Zach Stone, Communications & Community Engagement Coordinator

If you already have your health care coverage in order for 2017, pat yourself on the back. Now is the time to relax and reflect on how terrific you are for taking care of things on time and avoiding a gap in coverage in 2017. Soak it all in.

But once 2017 kicks off, you’re going to want to make sure that you’re utilizing your coverage in a fashion that meets all of your health care needs. That often means finding a specific specialist that’s in your insurance network and setting up an appointment. But what if you can’t find a specialist you need, because your provider directory is littered with inaccuracies? Or what if you do find that specialist, but they aren’t accepting new patients?

We know from our partners, along with our own work that issues with inadequate health insurance networks—like an inaccurate provider directory in the case above—can be a real problem for Colorado consumers, limiting their access to the care they need in a timely manner. So, in an attempt to better understand the problem, we set out to talk to some consumers to see if their carriers’ networks were affecting their ability to get the care.

What we quickly realized is that our concerns about networks were at times not the initial concern of consumers. That is not to say that network adequacy isn’t a problem, but that some consumers simply aren’t there yet.

Take Toni Fisher as an example.  When I spoke with Toni, she was clearly more preoccupied with affording her plan than she was with utilizing all her health insurance had to offer. She makes too much to qualify for financial assistance, but still feels the financial strain of her premiums. She goes to her doctor and taps her insurance when she feels it’s necessary, but doesn’t bother going to the doctor when she has minor health issues. Because Toni considers herself in good health, she felt ill equipped to answer my questions about the adequacy of her insurance network: “If you’re not sickly, you don’t get to experience all the avenues of what health care can provide,” she said.

We also spoke with Victorio and Silvia Aparicio, a husband and wife that had just gotten covered through Connect for Health Colorado and received financial assistance to help cover the cost of their premiums. They felt that it was important to have coverage in case of an emergency, but worried about paying their deductible if something happens. While they hadn’t encountered issues with their health insurance network, they did mention that having access to translation services was very important to them—so being able to communicate with the providers is an important consideration when looking at the carrier network..

In our investigation into the consumer perspective on network adequacy, we learned that, for consumers with lower health care needs or affordability concerns, access to doctors and network issues are a secondary problem. For these folks, their concern about the cost of care and access to basic care tend to reign supreme. All that is not to say that network inadequacy isn’t a significant problem—it still most certainly is. We’ve heard that it’s an issue from consumers in the past, we saw it in our provider directory study, and we heard it when Victorio and Silvia Apricio told us how much they value access to translation services. But for the folks like Toni Fisher that aren’t there yet, it’s clear that we’re going to have to address their topline concern—the cost of care—first, so that they have the opportunity to truly utilize all that their health coverage can offer them. Network inadequacy is a big concern for consumers to be able to access the care they need, but some consumers can’t get past the costs of care to more meaningfully delve into the network adequacy conversation.

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