narrow networks.” The objective of this study is to assess the adequacy of ACA Marketplace plans for outpatient neurosurgery in Louisiana.

Methods: The Marketplace Public Use Files (PUFs) were searched for all “silver” plans. A total of 7 silver plans were identified in Louisiana. Using the plans’ online directories, a search of in-network neurosurgeons in Louisiana parishes with >100,000 population was performed. The primary outcome was lack of in-network neurosurgeon(s) in silver plans within 50 miles of selected zip code for each parish with >100,000 population. Plans without in-network neurosurgeon(s) are labeled as neurosurgeon-deficient plans.

Results: Several plans in Louisiana are neurosurgeon deficient, i.e. no in-network neurosurgeon within 50 miles of the designated parish zip code. The Community Blue silver plans are deficient in all 5 parishes, while Humana and Vantage silver plans are deficient in 4 out of 14 (29%). Combined results from all counties and plans demonstrates that 43% (3 out of 7) of all silver plans in Louisiana are neurosurgeon deficient in at least 4 parishes with population > 100,000.

Conclusions: In Louisiana, narrow networks have limited access to neurosurgical care for those patients with ACA silver plans

Patient Care: This research concludes that in Louisiana narrow insurance networks have limited access to neurosurgical care for those patients with silver Marketplace plans. Similar projects are currently under way in Arizona and California. These projects will make neurosurgeons aware of the deficiencies in delivery of neurosurgical care under the current silver Marketplace plans.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) define the term narrow networks, 2) learn the different types of plans offered through the Marketplace (bronze, silver, gold, and platinum. 3) understand that an analysis of silver plans captures 74% of 2017 Marketplace enrollees; therefore, an analysis of all silver Marketplace plans purchased by Louisiana enrollees offers a cogent statewide analysis of the impact of narrow networks on access to outpatient neurosurgery.

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