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Will Physicians Be Dropped From Managed Care Networks?

Greg Freeman, January 22, 2014

In addition to the risk of being dropped from networks, some physicians will have to decide whether they are willing to participate in the exchange products at a lower reimbursement rate, Osowski says. That decision will be based largely on the makeup of your current patient base. If you have a patient base that is primarily Medicare, the reductions in the exchange plans may not be a dramatic change. But if you have a more commercial base, the cuts will be more of a shock.

Osowski and Laurence both say the reimbursement picture for physicians will continue to be fluid and unpredictable for months as managed care plans try to determine the best path. Osowski suspects the insurers are going too far with the drive to narrow networks in hopes of lower premiums making their products more competitive. They may realize that error and expand their networks again to draw in consumers who want more access to their physicians, he says.

In the meantime, physicians could have tough decisions to make.

"If you are operating with a preponderance of commercial rates and now they want to pay you at these much lower rates, this could be quite a shock," Osowski says. "You're going to have to figure out how to keep your staff, how to cover the costs of keeping your practice running. Physicians are going to face a real economic challenge."

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4 comments on "Will Physicians Be Dropped From Managed Care Networks?"


F.H. Netter (2/17/2014 at 4:42 PM)
This is just one more reason the for-profit health insurance system must go. We need single payer and we need it yesterday.

Barbara Ryan (1/23/2014 at 8:09 PM)
Insurers only have to "rein in costs" in order to maintain (or grow) their profit margins. Insurers have been decreasing payments to providers while increasing charges to those they insure for a long time. Obamacare is only the tip of the iceberg of making medical care accessible and affordable[INVALID]insurance industry reform and regulation is also critical.

Doyle (1/23/2014 at 4:48 PM)
Looks like some high quality physicians will draw the higher income patients. Ones that can afford out of network fees. That would be different