AMA: Calls Out Skinny Health Insurance Networks!

Posted on September 15, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Patients aren’t the only ones voicing concerns over the state of the US health insurance industry. The American Medical Association’s (AMA) policy making arm just called for new oversight and standards that ensure health plans don’t improperly limit patient access to in-network care.

The AMA House of Delegates voted to establish and enforce health insurance network adequacy standards as it met in National Harbor, Maryland, last year. The body adopted the proposal—along with several others—as part of the AMA’s continued efforts to ensure health plans meet patient needs and are held accountable for narrow networks.

The association said inadequate networks can create difficulties for patients in need of new or continued care. They can further limit patient choice when it comes to who is able to treat them and where they can be treated.

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What is Health Insurance Network STEERAGE?

Posted on October 18, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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What is health plan network steerage?

Network steerage is the practice of directing employees and members on your benefits plan to in-network doctors, hospitals, and other points of care. A network steerage strategy is crucial for healthcare payers who are looking to tackle high healthcare costs. An admirable goal.

CITE: https://www.r2library.com/Resource/Title/0826102549

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But, what is steerage – really?

The Centers for Medicare & Medicaid Services has raised concerns about a hospital practice known as “steerage”–which involves a provider buying commercial insurance coverage for patients who are already eligible for Medicare or Medicaid coverage in order to obtain higher levels of reimbursement.

IOW: The plan charges a fixed monthly fee so its members can receive health care. There will be a small co-payment for each doctor visit; however with the HMO, fees can be fore-casted unlike a fee-for-service insurance plan. Although freedom of choice is given up, out-of-pocket expenses are very low.

RELATED CONCERNS: https://www.fiercehealthcare.com/finance/cms-looking-for-data-practice-steerage-hospitals-voice-concern

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TEXT: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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DHIMC: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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Filed under: Ethics, Glossary Terms, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc. | Tagged: , , , | Leave a comment »