Johns Hopkins Hospital is one of the biggest health systems in the state.
Johns Hopkins Hospital is one of the biggest health systems in the state. (Lloyd Fox, Baltimore Sun)

Consumers who buy certain policies from UnitedHealthcare through the Maryland health exchange will not be able to use Johns Hopkins physicians or hospitals, the health system and insurer said Thursday.

Hopkins, one of the biggest systems in the state, is not excluded from all of the insurer's plans or by the other carriers on the exchange, created under the Affordable Care Act for people who don't get their insurance through their employers.

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Open enrollment begins Saturday, though the exchange plans only one enrollment fair in Glen Burnie. The website won't become available to the public until Wednesday.

Hopkins officials said in a statement that they wanted to warn consumers about the exclusion.

"We believe patients have the right to make informed decisions regarding their health care," said Patricia M.C. Brown, senior vice president of managed care and population health for Johns Hopkins Medicine. "Unless this limitation is clearly communicated, consumers who consider plans based on price alone may not realize they are restricting their access to the quality care and expertise that Johns Hopkins provides."

UnitedHealthcare officials would not say why Johns Hopkins was excluded from some plans but did note that the carrier still offers plans with Hopkins doctors and hospitals.

"Individuals and families in Maryland deserve a strong choice of quality health insurance plans that can provide them with more affordable access to health care, along with first-rate customer service," said Ben Goldstein, a spokesman. "Consumers will find that our plan design offerings provide a wide range of options, including networks that feature Johns Hopkins Medicine."

Providers are taking a number of steps to keep premiums from rising, though advocates and exchange officials have sought to make sure consumers understand that can mean limitations or higher out-of-pocket costs for co-pays and deductibles.

The state has some requirements that insurers' networks be adequate to meet consumer needs, according to the Maryland Insurance Administration, though exchange officials decided not to place any additional requirements on the five carriers offering plans this year.

The networks are all different, and exchange officials warn consumers on the website, marylandhealthconnection.gov, to see whether their doctors are in their policy's network because using an out-of-network doctor can cost significantly more. There is a search tool on the website.

But mindful that premium costs are an important factor in consumer decision-making, some insurers are trying to control costs by using "narrow network" plans that sometimes exclude the biggest hospital or health systems, one insurance expert said.

"Narrow network plans are being offered in many states as a means to help keep costs and premiums down for potential customers who are very sensitive to price," said Scott Harrington, chair of the health care management department in the University of Pennsylvania's Wharton School of Business.

UnitedHealthcare is also still negotiating with the University of Maryland Medical System.

Other carriers may yet exclude some other health systems, though officials from CareFirst BlueCross BlueShield, the state's dominant carrier, said its networks were not narrowed for exchange policies and include about 45,000 providers.

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