President of SWIM Featured in Life Health Pro

Look at the insurers’ own provider directories.

Jeff Ungvary, president of Strategic Wellness & Insurance Management Services Inc., said he thinks brokers should also talk about the ramifications of network decisions when helping customers choose health coverage.

When he helps midsize employers analyze networks, he gets a list of the enrollees’ primary care doctors and specialists, then checks to see how many are in the current health plan network and how many would be in other networks the employer is considering.

At one employer, for example, the employees were using 136 doctors, and 18 of the doctors were not in any of the networks under consideration.

When an employer compares the percentage of the listed doctors who would be in-network in Plan A and in Plan B, some employers will choose the cheaper network, and some will choose the bigger network, Ungvary said.

Some have suggested that the exchange plans may now have especially narrow networks. Ungvary said he thinks that, even if the new, narrow networks are often too small for many enrollees to keep their doctors, they are still larger than the staff model HMO networks of the 1980s.

“Realistically, people will still be able to get care,” Ungvary said.

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Jeffrey R. Ungvary

 

Jeffrey R. Ungvary

President