Bill Proposes More Options for HMO Health Plans

None by KCPW

(KCPW News) Usually when you choose the HMO or PPO option on your employer's health plan, you're limited in your choice of doctors and hospitals. But State Senator Michael Waddoups is planning a new law that would require insurance companies to let you go outside the network for a little more money:

"So if you're going, under your employer's policy, to St. Mark's and your favorite doctor's at IHC, they'd have to allow you to go there," said Waddoups. "But they would only get paid 85% as a opposed to 100% under your policy."

Independent clinics and ambulatory surgery centers tend to support Waddoup's proposal, because it gives them access to patients covered under large insurance plans in Utah. But HMOs tend to be less expensive because of the exclusive arrangements insurance companies have with providers. So the bill could force prices up.

"My agenda is lower health care costs for Utah citizens and better, more accessible care," says Waddoups. "That would be done through more choices and better transparency."

Waddoup's bill would give employers the option to pay the extra cost for the mandatory "swing out" or pass it along to employees who choose the plan. He also wants to limit the additional deductible costs an insurance company can charge for the option to 250-dollars. As for his efforts to make health coverage more affordable for low-income and uninsured Utahns, Waddoups admits this bill won't be much help.

Email to a friendPosted in KCPW Newsroom. Copyright 2008 KCPW