Health insurance that restricts employees from receiving care outside of employer owned ho

  1. I work for a hospital that is part of a large and growing healthcare system consisting of multiple hospitals. Currently, employees have health insurance through a large national health insurance company. We have coverage for any care provided by hospitals within the insurance company's network. We do get a smaller copay if we stay within our healthcare system.

    Starting in 2019, we will only be covered for care if we stay in a new "custom network." This new network consists of only our healthcare system as well as just a few other hospitals. Three very large nearby hospitals and many smaller community hospitals will not be covered except for life threatening emergencies.

    I think this is unfair to employees. It also seems very convenient that the uncovered hospitals are our biggest competitors.

    Does anyone else's employer do this?
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    About floatRN

    Joined: Sep '06; Posts: 137; Likes: 122
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    Specialty: 4 year(s) of experience in Med-Surg

    45 Comments

  3. by   traumaRUs
    This is typical and what I experienced when I worked for the local large system. Its cost-savings for them.
  4. by   elkpark
    My employer (which has an insurance division as well as a healthcare division) does this. I think it just makes sense (to them) that they want to keep the money they spend on us "in the family," and not be giving it to the competition. The hospitals and providers in my system are, generally, very good. I might feel differently if the hospital was providing poor quality care.

    This is a national trend. Regardless of what any of us think about it individually, I doubt it's going to change.
  5. by   JKL33
    Considering that this is part of the compensation for work performed and not a gift given out of the goodness of a corporation's heart, yes I don't think it is right. I don't really get how they are able to skirt anti-kickback and antitrust laws with stuff like this; but that's my ignorance talking. Plus no one makes much of a stink about it because health benefits like health insurance contributions are viewed in terms of being "employer provided" rather than "employee earned."

    Not too many good alternatives. (Which is another reason all of this is possible).
  6. by   KelRN215
    Is that the only plan you're offered?

    My hospital system offers 3 options for health insurance. The first option, which is free, only covers care within the hospital system and emergent care elsewhere. The second option, which I have, is an HMO and we have access to all providers within the network but it's a tiered plan so we pay higher out of pocket costs for the more expensive providers. The third option is a PPO.

    I know I'm in the minority but I always ask for the health insurance information up front before I accept a job. I need to know that I won't have to change my specialists because my medical history is pretty complex. And health insurance played a large part in my decision to leave my last employer.
  7. by   floatRN
    Quote from KelRN215
    Is that the only plan you're offered?

    My hospital system offers 3 options for health insurance. The first option, which is free, only covers care within the hospital system and emergent care elsewhere. The second option, which I have, is an HMO and we have access to all providers within the network but it's a tiered plan so we pay higher out of pocket costs for the more expensive providers. The third option is a PPO.

    I know I'm in the minority but I always ask for the health insurance information up front before I accept a job. I need to know that I won't have to change my specialists because my medical history is pretty complex. And health insurance played a large part in my decision to leave my last employer.
    We have 2 options: a high deductible plan or more expensive POS plan. Both options have the same restrictions regarding which hospitals are covered.
  8. by   KelRN215
    Quote from floatRN
    We have 2 options: a high deductible plan or more expensive POS plan. Both options have the same restrictions regarding which hospitals are covered.
    Those options would definitely have me looking for another job.
  9. by   hherrn
    One of the ways in which you are compensated for your work is with health insurance. As with other forms of compensation, like salary, vacation, and sick time, the employer can offer whatever they want, as long as it is legal. The employee cam accept the offer, or look for a better one.

    We are American. Apparently, we like the free market economy. When government steps in to regulate it, we yell, and call it socialism, which is, apparently bad.

    They can offer whatever they want. You can take it, or look for a better offer.

    For anybody who doesn't like the system: Vote. Mid terms are coming up. A big part of making America great again is deregulating businesses like the ones we work for. If you want them to have to offer you decent health care like most of the rest of the 1st world, vote.
  10. by   MunoRN
    To clarify, your employer isn't restricting you from receiving care outside of their preferred providers, they just aren't going to cover that care to the same degree as what they cover for using their own or preferred providers, if at all.

    This isn't new by any stretch, group insurance plans (employer provided plans) have always included or solely consisted of plans that reduce costs by utilizing providers that cost less, if you want to use providers that cost the plan more then you need to pay more. A high deductible plan, for instance, typically offers more options for providers but that's because you're agreeing to pay more of that additional cost yourself.
  11. by   Jedrnurse
    Quote from hherrn

    They can offer whatever they want. You can take it, or look for a better offer.

    For anybody who doesn't like the system: Vote. Mid terms are coming up. A big part of making America great again is deregulating businesses like the ones we work for. If you want them to have to offer you decent health care like most of the rest of the 1st world, vote.
    Wait, they "can offer whatever they want to", but should be deregulated so the offering (healthcare) will improve? Are you being sarcastic? I can't tell.

    Deregulation, for example, will result in more and more pre-existing condition coverage denial, among other bad effects (for insured folks) because it's all about maximizing profit by minimizing benefits.

    Insurance company shareholders and CEOs will definitely like the results, however.
  12. by   hherrn
    Quote from Jedrnurse
    Wait, they "can offer whatever they want to", but should be deregulated so the offering (healthcare) will improve? Are you being sarcastic? I can't tell.

    Deregulation, for example, will result in more and more pre-existing condition coverage denial, among other bad effects (for insured folks) because it's all about maximizing profit by minimizing benefits.

    Insurance company shareholders and CEOs will definitely like the results, however.
    I did not say health care should be deregulated- our president did. Our legislators did.
    That is the current direction of our administration. Deregulation of healthcare is a priority. Our director of Health and Human Services is the former high level drug company executive. He spent the prior five years maximizing profits for Eli Pharmaceuticals. I have no reason to think he has changed his objectives.

    What I did say is that a big part of the "make america great again" movement is the deregulation of business, including healthcare. The idea being sold, and bought, is that when these big companies make money, we all will prosper.

    If you feel an employer has a responsibility to offer a certain level of health insurance, vote.
  13. by   CharleeFoxtrot
    Quote from KelRN215
    ...I know I'm in the minority but I always ask for the health insurance information up front before I accept a job. I need to know that I won't have to change my specialists because my medical history is pretty complex. And health insurance played a large part in my decision to leave my last employer.
    I always ask as well, and like you health insurance issues caused me to leave my last job. They went to a plan like the one the OP posted, I would have lost all my specialists, PCP I've had for a decade and my dentist.

    Put my resume out the day they announced the change and ironically got a job in the parent organization my PCP belongs to. And yes I did ask if "we took our own employees insurance"before I took the job
  14. by   KelRN215
    Quote from CharleeFoxtrot
    I always ask as well, and like you health insurance issues caused me to leave my last job. They went to a plan like the one the OP posted, I would have lost all my specialists, PCP I've had for a decade and my dentist.

    Put my resume out the day they announced the change and ironically got a job in the parent organization my PCP belongs to. And yes I did ask if "we took our own employees insurance"before I took the job
    My out-of-pocket costs for my annual MRI/Neuro-Onc follow up this year vs last year: $50 vs $2100+. That alone makes changing jobs worth it.

    When I resigned from my last job, I was honest and said that the benefits were insufficient to meet my needs. When my boss (who was very new and I actually never met before I gave him my notice) asked me if money was the reason I was leaving I said "no, but the new job does pay more and will save me thousands a year in medical costs." He didn't believe me. It already has.

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