To control costs, some plans may restrict their provider networks, establishing a ‘narrow network,’ a limited group of providers contracted for standards of established quality for specialized services and/or with lower reimbursement rates for the expectation of higher patient volume. Moreover, for durable therapies, there may be limited healthcare centers (COEs) that are authorized by either a developer or a payer to deliver a particular therapy, in order to ensure quality administration.
Patients may need to seek out new providers or travel—perhaps even across state borders—in order to access treatment. Travel can have cost implications for patients, in addition to time lost from work, and may require payers to establish specific processes for patients to access providers who are not typically ‘in network’. This is particularly relevant for Medicaid payers who may traditionally work only with in-state providers.