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Playing Russian Roulette with In-Network Coverage: Are You Feeling Lucky?

Playing Russian Roulette with In-Network Coverage: Are You Feeling Lucky?

Jun 13, 2024

Playing Russian Roulette with In-Network Coverage: Are You Feeling Lucky?

So here is a story I see way too often that I came across the other day. Let me summarize it before I explain why it’s essential for what we are doing at Crowdhealth today.

In November 2023, Sarah Feldman, a 35-year-old from New York, received a confusing notifications from Mount Sinai Medical. The messages detailed ongoing struggles in contract negotiations with UnitedHealthcare, which manages Oxford Health Plans, Feldman’s health insurance provider.
The communications initially reassured her, stating, "We are working diligently with Oxford to finalize a fair new agreement. Your physicians will remain in-network, and you should continue attending your scheduled appointments."
However, by late February 2024, the situation took a turn for the worse. Starting March 1, Mount Sinai announced it would no longer be in-network with Feldman’s insurance, forcing her to seek new healthcare providers, including her primary care doctor and several specialists.
This scenario underscores a critical flaw in the healthcare insurance system: patients are typically locked into their insurance plans, only able to switch during annual enrollment periods or after significant life events. Conversely, insurance providers can modify or terminate their agreements with healthcare providers at any time, often leaving patients without coverage for their chosen doctors or necessary medications.
This issue is exacerbated by the increasing number of disputes between large hospital systems and insurance companies over contract terms and pricing, as reported by the Robert Wood Johnson Foundation and Becker’s Hospital Review. These conflicts, which have surged by 91% in recent years, often result in sudden network changes that can disrupt patient care significantly.
For instance, last year, Baptist Health in Kentucky and Vanderbilt Health in Tennessee ended their contracts with Humana, pushing countless patients to scramble for new in-network healthcare options. Such abrupt changes highlight the volatility of the current healthcare market.

Here is why this is so important for anyone using insurance in America today. State and federal regulators have the power to enforce network stability; however, there has been little to no action to ensure continuity of coverage. This lack of regulation may stem partly from new hospital price transparency rules that allow healthcare providers to compare rates, prompting them to renegotiate contracts more aggressively.

Insurers often offer limited extensions of coverage following a contract termination, which may cover ongoing treatments like pregnancy but leave other long-term care, such as cancer treatments, in a precarious position.

Patients frequently find themselves unexpectedly out-of-pocket as a result. For example, a woman incurred nearly $10,000 in costs when her hospital and surgeon were “In-Network.” Still, her anesthesia was out-of-network due to a dispute with her insurance provider. Read that again.

This is a widespread issue in healthcare coverage—a system that can leave patients vulnerable and financially burdened without warning. Such situations cause financial strain and significant stress as patients navigate their recovery alongside insurance disputes.

The No Surprises Act, implemented in 2022, aimed to shield patients from some of these shocks by banning certain types of out-of-network charges. However, this legislation does not address the core issue of network instability during the insurance policy term.

To better protect consumers, regulatory measures could require that healthcare providers and insurers maintain their contract agreements for the entirety of the policy term, ensuring that patients are not left without coverage or forced to switch providers unexpectedly, but they won’t. So this is where Crowdhealth comes in.

We do not do this “In-Network” / “Out-of-Network” nonsense at CrowdHealth. The health insurance industry has become so prominent since the advent of Obamacare that it is almost impossible for anyone to navigate it. Our model is totally different, so you get the best care you need when you need it.

While most people fear walking into a doctor and saying, “I do not have health insurance,” let me ask you a question. Would you rather have 5 seconds of embarrassment of saying I have “no network” versus ending up with a 10,000-dollar bill? I know what I would pick, and if you would look at what some of our 7,000+ strong community says about living without insurance but are as healthy as ever.

So check us out and use new member code "healthy" for $89 dollars for the first 3 months.


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