Healthcare choices may narrow for some Nevadans

The Affordable Care Act may put your health insurance network on a diet.

With dozens of coverage mandates taking effect Jan. 1, Nevada’s insurers are looking to control costs by slashing the number of doctors and hospitals they contract with to create what local employee benefits consultants call “skinny networks.” Industry observers disagree on what it means for you: Insurers say leaner networks will improve delivery of care, while brokers say wait times for care will worsen even more than experts already predict.

It’s not clear just how thin those networks might get. Plan designs won’t be available until Oct. 1, when the Silver State Health Insurance Exchange starts selling policies. But early indications show some cuts could be dramatic. One large carrier will roll out a plan with just three Las Vegas-area hospitals in its network, down from the usual dozen, said Michael Caparso, cofounder of National Healthcare Access, an employee benefits firm in Las Vegas. And they won’t be “premier hospitals,” Caparso said.

Plus, where many plans now have 1,800 to 2,000 network doctors, expect to see plans with as few as 500 docs after January.

Not every insurer is trimming networks now, but as large ones scale back, others will follow to compete, Caparso said.

Glenn Shippey, an actuary in the life and health section of the Nevada Division of Insurance, said agency officials are seeing more insurers considering skinny networks in cities, which have thousands of providers. In rural markets, where hospitals and doctors are scarce, it’s less practical.

“In urban areas, there are opportunities for carriers to better control costs with smaller networks, so there’s greater interest in it for that reason,” Shippey said.

There’s more to it than cost-cutting, though, said Christy Daffern, director of operations for Aetna. Aetna will keep plans with fatter networks, and add two plans with smaller networks. An Aetna HMO will partner with all local hospitals except University Medical Center, while its Coventry Health Care of Nevada HMO will work only with HCA Healthcare’s three hospitals, and Valley Health System’s five hospitals. Neither plan will have fewer docs than average, but both will use just one physician practice: HealthCare Partners, a local system of about 300 primary-care providers and 1,700 specialists.

The HMO networks will save consumers as much as 15 percent on premium costs, Daffern said.

Yet, lower premiums won’t mean skimpier care, Daffern said. Aetna calls the coverge a “high-performance network product,” because its smaller provider count allows for easier management and more personalized care, she said.

“‘Narrow network’ has a bit of a negative connotation. With a high-performance network, all of our providers partner to share data, coordinate care and focus on getting members access to the care they need in the right setting at the right time,” Daffern said. “It really helps us with complex case management and on-site hospital reviews.”

Nevada’s biggest insurer, UnitedHealthcare, didn’t comment. The No. 2 insurer, Anthem Blue Cross Blue Shield, said it wouldn’t comment until later this month, when it has firmer plan designs.

Whether you’ll see a trimmed-down network in 2014 depends on your current coverage. If you have a policy through a big company or a self-insured business, and you don’t change plans Jan. 1, your network should stay the same. If you have to change plans, or if you’re buying for the first time, you could see thin networks.

For carriers who offer them, skinny networks save money two ways. First, with fewer providers, consumers won’t seek as much care. If the closest hospital in your network is 20 minutes away, you’re less likely to make an unnecessary trip to the ER, for example. So the networks cut patient-use rates.

They also let insurers carve out the priciest providers. One carrier told Caparso a heart procedure that costs $19,000 at one local hospital runs $43,000 at another. With a skinny network, that carrier can offload the more expensive hospital and cut its reimbursement exposure by more than half.

“In some cases, insurers are looking for the cheapest providers, as long as they’re in good standing, with no violations or Medicare fraud on their record,” Caparso said.

But there’s a flipside to potential savings, Caparso said. Putting thousands of Nevadans into plans with smaller networks could mean long wait times to see a doctor. That could affect quality of care and discourage people from staying in the system. If they have to wait six months for a routine physical, they might decide insurance isn’t worth it, and opt out of coverage.

“There’s going to be a big wave of people entering the health care system, but you’re not increasing providers. In most cases, you’re decreasing providers. People might question why they’re paying premiums, and if they can’t access even the most fundamental services, they’ll get sicker,” Caparso said.

Daffern said Nevada’s acute doctor shortage will create supply issues regardless of insurance networks.

What’s more, given potential savings, it’s important to offer smaller networks for consumers who couldn’t otherwise afford a plan, Shippey said. “If someone is willing to exchange a lower premium for restricted access to broader networks, it could be a good option for them. But it won’t be the only option.”

