|By Kate Harrison, Chattanooga Times Free Press, Tenn.|
|McClatchy-Tribune Information Services|
Roughly 52,800 Tennesseans looking at some of cheapest plans in the country chose a brand-new BlueCross BlueShield of
For many, the transition from shopper to Network E patient has been satisfying. They have access to quality doctors, many for the first time, at a good price.
Others, though, are reckoning -- sometimes painfully -- with the fact that Network E coverage is cheaper for a reason: There is a much narrower field of doctors to choose from. And it may not include the doctor they want.
The realization has led 4,475 members to switch to the company's S and P networks, which include more doctors,
Other states are dealing with the same issue.
Several factors are playing into the confusion and disappointment, health experts say.
Many first-time insurance shoppers picked plans based on price, without researching the providers.
Inconsistencies on the federal marketplace website and in insurers' doctor directories meant some patients went to an "approved" place for treatment, only to find out later that the doctor was not actually in-network.
And some physicians didn't realize there was a new BlueCross network. Saying they took "all BlueCross plans," they accepted patients' Network E cards, only realizing their mistake when claims were denied.
"There was a lot of confusion with the advent of the new network," said
BlueCross vice president of communications
All messaging about Network E, he said, made it clear: It was for people who valued savings over broad selection.
"We want everyone to choose the plan that works best for them. That's the best business model," Vaughn said.
"To think we're going to try to confuse people or make it seem like they're buying something they're not -- that's not something you do to build trust."
"The better that the health plans are able to negotiate, the better off it is for the patients paying the premiums," said Van Horn.
But the confusion also only highlights the need for more patient education, experts say.
"The only insurance decision most of us have ever made is if we wanted to be on our workplace plan, or our spouse's workplace plan," said Bond.
"We're in a new era in which we need to be more proactive consumers."
When BlueCross rolled out Network E last year, it put
One analysis by
"E is really good for people who are right above that poverty level. A lot of those consumers have never had health insurance or doctors," said
The exclusive Network E health system in
BlueCross dominated sales on the new insurance marketplace in
"As people are becoming more price-sensitive and we're facing greater and greater out-of-pocket costs, so they are more willing to make trade-offs of how much choice they're willing to give up versus how much price they're willing to benefit from," said Van Horn.
The home health care worker from Brainerd bought a Network E plan in March after not having insurance for a year. She found a low-deductible plan and was granted
She initially wanted a particular doctor, but found one she likes just as much on E.
"I do not have to worry about my health anymore," she said. "I now know that I have a doctor I can see."
"We found out that none of the primary care doctors or specialists we use were in the network," he said.
Even educated shoppers have been frustrated by kinks in the new insurance market.
Swann, a retired nurse anesthetist who lives in
In May, she made an appointment with a doctor in the Network E directory. But a few days after her checkup, the doctor's office said her claim had been denied. The doctor was not in Network E, she was told.
"It's frustrating," said Swann. "You call. You do everything you're supposed to do, and then it's not right."
BlueCross officials said they were working to clear up the matter to prevent such confusion in the future. They said their own site regularly updates its doctor directories.
Buell, at the
Some consumer advocates say patients shouldn't be stuck with out-of-network bills if they didn't know were out of network in the first place.
In Swann's case, the doctor absorbed the cost, asking Swann only for the original copay amount. And she has since referred Swann to another in-network doctor.
For now, Swann says she plans to stay in Network E. She likes the price. She just wants everyone to be on the same page.
"I just want them to get their facts straight," she said. "I just want to make sure I know what I'm getting."
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