Tiering & Narrow Networks
Health insurers stratify physicians and other health care providers into tiered or narrow networks in an attempt to control resource use and steer patients towards less costly providers. Patients in a tiered network frequently pay higher co-pays or coinsurance when they see physicians that the insurer has placed in a more expensive tier. Patients in a narrow network are frequently prevented from seeing any physicians that are deemed too expensive by the insurer, and are therefore denied a place in the insurer’s narrow network.
Physicians often have concerns about the methodology used to place them in these networks, and the resulting disruptions in the physician/patient relationship. Learn more about tiering and narrow networks, including how to dispute insurers’ network decisions, with the AMA resource Tiered and narrow physician networks: How to challenge your profile or placement. This flier provides a list of tips for physicians to consider when challenging placement in an insurer’s network.