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.

ad-high_impact_4
Business
Neon wraps can light up the night for advertising
Vinyl wrap company 5150 Wraps talks about neon wraps, a new technology that the company believes can boost advertising at night. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Nevada on the forefront of drone safety
Dr. Chris Walach, senior director of Nevada Institute for Autonomous Systems, talks to a reporter at NIAS's new Nevada Drone Center for Excellence of Public Safety, located inside the Switch Innevation Center in Las Vegas. K.M. Cannon Las Vegas Review-Journal @KMCannonPhoto
Motel 8 on south Strip will become site of hotel-casino
Israeli hoteliers Asher Gabay and Benny Zerah bought Motel 8 on the south Strip for $7.4 million, records show. They plan to bulldoze the property and build a hotel-casino. Motel 8 was built in the 1960s and used to be one of several roadside inns on what's now the south Strip. But it looks out of place today, dwarfed by the towering Mandalay Bay right across the street.
Project billed as one of the world's largest marijuana dispensaries plans to open Nov. 1
Planet 13 co-CEO Larry Scheffler talks about what to expect from the new marijuana dispensary, Thursday, July 19, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Oasis Biotech opens in Las Vegas
Brock Leach, chief operating officer of Oasis Biotech, discusses the new plant factory at its grand opening on July 18. (Bailey Schulz/Las Vegas Review-Journal)
UNLV Tech Park innovation building breaks ground
Construction on the first innovation building at the UNLV Tech Park is underway. (Bailey Schulz/Las Vegas Review-Journal)
Caesars Forum Meeting Center
Caesars broke ground Monday on its $375 million Caesars Forum Meeting Center (convention center) just east of the High Roller observation wheel. (Caesars Entertainment)
Technology reshapes the pawn shop industry
Devin Battersby attaches a black-colored device to the back of her iPhone and snaps several of the inside and outside of a Louis Vuitton wallet. The device, installed with artificial intelligence capabilities, analyzes the images using a patented microscopic technology. Within a few minutes, Battersby receives an answer on her app. The designer item is authentic.
Recreational marijuana has been legal in Nevada for one year
Exhale Nevada CEO Pete Findley talks about the one year anniversary of the legalization of recreational marijuana in Nevada. (K.M. Cannon/Las Vegas Review-Journal)
Young adults aren't saving for retirement
Financial advisors talk about saving trends among young adults. (Bailey Schulz/Las Vegas Review-Journal)
President Trump’s tariffs could raise costs for real estate developers, analysts say
President Donald Trump made his fortune in real estate, but by slapping tariffs on imports from close allies, developers in Las Vegas and other cities could get hit hard.
Las Vegas business and tariffs
Barry Yost, co-owner of Precision Tube Laser, LLC, places a metal pipe into the TruLaser Tube 5000 laser cutting machine on Wednesday, June 20, 2018, in Las Vegas. Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye
Nevada Film Office Connects Businesses To Producers
The director of the Nevada Film Office discusses its revamped locations database and how it will affect local businesses. (Bailey Schulz/Las Vegas Review-Journal)
Opendoor isn't the typical house flipping company
Unlike most house flippers, the company aims to make money from transaction costs rather than from selling homes for more than their purchase price.
The Venetian gondoliers sing Italian songs
Gondolier Marciano sings a the classic Italian song "Volare" as he leads guests through the canals of The Venetian in Las Vegas. (K.M. Cannon/Las Vegas Review-Journal)
Building In Logandale
Texas homebuilder D.R. Horton bought 43 lots in rural Logandale. (Eli Segall/Las Vegas Review-Journal)
Indoor farming in Southern Nevada
Experts discuss Nevada's indoor farming industry. (Bailey Schulz/Las Vegas Review-Journal)
Former Fontainebleau could have become a Waldorf Astoria
Months after developer Steve Witkoff bought the Fontainebleau last summer, he unveiled plans to turn the mothballed hotel into a Marriott-managed resort called The Drew. But if Richard “Boz” Bosworth’s plans didn’t fall through, the north Las Vegas Strip tower could have become a Waldorf Astoria with several floors of timeshare units. (Eli Segall/Las Vegas Review-Journal)
LVCVA CEO Rossi Ralenkotter announces plans to retire
Rossi Ralenkotter, CEO of the LVCVA, on Tuesday confirmed a Las Vegas Review-Journal report that he is preparing to retire. Richard N. Velotta/ Las Vegas Review-Journal
