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Struggle Over HIX Provider Networks Will Get Rough

Christopher Cheney, for HealthLeaders Media, February 12, 2014

Sebelius, formerly Kansas insurance commissioner, is quoted as saying: "You have to have a network, a number of providers, ob-gyns, neurologists, pediatricians, folks who deal with patients or you can't get your product license... You will have access to specialty care needed. You will have access to hospitals. You will have access to prescription drugs, mental health services. Substance abuse will be part of plans as well as lots of preventive care without co-pays. These are real, robust insurance products, and I think people will be incredibly pleased with the prices."

'Devastating to Rural Hospitals'
Under the banner "narrow networks," critics are assailing commercial insurers who are selectively choosing their public exchange network providers and service areas. From coast-to-coast, providers left out of new exchange networks are claiming that their organizations, and in some cases their entire communities, are being redlined.

The critics are particularly concerned about provider networks that exclude hospitals in rural or economically disadvantaged areas, where transportation is a major healthcare access barrier.

"It's going to be devastating to rural hospitals," Dr. Earl Ferguson, a California cardiologist and medical director of the National Rural Accountable Care Organization, told me this week.

Ferguson said the financial sustainability of rural hospitals is at stake. "The bottom line is we need to do what's right. We've got to get on this, and we're got to show people what can be done."

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