When it comes to health insurance, "in-network" means a provider or facility that's contracted with your insurer to provide services at an agreed-upon rate. "Out-of-network" means a provider or facility that doesn't have an agreement with your insurer. Whether in-network or out-of-network providers and facilities are covered, and to what extent, depends on your particular health insurance plan.
It's pretty basic: in order to save a little money, most people have to stick to a budget. But before you can sketch out that spending plan, you need to know where your money's been going and how much you've been spending on everything. Then you can look for places to trim and skimp.
So too goes the theory with health care spending. Or at least, that's the idea behind several new efforts:
New rules for Medicare Advantage plan members give seniors more flexibility to opt out of plans that drop their doctors from the network.
The Centers for Medicare and Medicaid Services has announced that Medicare Advantage plan members will be able to switch plans if those plans drop doctors mid-year without cause. These are Medicare plans offered by private insurance companies and often operate like HMOs.
Connecticut doctors sued United Healthcare for dropping them from their Medicare Advantage network. Will Rhode Island follow suit?
Probably not, says Steven DeToy with the Rhode Island Medical Society. He told me he thinks it's unlikely the doctors will have any luck in court because United had the right to drop doctors - it's in their contract. And if they did, it could get expensive and messy: doctors could be responsible for half the cost of mediation if it comes to that.
A federal judge in Connecticut is blocking United Healthcare’s move to drop hundreds of doctors from its Medicare Advantage network.
The Hartford Courant reports that the Fairfield and Hartford County Medical Associations convinced the court that removing the more than 2-thousand doctors in Connecticut from the health insurance network would be too damaging. And that the insurer plans to appeal the decision.
RIPR health care reporter Kristin Gourlay joined host Dave Fallon in the studio to talk about what United Healthcare's recent decision to drop several hundred doctors from its Medicare Advantage plan means for the 36,0000 or so Rhode Islanders in that plan. Following is a transcript of their conversation, and a link to listen.
Rhode Island Attorney General Peter Kilmartin and Health Department director Michael Fine have sent a letter to the CEO of United Healthcare New England expressing their concern over the insurer’s dropping of dozens of doctors from its managed Medicare plan in the state. They want United to reinstate doctors until they submit a plan to handle the transition.