Is Access to Outpatient Neurosurgery Affected by Narrow Insurance Networks? Results from Statewide Analysis of Marketplace Plans in New Jersey

• Published in: Neurosurgery Vol. 67; no. Supplement_1
• Main Authors: Jumah, Fareed, Atanassova, Tania, Raju, Bharath, Rallo, Michael S, Narayan, Vinayak, Menger, Richard P, Dossani, Rimal Hanif H, Gupta, Gaurav, Nanda, Anil
• Format: Journal Article
• Language: English
• Published: Philadelphia Wolters Kluwer Health, Inc 01.12.2020
• Subjects: Neurosurgery; Surgical techniques; New Jersey
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa447_128

INTRODUCTION The aftermath of the Affordable Care Act witnessed the rise of narrow network, which feature fewer providers in exchange for lower premiums. Debate still continues on whether narrow networks provide adequate access to healthcare, especially in specialty care services like neurosurgery. METHODS The 2019 Marketplace Public Use Files were queried for “silver” plans, identifying a total of 11 plans across 3 insurance companies. Online search engines were used to identify the number of in-network neurosurgeons within 20–25 miles of zip codes at the center of each county. The primary outcome was the number of “neurosurgeon-deficient plans”, defined as those having no in-network neurosurgeons within the assigned mile radius. RESULTS Of all individuals who purchased an insurance plan, 73% (n = 185,797/255,246) opted for a silver plan. Out of 111 active neurosurgeons in NJ, 25% (n = 28/111) did not participate in any of the silver plans. Analysis showed 8 plans as neurosurgeon-deficient in Sussex and Warren. Meanwhile, majority of the silver plans provided access to >5 neurosurgeons within 20–25 miles of most (n = 17/21) county centers. CONCLUSION In more densely populated states like New Jersey, the impact of narrow networks on neurosurgical coverage is less apparent. However, frustrations regarding access to care still exist as nearly 25% of neurosurgeons do not participate in the standard ACA insurance product. Furthermore, guidelines that define network adequacy in neurosurgery remain elusive, which calls for more robust parameters to monitor and ensure adequate access to healthcare.