Cousins Maine Lobster to open inside 2 Las Vegas Smith’s stores
Cousins Maine Lobster food truck company will open inside Las Vegas’ two newest Smith’s at Skye Canyon Park Drive and U.S. Highway 95, and at Warm Springs Road and Durango Drive. Cousins currently sells outside some Las Vegas Smith’s stores and at Fremont Street and Las Vegas Boulevard. (K.M. Cannon/Las Vegas Review-Journal)
Las Vegas home prices to continue to rise, expert says
Lawrence Yun, chief economist at the National Association of Realtors, gives homebuyers a pulse on the Las Vegas housing market. (Eli Segall/Las Vegas Review-Journal)
NV Energy announces clean energy investment
The company is planning to add six solar projects in Nevada, along with the state's first major battery energy storage capacity. Bailey Schulz/Las Vegas Review-Journal
3 Mario Batali restaurants on Las Vegas Strip to close
Days after new sexual misconduct allegations were made against celebrity chef Mario Batali, his company announced Friday that it will close its three Las Vegas restaurants July 27. Employees of Carnevino Italian Steakhouse, B&B Ristorante and Otto Enoteca e Pizzeria, all located in The Venetian and Palazzo resorts, were informed of the decision Friday morning. Bastianich is scheduled to visit the restaurants Friday to speak to employees about the next two months of operation as well as how the company plans to help them transition to new positions.
Nevada has its first cybersecurity apprenticeship program
The Learning Center education company in Las Vegas has launched the first apprenticeship program for cybersecurity in Nevada. It was approved by the State Apprenticeship Council on May 15. (K.M. Cannon/Las Vegas Review-Journal)
Las Vegas union members voting to authorize the right to strike
Thousands of Las Vegas union members voting Tuesday morning to authorize the right to strike. A “yes” vote would give the union negotiating committee the power to call a strike anytime after June 1 at the resorts that fail to reach an agreement. (Todd Prince/Las Vegas Review-Journal)
Small businesses struggle to find qualified candidates
A 2018 survey found that over two-thirds of small businesses in Nevada find it somewhat to very difficult to recruit qualified candidates. Bailey Schulz/Las Vegas Review-Journal
Life
Kids become firefighters at Fire Station 98 open house
Henderson residents wore fire hats, learned about CPR and met firefighters at the Fire Station 98 open house Saturday, August 11, 2018. (Marcus Villagran Las Vegas Review-Journal) @brokejournalist
People from all over the world attend RollerCon 2018
RollerCon 2018 is a five-day convention focused on the roller derby community and culture at Westgate in Las Vegas. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Camp Broadway teaches kids how to sing and dance
The Smith Center's seventh annual Camp Broadway musical theater program gives 150 kids ages 6-17 an opportunity to learn musical theater skills from industry professionals over a five-day period. Marcus Villagran/ Las Vegas Review-Journal @brokejournalist
Las Vegas police officer on being PETA's Sexiest Vegan Next Door
Las Vegas police officer David Anthony talks vegan lifestyle and how he feels about being voted PETA's sexiest Vegan next door from his home on Monday, July 9, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
'NO H8' Campaign comes to Las Vegas
Hundreds of locals participate in the NO H8 campaign founded by Adam Bouska and Jeff Parshley as a response to Proposition 8, a California ban on same-sex marriage. The campaign has since evolved to represent equal treatment for all. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Over 40,000 People Attend The 4th Of July Parade In Summerlin In Las Vegas
Over 40,000 People Attend The 4th Of July Parade In Summerlin In Las Vegas. (Janna Karel Las Vegas Review-Journal)
Star Wars and Golden Knights mashup at downtown art shop
Star Wars and Vegas Golden Knights fans attend the Boba Fett Golden Knight Paint Class at The Bubblegum Gallery in Las Vegas, Friday, June 29, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Bark-Andre Furry meets Capitals superfan Ovie the Bulldog
Two of NHL's furriest fans met at the Forum Shops in Caesars Palace on Tuesday, June 18, 2018, in Las Vegas. Vegas Golden Knights superfan Bark-Andre Furry and Washington Capitals superfan Ovie the Bulldog shared a plate of meatballs and spaghetti with help from Logan, "The Girl with the Hat." (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
TOP NEWS
News Headlines
Add Event
Home Front Page Footer Listing
Circular
You May Like

You May Like