Negotiations over whether a provider will join a health plan's network involve confidential financial terms, so there is no transparency about all the factors that lead to a dispute.
In general, analysts suspect that health insurers are working harder to keep costs low because of the federal government's changes to how Medicare Advantage plans are paid.
With Medicare Advantage, seniors receive government benefits through private managed care companies. The government pays insurance companies a fixed fee for each enrollee, depending on the health condition of the elderly.
Last year, the federal Centers for Medicare and Medicaid Services announced it would phase in changes to risk adjustments after allegations that some carriers were gaming the system. The carrier said the changes were hurting its revenue, although it denied any gaming had taken place.
“That could lead to tougher negotiations with hospital systems, physician groups and others,” Hoadley said. “Of course, that part is behind the curtain, so you can't directly see what's going on there. But it's important to understand what's going on and why some of these hospital systems are 'paying off their bills.' I'm guessing whether he's saying he doesn't want to negotiate a lower price and would rather be removed from the network.”
Sheryl Danberg, a health economist at the Rand Corporation, said market dynamics often come into play.
