The Piedmont, Emory and WellStar health systems, which run some of Atlanta’s marquee hospitals, will not be available under many of the health plans being sold on the new Health Insurance Marketplace.
News coverage of the insurance exchanges has focused on bad software and big crowds on the federal sites. But the exchanges have other, more far-reaching limitations: the official networks of hospitals and doctors are smaller than many shoppers might expect.
Wellstar Health, which has five hospitals in Cobb, Paulding and Douglas counties, including Kennestone Hospital, is not in network for many competitively priced plans. But some providers, like Humana, offer two types of plans. Plans that offer a larger network of doctors and include most hospitals in the state are available but are also more expensive.
For example, statewide the new Blue Cross and Blue Shield of Georgia network for the Obamacare plans contains about half as many doctors and slightly more than half as many hospitals as Blue Cross’ overall commercial network. The insurer, the state’s largest, said networks can change and more providers may sign on in the coming months.
“These networks are going to be a surprise to many people with coverage now,” said Bill Custer, a health care expert at Georgia State University. “The narrowness of these choices is going to be a concern.”
Another likely shock will be the consequences of “going out of network.” Under many of the new plans, you would have to pay 100 percent of out-of-network charges for anything other than emergency care.