My Patient Now Has Insurance, So Why Can’t They Get Care?

The passage of the Affordable Care Act has greatly improved access to health insurance by giving Americans an alternative who lack access to traditional employer-based health coverage. The ACA Marketplace gives individuals and families the opportunity to purchase affordable health insurance. However, having insurance does not guarantee the family can see their preferred medical providers.

 One way for all insurance companies to keep premiums low is to restrict where patients can receive covered care. The insurance companies are trying to save consumers money by choosing the most inexpensive hospitals for many marketplace plans. Yet comparing costs for an appendectomy at a community hospital to a stand-alone children’s hospital is like comparing apples to oranges. Pediatric hospitals treat kids with rare and serious diseases with specialized resources and staff which a community hospital may lack, so pediatric hospitals may have more expensive care in order to serve those medically complex patients.

 Families need to be better informed about network restrictions on providers when they choose insurance through the marketplace. This will help the family choose a plan with a network of providers to meet their needs. Pediatric hospitals and providers should follow the example of Cincinnati Children’s to educate families about which plans will be covered at their institution. Families also need to know how to change plans if they qualify.

 To Learn More:

Washington Post

New York Times

Kaiser Health News about Seattle Children’s

New Republic Article about Hospitals in Los Angeles

Center on Health Insurance Reforms

 by Katie Collins, MD


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