Introduction: The chief objective of the Affordable Care Act (ACA) was to make health insurance affordable to all Americans. In the face of rapidly increasing enrollment and rising demand for cheaper plans, insurance network providers are limiting the number and type of in-network physicians. Provider networks offering plans with limited in-network physicians are dubbed as “narrow networks.” It is important for neurosurgeons to know if narrow networks restrict outpatient access to neurological surgery. This article assesses the adequacy of access to outpatient neurological surgery in marketplace plans offered in Louisiana.
Methods: Marketplace Public Use Files (PUFs) are published data from Center for Medicare and Medicaid Services (CMS) containing plan and issuer-level data on benefits, coverage, premiums and co-payments for certified Qualified Health Plans (QHPs). The PUFs were searched for all “silver” plans (purchased by 74% of all marketplace enrollees in 2017) available in the Louisiana state marketplace. The silver plan represents a cost sharing of about 70% on the part of the insurer and 30%
on the insured. A total of 7 “silver” plans were identified in Louisiana. Using the plans’ online directories, we performed a search of in-network neurosurgeons in Louisiana parishes with >100,000 population. The primary outcome was presence of in-network neurosurgeon/s in each individual silver plan within 50 miles of selected zip code for each parish with >100,000 population. Plans without in-network neurosurgeon/s were labeled as neurosurgeon-deficient plans.
Results: Neurosurgeon-deficient plans exist across all 14 parishes with >100,000 for this study. The proportion of neurosurgeon-deficient “silver” plans in each parish ranges from 14% to 57%. Therefore, there is at least a 14% chance that an individual living in a Louisiana parish with >100,000 population will be enrolled in a neurosurgeon-deficient “silver” marketplace plan.
Conclusions: This study presents evidence that narrow networks exist within “silver” plans offered via the Louisiana state marketplace. Lobbying efforts from neurosurgeons are required to promote equitable access to outpatient neurological surgery across all “silver” marketplace plans.
Patient Care: It is important for neurosurgeons to know if narrow networks restrict outpatient access to neurological surgery. Lobbying efforts from neurosurgeons are required to promote equitable access to outpatient neurological surgery across all “silver” marketplace plans.
Learning Objectives: 1. To discuss the concept of narrow networks within insurance plans
2. To review insurance data from state of Louisiana to demonstrate that narrow networks exist within neurosurgery