In Which I Am Even More Confused About Healthcare in America

A letter from my health insurance provider leaves me with more questions than it answers.

I just got an interesting (and dispiriting) letter from my health insurance provider announcing that a group of emergency physicians had “chosen” to no longer participate in the health insurer’s network.

The letter then listed twelve hospital emergency rooms that were now out of my network, and warned me that although I could still receive treatment at these emergency rooms, I will pay higher out-of-pocket costs, compared to the lower out-of-pocket costs I would pay if I used an emergency room in my network.

(There is no option that includes zero out-of-pocket costs, of course.)

When I looked at the list of emergency rooms that were now out of network, I wasn’t particularly concerned. These were emergency rooms in places like Bellingham, Gig Harbor, Centralia; cities so far away from Seattle that I’d only need to access the emergency rooms if I found myself there on a day trip.

Then I looked at the letter’s list of emergency rooms with physicians in my network. None of those emergency rooms were in Seattle either.

Okay, I thought, Maybe they just filtered out all of the Seattle emergency rooms. For some reason. Maybe this is a letter designed to inform everyone within 200 miles of Seattle but not actually in Seattle. Like a donut. Maybe this is a donut letter.

So I logged in to my health care provider’s website and pulled up its ER provider directory. It was the first time I realized that their ER benefits came in two tiers: one for the people on the “plus” networks, and one for everyone else, including me.

Huh, I thought. Should I have known this earlier? Was it in my documentation? I read all of that documentation pretty carefully. It wasn’t like they listed all of the participating hospitals in the documentation, though; I’d have to go to the website for that, and I didn’t.

The ER provider directory listed eight participating hospitals in Seattle, including one in my neighborhood. It also noted that the information in the document might not be accurate (although the health insurance provider had made “reasonable efforts” to ensure accuracy) and that we should contact hospitals and physicians directly to ensure they were still in our networks.

Okay, I thought. But why weren’t these hospitals included in the letter? Why did the letter pick and choose a few selected providers from the directory? Why can’t the directory be a regularly updated and accurate document? Why are there two tiers of emergency room services, and why do people who pay higher premiums get access to more emergency rooms? You’d think it would be “people who pay higher premiums have a lower co-pay, but we all get access to the same hospitals.” Except maybe it’s that way for, like, traffic? So the hospitals for people on the Plus plans aren’t overcrowded with people on the non-Plus plans (and, if I’m being generous, vice versa)? But there’s a lot of hospital overlap on the two lists, so that can’t be it.

If any of you can help me understand this situation a little bit better, I’d love to hear your thoughts.

Also, if you’re in Seattle or the 200-mile-radius surrounding area, you’re now paying the same health insurance premiums for slightly fewer benefits.

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