Tip # 698 - WHO'S PLAYING FAVORITES?

Edward has an acute condition requiring on-going care. His health insurance company is one of those exiting the individual market at the end of the year. When selecting a new Plan, he'll want to make sure his Specialists are In Network.

For each of the alternate Insurers under consideration, we showed him how to look up participating Health Systems (hospitals) and Providers (doctors), but I was curious if he had discussed this with his Specialist.

 Nope.

So, for the heck of it, I called the Billing Department of XYZ Health System wondering how they’d address this question.

Unexpectedly, they suggested just one Insurer.

Concurrently, this week I received a letter from my PCP. He’s an employee of a Health System that happens to own an Insurance Company. His letter encouraged me to consider (just) that Insurer for a Medicare Advantage Plan during the Open Enrollment Period. Conflict of interest?

Admittedly, these are only two anecdotes, but they contrast sharply with my understanding the contracts between Health Systems and Insurers require Insurers to be Provider agnostic. 

When asked, AI tells me the most famous one-way street (Lombard, in San Francisco) is also the “crookedest.”

Uh, oh. Did I just cross the Rubicon?