News & Events

Boston Globe: Tiered health plans cutting costs, restricting options

By Robert Weisman and Chelsea Conaboy

Told he had an aggressive form of prostate cancer, Glenn McCarthy faced a decision this year.

He could make a $1,000 copayment and have surgery at Brigham and Women’s Hospital in about two weeks. Or he could wait more than a month for an opening at Faulkner Hospital, paying just $150 for the same procedure by the same surgeon.

His doctor advised against a delay.

“It was life or death,’’ said McCarthy’s wife, Tracy. “We really didn’t have a choice.’’

McCarthy, 48, of Weymouth, is back at work as an insulation installer. But he is still recovering from his out-of-pocket costs, which totaled more than $4,500 after there were surgical complications.

The expenses were dictated by his “tiered network’’ health insurance, a kind of plan that ranks hospitals and doctors by cost and quality measures and assigns patients’ payments with costs in mind.

More Massachusetts employers and consumers are embracing such plans – along with other “limited network’’ plans that restrict members to certain providers and require them to pay higher rates for out-of-network care – in an effort to stem the rising cost of health insurance by directing patients to lower-cost hospitals.

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