Confusing California Health Insurance Provider Network Names Harm Consumers

Local Access+, Trio, Open Access Plus, Select Plus, Harmony, Signature, Priority Select…. what does this gibberish mean?  They are the names that clever people in the marketing departments of California health insurance companies have come up with to describe the provider networks for their health plans.

Some of the names have “hip” spellings and abbreviations, like Access+ (for “plus”) and “SmartCare” and “WholeCare” with the space between the words removed… apparently to look cool but certainly not to help consumers understand how many doctors and hospitals they can see.

Some networks have thousands of doctors and hundreds of hospitals.  Others, have a few doctors and hospitals.  The differences are dramatic but no matter what your education, unless you’re an insider (like a broker) you’ll have no clue what these names mean.  Trying to decipher these names is like Alice going down the rabbit hole where up is down.

In this article, we help you decipher the names of the “provider networks” which is already a confusing concept.  In the bizarre world of small business health insurance, a “provider network” refers to the group of doctors, hospitals and laboratories that have contracted with an insurance company for a specific medical insurance plan.  These “providers” will either discount their fees for PPO members or on HMO plans they receive a monthly payment from the insurance company to manage your care.  These contracted medical professionals and facilities are called “providers.”

Here is an example of the confusion these names cause. Let’s say you’re enrolling with Blue Shield and you’re debating between a Platinum Trio HMO plan and a Gold Access+ HMO plan. The Platinum-level plan is a better plan that pays 90% or more of the cost of medical care while the Gold-level plan is a lower benefit plan that pays about 80% of the cost of medical care. You may decide to enroll in the Platinum Trio HMO plan because the plan has better benefits AND is less expensive than the Gold Access+ HMO plan.

How is it possible that a plan with better benefits could be less expensive than one with worse benefits?  It’s because of the provider network. Blue Shield’s Trio is, as we say in the business, a “narrow network.” The Trio network has fewer medical providers than Blue Shield’s Access+ which is a “wide network” that has more medical providers.

Below is a list of the confusing provider networks for each insurance company that we’ve sorted out for you.  You’ll be able to understand the difference between “tandem” “harmony” and “alliance.”

Here’s an idea:

California state regulators could end the practice of health insurance companies intentionally confusing consumers and require that medical insurance plan names make sense to consumers. “Small, medium and large” would work.  Heck, I’d even be happy with “big, bigger, biggest” so that an insurance company can claim that they only offer big networks.

While I jest, this is a serious problem.  Many times, consumers have come to us and said that their doctors “took” Anthem Blue Cross medical insurance for example, only to discover at the doctor’s office or after they’d been admitted to the hospital, that the doctor or hospital wasn’t a participating provider in the Select PPO network, they only accept patients who are enrolled in the full Anthem Blue Cross Prudent Buyer PPO network.  Consumers can incur thousands of dollars of claims before they realize that their doctors are not in the network of the plan they selected.

Below is a guide of provider networks for California small business medical insurance plans that includes our estimate about the relative size of the network: large, medium or small.