Many exchange health plans exclude top hospitals

CHICAGO (AP) — Chicago’s best known hospitals don’t accept many of the health plans sold on the new insurance marketplace that’s part of the nation’s health care law, and consumer advocates are worried patients will get stuck with unexpected bills.

It may turn into the next big challenge for the insurance system created by President Barack Obama’s law. Obama promised Americans could keep their doctors. But experts say the new plans appear to offer a narrow choice of hospitals and doctors — less choice than offered by Medicare or employer-based coverage.

As insurers compete for new customers within the law’s strict limits, they’re excluding higher-cost hospitals to keep premium costs low for some policies.

For Illinois residents, the best advice is to shop carefully, making sure a preferred hospital or doctor is in the plan’s network, said Jim Duffett, of the Campaign for Better Health Care. “If it is not, and you go to that hospital, you will be stuck with the bill,” Duffett said.

Shopping carefully could be a nightmare. There’s no central provider directory on HealthCare.gov, the federal website that Illinoisans must use to compare insurance plans on the marketplace. That leaves people clicking on multiple links to individual plans in a search for those that cover their doctors.

Keeping her doctor is important to Maureen Bardusk of Galena, who completed breast cancer treatment two years ago. She said she’s found a Blue Cross health plan on the marketplace that includes all the specialists she wants to see. She hasn’t made a decision yet, but she was glad to discover the plan she’s considering has a lower premium than what she’s paying now, although a higher deductible. A checklist from the Cancer Support Community helped guide her through the decisions, she said.

“I wanted that continued care,” Bardusk said. “You don’t want a surprise at a moment when you can’t handle it.”

Why are some of the top hospitals excluded? Major academic medical centers have higher prices because of the cost of training medical students and conducting research. The law limits how insurers can keep costs down, but doesn’t require them to cover all hospitals.

In Chicago, Rush University Medical Center used to be covered “in network” by all the health plans insurers offered in Cook County. Now, of the 71 plans offered on the Illinois marketplace in the county, Rush is covered in only 38.

“So we’re in about half the plans,” said Brent Estes, senior vice president of business and network development at Rush. “It’s the way it is for right now,” he said with resignation.

Northwestern Memorial HealthCare in Chicago, another academic medical center, is included in 36 of the 71 Cook County plans on the marketplace.

The state’s largest insurer on the individual market, Blue Cross Blue Shield of Illinois, offers an array of network options, “including our broad PPO network that includes both Rush and Northwestern for those who wish to have broader access,” said Greg Thompson, a spokesman for Health Care Service Corporation, the operator of Blue Cross plans in Illinois and four other states.

The Illinois Department of Insurance requires all health plans in the state to offer enough providers to assure a patient can get access to all medical services without unreasonable delay, based on travel time and distance, said department spokesman Mike Claffey. Consumers with concerns can file a complaint with the department, he said.

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Associated Press Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

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