Archive for January 8th, 2014

Transparency In Health Care Can Be Illusory

Wednesday, January 8th, 2014



What You Need To Know About Provider Networks Under ACA

Wednesday, January 8th, 2014

By   – January 6, 2014 •


“PPACA started to phase in limits on how insurers could use annual benefits limits, medical underwriting and plan benefits choices to hold rates down. Insurers reacted by creating narrow, ultra-low-cost networks; narrow networks made up of providers with high quality scores (LOW FEES); and big networks (High Fees) aimed at the Cadillac plan market.”

Editor’s Note: Translation – ACA limits insurers to pre-defined “metal” plans that leave no room for cost shifting. So, how do carriers compete now? By paying providers less. Narrow networks are  SBPPO’s – composed of providers who charge less than others – (type in “sbppo” in search box on this blog for information on SBPPO’s).

ACA provides  high octane fuel for Cost Plus / Reference Based Pricing schemes.