Coverage for example in one market where we are the narrower provider we found they had no access to pet scans. Another glitch we found as their exclusive Network Provider they had not contracted with any Lamp Services or radiation therapy. We can provide these services but frankly getting Outpatient Lab testing at your hospital may not be as convenient as some of the labs that are available with better parking and hours. Finally id like to reemphasize the reality of the marketplace is that price dominates. Premiums is what people are most likely to look at. Those with low income still leave outofpocket medical expenses that are unaffordable below this operation. As a result, even modest out pocket costs create affordability programs. This is from one of our markets. A married couple. Income 48,000 a year. They chose a bronze plan. Their premium is subsidized. They have a 3,600 deductible and a 12,000 potential outofpocket maximum. If one of this group needed a jant re placement or hth
That somebody can be get to in tough numbers and types in a reasonable amount of team states can look at the networks to make sure that that definition of reasonable is reasonable. When you look at the time it takes people to get to them, any waiting periods, any distance issues that you make sure that everybody can get to somebody in a sufficient way. If not, if there is an insufficient network the carrier makes sure the patient can go to another doctor or provider and that they would be not charged more for going to them. They require the carriers to file an access plan with the commissioner prior to offering the new managed care plan. What goes in that is a description of the network and also say how they are going to monitor the network on an ongoing basis. What their egregious procedures will be if somebody has a problem or question about the network. Notification. How do they notify if theres a change. Also, the continuity of care if somebody is dropped how are you going to make
Regulate and have transparency for limited network plans. Because they are and im familiar with some anecdotes where say in ophthalmology, which i know fairly well where the issue about retina specialists was raised. And, you know, through the academy of ophthalmology went to the insurer who i think just responded. Oh, we didnt know that. So we will make sure to put some retina specialists in the plan. So i think its just discovery that this is an issue. And i would say yes, you know, the detail that is going to be needed in some specialties will probably have to go by sub specialty. And it is going to make it more complex but this is going to be a big part of our market environment. So we mights well ju as well ju that. Anybody else . Brian. It does vary by state. But some do a deep dive and they go down to specialists, subspecialists. Not at medicare venues though. We dont get to regulate that. So were excluded. Yes, go right ahead. I work with the American College of nurse mid wives
Couple of years. You can get that as well which kind of looks at the issues that we are now going to be looking at as we look to revise our model. We have set up a subgroup which is currently doing regular phone calls. They are open phone calls, anybody, anybody in this room can sit in on them if you have nothing else better to do with your life. I always picture a 40yearold man in his mothers basement. I dont know why. You can provide comments anybody and everybody can provide comments, suggested changes, however you want to do it. Weve gone through a series of calls now where weve had all the stakeholders, the carriers, provide providers, consumers, of course, others that have come in and brought us their ideas. Were going to soon start the process of updating it. There are a couple of areas we are clear we need to update. One is essential Community Provider. Thats not something we were really looking at before. Are those now included in your networks . Theres also issues in the new