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Health Insurers Narrow Doctor Network Choices to Control Costs for Affordable Care Act Plans

Although the Affordable Care Act has helped the United States make significant strides insofar as reforming the health sector is concerned, the health sector still face some challenges that should be addressed. For instance, the law has seen the health insurers attenuate doctor network choices. As a result, the law has limited the access to healthcare services in rural areas and inner cities. Research shows that this challenge could be overcome by doing away with the regulations to give room for telehealth providers.

Telemedicine allows health care services consumers to have easier access to physicians via electronic gadgets such as phones and computers. This trend is becoming popular as consumers, employers, and private insurers seek to reduce the cost incurred through unnecessary trips to health centers. However, the narrow doctor network resulting from health insurance plans under the Affordable Care Act is leaving out patients in the inner cities and rural areas. Nonetheless, this is a weakness that telehealth providers network can exploit in persuading the regulators to accommodate them in the Obamacare-compliant network.

Robert Wood Johnson Foundation sponsored the Georgetown University research on network adequacy. According to the study, states limit access to telemedicine by insisting that patients have to meet doctors in person. Telemedicine also faces opposition from local medical practitioners who feels like they are being replaced systematically. In a statement accompanying the study, Kathy Hempstead of the foundation suggested that there could be ways for telehealth providers to prove that they offer adequate services to patients in the wake of stricter definitions of network adequacy in the states. According to Dr. Henry DePhillips, the chief medical officer at Telacod (a telehealth service provider), telemedicine should be valid for network adequacy rules under Obamacare.

Some health plans such as Aetna, Cigna, and United Health group are offering myriad benefits to employers including covering telehealth consultations. Unfortunately, they are not able to do the same when it comes to plans offered on the exchanges. In states like Ankara and California, patients have greater access to telehealth services. However, Professor Curtis Lowery of the University of Arkansas for Medical Services warns that having different network adequacy rules from state to state can create problems.

According to Hempstead of Robert Wood Johnson Foundation, it is imperative that telemedicine is recognized under the Affordable Care Act. He argues that the challenge relating to cost control has to do with making telemedicine a substitute rather than a complement to other more traditional health services. Hempstead believes that there are areas where telemedicine can help establish network adequacy and improve access, particularly to underserved communities.