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Will your hospital be 'in network' under ACA?


Date published: 12/10/2013

The Affordable Care Act has been the subject of many news stories. Yet little attention has been given to this issue: Virginia, and other states such as New Hampshire and New York, will only have HMO plans available. This means that there will be no out-of-network health care coverage available.

The PPO plan I currently have has out-of-network coverage, with a reasonable premium, to cover issues that may arise while I travel for work or for the times when out-of-network options are all that are available (e.g., testing, specialists).

However, my plan will no longer be offered as a result of ACA. I will need to move to an HMO where I will have to pay for out-of-network care 100 percent out-of-pocket, with no limit.

To add to this, the Fredericksburg area hospitals will be out-of-network. I was informed by Anthem that the Mary Washington Hospital will be out-of-network and that the Stafford Hospital may be as well. The Kaiser Permanente website indicates that Mary Washington Hospital and Spotsylvania Regional Medical Center are both out-of-network.

As many doctors and labs are affiliated with these hospitals the scope of this lack of coverage is substantial.

The explanation I was given for the lack of out-of-network coverage was that the law was developed to allow for states to control the details of the law implementation. This has resulted in differences across state lines, making it difficult to administer plans. A news story in the New York Post suggests that this would make plans cost too much. I cannot tell if it would cost too much, however, since I am not being provided this as a choice. This also doesn't address the lack of network options in the Fredericksburg area.

I have heard that the ACA has benefited many. However, this issue of no out-of-network coverage is a significant concern I have with how ACA is changing my health insurance coverage. This, while being faced with dramatic premium increases in the range of 50 percent plus with far less coverage.

I am writing this letter to highlight the issue so journalists, policy makers and others of influence can investigate it to find and raise awareness on solutions to provide affordable out-of-network coverage to the citizens across all states.

Cheryl Baldwin

Stafford