This blog comes to you courtesy of a nasty exchange on Facebook. It started with a posting about the fact that an insurance plan offered through the state exchange did not include the regional children’s hospital in its network.
This is happening around the country as insurers limit provider networks in order to keep premiums within prescribed limits, whether those limits are mandated by the Affordable Care Act or by the employer paying for the health insurance. And it’s no secret that specialty hospitals like children’s hospitals and teaching hospitals have far higher costs than community hospitals. Reasons include the cost of training medical residents and fellows, the high percentage of Medicaid patients they see as well as the high percentage of uncompensated care they provide, and their mission to do research as well as provide patient care. They do receive additional federal and state funding to compensate — at least partly — for those expenditures, but in this day of shrinking budgets it doesn’t cover it all.
On the other hand, insurers offering policies on the exchanges must keep premiums within a certain limit based on actuarial data in their region. In addition, employers are looking for ways to … Continue Reading