Within the past year, patients in several states received letters from their insurance carrier informing them that their long-time family physician was abruptly being dropped from their health plan.
Patients with long-established relationships with their physicians were told they must select another physician within a few months with no explanation for the change and, typically, no way to appeal the decision. Suffice it to say that such sudden changes caused widespread frustration among both the patients and physicians involved.
Now, the AAFP is asking members who have been eliminated from an insurer's provider network or who are experiencing complications with a narrow network to participate in an online survey on the topic. Survey results and other documentation will be presented to federal officials when AAFP Board Chair Jeff Cain, M.D., of Denver, meets with CMS Administrator Marilyn Tavenner, M.A., on Sept. 24 to discuss the issue.
Insurance networks are classified based on the proportion of large hospitals in a community or region that participate in a given plan. Defined broadly, a narrow network includes 31 percent to 70 percent of area hospitals, according to consultant McKinsey & Co. An ultra-narrow network has less than 30 percent of area hospitals participating. The fewer the hospitals that participate, the fewer the physicians who do so, as well.
In July, the AAFP sent a letter to Tavenner(2 page PDF) asking CMS to step in to protect the interests of Medicaid beneficiaries in Tennessee. At issue was the fact that many of the state's Medicaid patients insured by UnitedHealthcare Community Plan had received letters stating that their primary care physician would no longer be included in the plan's network.
In its letter to the agency, the Academy also stated, "The AAFP has evidence that thousands of patients, in multiple states, are being told that they must identify a new family physician in the next few months as a result of their physician being 'dropped' from certain insurance products as a result of insurers 'optimizing' their provider networks to better align resources." Such actions disrupt patient care and can ultimately endanger patients' health, said Cain.
The upcoming meeting will follow up on those concerns.