You pay for health insurance so you can see a doctor when you need one. But too often, insurance companies limit which doctors you can see, make it difficult to find a specialist, and create delays that keep you from getting care.
But certain actions by large insurance companies – including creating monopolies and resisting independent dispute resolutions – are giving these corporations more control while leaving patients with fewer choices and less access to care.
Insurers have enormous power to decide which physicians participate in their networks and how much they are paid. When insurers offer take-it-or-leave-it contracts with payment rates that do not reflect the cost of delivering care, independent practices face an impossible choice: accept unsustainable terms or remain outside the network.
Either way, patients lose.
Inadequate reimbursement can force practices to reduce services, stop accepting certain insurance plans, or close altogether. That leaves patients searching through provider directories that may look extensive on paper but offer far fewer real options in practice.
Insurers should not be allowed to charge high premiums while offering networks that fail to provide meaningful access to doctors and specialists.
Insurers should not be able to limit access from both directions: first by offering inadequate terms to in-network physicians and then resisting independent review of out-of-network payments.
Patients were rightly removed from the middle of surprise-billing disputes. They should not be placed back in the middle through narrower networks, disappearing practices, and reduced access to specialists.
The bottom line is simple: when insurers keep more and pay less, patients get less. Protecting competition and independent dispute resolution is essential to protecting patients’ access to care.