Network Disruption: When Providers and Health Insurers Spar, Members Are Caught in the Middle
Recurring contract disputes between insurers and medical providers disrupt people’s lives in numerous ways. As big players on both sides of the national health insurance industry try to gain more market share and profits, members are tossed into uncertainty. Contract standoffs can also become highly publicized battles.
Unfortunately, the real consequences of these high-stakes negotiations are network disruptions, which can have lasting effects on people’s lives.
How the Canopy Health Alliance Collaborates with Providers and Carrier Partners
Canopy Health offers a different value proposition from traditional networks in the market. Canopy Health is a single network of alliance partners owned by our physicians and hospitals. We own the risk and pay claims so that the doctors can focus on providing the most efficient and effective care. We collaborate with trusted health insurance carriers to create health plans and innovative products that fit our members’ needs and provide more choice. Members can also access our entire network by simply choosing an insurance carrier partnered with Canopy Health and a primary care doctor from one of our medical groups.
Our unique partnership is bound by joint quality measures that ensure a member-centric focus. We work with providers who share our values of expanded access to specialist care, cost transparency, and streamlined referrals to our entire network of Bay Area specialists, hospitals, and care centers. And we continually enable our community hospitals and select providers to deliver high-quality, seamless, and cost-competitive consumer-centric care.
A Brief History of Contract Negotiations in California
Unstable contract negotiations in California have a long history of putting profits over people. As recently as February 1, 2019, 20,000 members of a California plan were thrown into chaos and had to search for new doctors because big players and health insurers were at an impasse during contract negotiations.
Though each member faces unique challenges when a disruption occurs, the following scenarios are common:
- A major health insurer’s members with PPO plans are told that, until a contract negotiation is reached, they can only use the major health system’s doctors and hospitals at in-network rates for the next six months.
- Members with HMO plans face even less certainty: they may no longer be able to see their in-network doctors and go to certain hospitals, effective immediately, because the current contract has expired.
If a member doesn’t suffer from a chronic illness, a disruption may only be temporarily aggravating, but for the seriously ill, it can be extremely challenging. Some contracts are up for renewal annually, which makes network disruptions recurring events where members are repeatedly at the mercy of their health plan’s negotiating tactics. Not knowing which providers are ultimately in their health plan’s network can be stressful, and it makes something like a routine healthcare appointment or planning for a procedure very difficult.
In particular, the period of uncertainty while the contract is under negotiation but still enforceable puts members in limbo. They face the real possibility of physicians and hospitals they’ve come to trust no longer being in-network. Short of an agreement, the failure of health insurers and health plans to resolve negotiations often results in higher prices and less access to care because a member’s health plan no longer provides coverage.
Canopy Health: A Different Kind of Health Experience for Members, Patients, and Physicians
At Canopy Health, we’ve enabled our alliance partners to offer a different healthcare experience with added value to members, patients, and physicians. Through productive health plan partnerships, best-in-class care management, an engaged provider network, and competitive unit pricing, we’re making high-quality healthcare more accessible and affordable. As an alliance, we moderate pricing to pass savings on to members through affordable premiums.
One of the unique ways we’re collaborating with our alliance partners and eliminating barriers to care is through our Alliance Referral Program. Our simplified referral process gives members access to nearly 5,000 providers in the Canopy Health network, not just those in their primary care physician’s medical group. Our alliance partners work together to create a positive healthcare experience by referring patients to the best care in the most efficient way. This means better, faster, and more affordable care from the Bay Area’s top specialists.
References
Anderson, C. (2019, February 6). Sutter-Anthem contract dispute means 20,000 patients must find new doctors. The Sacramento Bee. Retrieved from https://www.sacbee.com
California Department of Managed Health Care. (2019). Continuity of care. CA.gov. Retrieved from https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/ContinuityofCare.aspx
Ostrov, B. F. (2019, January 30). Patients suffer as Insurers and big health systems spar for market share. National Public Radio. Retrieved from https://www.npr.org/sections/health-shots/2019/01/30/689543362/patients-suffer-as-insurers-and-big-health-systems-spar-for-market-share
Toland, B. (2014, April 27). How did America end up with this health care system? Pittsburgh Post-Gazette. Retrieved from https://www.post-gazette.com/healthypgh/2014/04/27/VITALS-How-did-U-S-employer-based-health-care-history-become-what-it-is-today/stories/201404150167
