Some insurers or payers segregate physicians into tiered or select networks based on the payers' claims data and/or performance program ratings. Some payers use their cost and quality ratings to encourage patients to choose selected providers (sometimes called "steering"). Payers may also provide financial incentives to physicians whom they designate as high-performing.
Read the AAFP discussion paper on Tiering Physicians and Steering Patients.
Tiered Networks
Our Stance
The AAFP has concerns about the practice of tiering because it may be based on unreliable data and may undervalue primary care. The AAFP position states (in part) that if a payer uses a tiered network, the network must:
- provide patients sufficient access to health care,
- support the physician-patient relationship, and
- focus on improving patient care.
Member Wins
- In January 2006, UnitedHealthcare responded to an AAFP letter by agreeing not to support benefit tiering around primary care in its new UnitedHealth Premium Designation Program. Read the AAFP's letter to UnitedHealthcare (2-page PDF file; About PDFs).
AAFP Advocacy Efforts
- AAFP has met face-to-face with Aetna, Cigna, Humana, UnitedHealthcare and Wellpoint to discuss benefit tiering and other issues. AAFP urges payers who practice tiering to adhere to AAFP performance measures criteria and its policy on physician profiling.
Make Your Voice Heard
- Have you been placed into a tiered network or excluded from a select/narrow network by any of your payers? Download this template letter (2-page Word document; About Downloading), fill in the appropriate information, and send to the payer as a response.
- We want to hear about your experiences. Submit a health plan grievance or view grievances submitted by other members (Members Only).
