Administrative professionals witness firsthand the challenges that people with marketplace insurance plans face when trying to access in-network health care providers. This brief report provides a perspective from administrative professionals on how narrow networks and complex benefits affect patients and shape their own work.
Based on in-depth interviews with twelve practice managers or office staff members from primary care, mental health care, and diabetes care practices, the scope and scale of this report are limited. All twelve interviewees reported that they were employed in offices that treat people covered by marketplace plans, including nine who reported that half or more of their patients were covered by marketplace plans. Interviewees were initially asked to reflect on their experiences with patients and plans in general, with selected follow-up questions focusing specifically on marketplace plans. These findings therefore do not pertain solely to marketplace plans. The methodology section provides details about this research.
- The administrative professionals interviewed discussed how difficult it can be for patients to keep up with changes in networks and insurance status.
- Interviewees described how patients’ care can be delayed when plans require referrals and how the process of getting referrals authorized creates burdens for administrative staff.
- Interviewees felt that prior authorization requirements for medical services negatively impact patients and make their own work unnecessarily complicated.
Support for this research was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.