A note on narrow networks

I’m prepping for my transition to the feasibility team and away from the plumbing department.  One of my major tasks is the creation of formal, documented knowledge instead of tacit knowledge that I just happen to know because I’ve been doing X for so long that I know why we made that decision in 2008 and how it is still echoing today and will still echo in three years. 

One of the documents I’ve been working on is the network bible.  Part of that process has been documenting all the networks and their membership.  Below is a chart of our biggest selling networks on the commercial side of the business and the percentage of hospitals and providers included in the network. The baseline for the percentages is the number of hospitals and total docs in the broadest commercial network that we sell.

Network% Broad Hospitals% Broad DocsPresident during year of 1st introduction
Broad100%100%when dinosaurs roamed the Earth
F28%100%Obama (before PPACA passed)
Mayhew Narrow82%85%Obama (PPACA Exchange)
Mayhew Super Narrow21%44%Obama (PPACA Exchange)

Note that the three commercial networks which are the top sellers by membership are narrow to very narrow networks and they were all fundamentally built when President Obama was either a state senator or a junior Senator in D.C.

Narrow networks have been around for a while and have been popular with some large employer groups as a means of controlling costs without shifting too much first dollar burden onto individuals.

13 replies
  1. 1
    BGinCHI says:

    “Narrow Networks” would be a good name if the GOP decides to re-brand.

  2. 2
    GHayduke (formerly lojasmo) says:

    Currently in the process of appealing a ROYAL FUCKING by my health insurance because they have no in-network detox centers, and I was in no mind to FUCKING GET PRE-APPROVAL for detox while I was withdrawing from alcohol dependency

    Grumble grumble.

  3. 3
    Richard Mayhew says:

    @GHayduke (formerly lojasmo): Bring this up with your state insurance regulator… network inadequacy problems are easy wins for them most of the time.

  4. 4
    GHayduke (formerly lojasmo) says:

    @Richard Mayhew:

    “Bubba” the fellow I just talked to, seemed to not care very much. I’ll just keep doing battle with my insurer until my options run out.

    Happily, it’s not a terrible hardship for me personally, but it’s sort of a shit situation to require pre-authorization of somebody who is in the throes of withdrawal…and a grand isn’t chump change, either.

  5. 5
    Mnemosyne says:

    @GHayduke (formerly lojasmo):

    Is it possible for you to get your primary care doctor (or whoever referred you to that center) to write a letter for the appeal? Sometimes it helps to have the backing of your doctor with stuff like that — they can say it was an emergency, couldn’t wait for pre-authorization, etc.

  6. 6
    GHayduke (formerly lojasmo) says:


    I have a request in to the chemical dependency councellor who referred me. Thanks!

  7. 7
    MomSense says:

    @GHayduke (formerly lojasmo):

    Sorry this is so frustrating for you. Even though you are dealing with the payment aspect of it now, I’m really glad you went to detox and send you lots of good wishes.

  8. 8
    GHayduke (formerly lojasmo) says:


    Thanks! Feeling blessed.

  9. 9
    Tommy says:

    @GHayduke (formerly lojasmo): Good luck my friend.

  10. 10
    mclaren says:

    Richard Mayhew is once again lying to you — this time by distracting you from the real crisis in American health care to focus on wonkish minutia like “narrow networks.”

    The real crisis destroying American health care is rising prices. Not costs, prices.

    Ordinary people are now getting priced out of vaccinations. That’s insane. If the vaccination rate drops below 95%, herd immunity collapses, and we get pandemics.

    In 1986, it took $100 to vaccinate a child from birth to age 18. Today, it costs $2,192. Because of this expense, insurance companies often don’t reimburse for the full price of a shot, and doctors lose money on each vaccination they give. As a result, many family doctors and primary care providers have stopped offering vaccinations to the general public, or even to longtime patients. Yet schools still require children to receive certain federally mandated vaccinations before students can matriculate. A NYT profile on rising vaccine costs shows the dilemmas this situation has created for parents…

    Source: Doctors Stop Offering Vaccines as Costs Skyrocket”

    Naturally, Mayhew’s dishonest deceptive posts utterly ignore the gigantic role of skyrocketing health care prices in the ongoing collapse of our broken health care system. And let there be no doubt whatsoever that health care costs are skyrocketing:

    Medical costs are skyrocketing and a survey published last month in JAMA has us doctors pointing fingers in every direction but at ourselves. The more than 2500 physicians surveyed rested most of the blame on malpractice lawyers, insurance companies, healthcare conglomerates, and drug/device companies. Patients came next. Trailing the lot were the doctors themselves.

    Doctors’ enthusiasm for cost-containment strategies that affected their compensation—eliminating fee-for-service reimbursement, “bundling” payments for the total care of patients, penalizing physicians when patients were re-admitted to the hospital—was notably lukewarm. However, nearly all were in support of eliminating waste and fraud, promoting continuity of care, minimizing corporate influence in medicine, and having better data about the relative quality of various medical interventions.

    The accompanying editorial by Ezekiel Emanuel and Andrew Steinmatz calls the current national debate about healthcare an “all hands on deck” moment in medical history. They wonder whether doctors will assume responsibility and step in to captain the ship, or stand aside, and let others navigate the future of healthcare while they swab the deck.

    Doctors are not nearly as rational as we like to tell ourselves, or our patients.

    Only one-third of doctors in the survey felt that they themselves had a major responsibility for reducing costs.

    Source: “Why Doctors Are Reluctant to Take Responsibility for Rising Medical Costs — If doctors feel health cost reform will just worsen the workload of practicing medicine, it will be hard to get them on board,” The Atlantic, 14 August 2013.

    American doctors have systematically dismantled medical schools so that today, in 2014, there are fewer medical schools than in 1965 — all in order to keep American doctors’ salaries double what doctors get paid in Europe.

    But American doctors refuse to take responsibility for this.

    American doctors take bribes from big pharma companies to prescribe insanely overpriced medications, but American doctors refuse to take responsibility for this either.

    American doctors have colluded with hospitals to form obscenely overpriced imaging and bloodwork and tissue testing clinics which sign sweetheart contracts with the hospitals to lock in sky-high prices and prevent potential competitors from seeing pricing information. Once again, American doctors refuse to take responsibility for this.

    Richard Mayhew is lying to you by yammering on about narrow networks and suchlike bureaucratic trivia, instead of talking about the real problems with American health care.

    Email John Cole. Demand that he throw this liar Richard Mayhew off Balloon-Juice.

  11. 11
    Kylroy says:

    @mclaren: Yes, throw off the guy who works for an insurance company (the player in the market who has a *reason* to lower costs) for not demonizing doctors enough. Have you *noticed* what happens when insurance companies fight doctors in the public eye?

  12. 12
    Fred Fnord says:

    @mclaren: Who is paying you for your sterling work here? High-quality frontier gibberish like that doesn’t come free.

  13. 13
    docg says:

    @Fred Fnord: Gibberish? Did you read the post? Grade A, extra virgin bullsh*t.

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