Bigger’s Not Always Better: It’s the Fit That Counts

When it comes to health insurance provider networks, our typical impulse – whether we’re a broker, a benefits administrator, or an individual shopping for insurance – is to operate under the assumption that “bigger is better.” In some ways, this sort of gut feeling is hard to argue with. After all, “bigger” means more providers to choose from. How can that not be a good thing?

The truth, however, is that bigger isn’t necessarily better.

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It all comes down not to the sheer number of doctors in a network, but whether yourdoctors, or your clients’ doctors, or your employees’ doctors, are in a particular plan’s network or not. If you want to keep your doctors, a large network without those doctors is no better than a narrow network without them. On the other hand, if you can find a narrow network plan that includes your doctors, you stand to save 15-35% versus a large network plan.  It all comes down to network fit.

Unfortunately, figuring out network fit hasn’t been easy for individuals, let alone for businesses. For an individual, the task of identifying the plans that include their doctors can be daunting. And time-consuming, as I found last year when I went looking for a new plan for my family. You can spend hours upon hours searching provider directories, or have a broker do the legwork for you. (Then they get to spend those hours.)  For businesses, finding the plan with the best doctor network fit is even more formidable.  Because such an effort is practically impossible, searching has often been limited to the doctors of few key employees. This robs a business of actionable information that could lead to lower costs and happier employees

The culprit here has been a lack of tools that could easily enable a broker to measure network fit for individual and business clients.

Fortunately, that’s changing. And, without getting into a shameless product plug here, PlanCompass is one way in which things are changing. PlanCompass lets you quickly see how your preferred doctors, or those of your clients’ or employees, match up to available plans.  The process takes minutes, not the hours spent plowing through online – or, worse, paper – directories – that has traditionally been the only way to determine network fit.

Bigger may, in fact, turn out to be better. But that won’t always be the case. Narrow networks may well turn out to be the better fit, both financially and in terms of how well they match up with your clients’ doctors. They shouldn’t be overlooked.


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