Nancy Pippenger and Marcia Perez live thousands of miles apart but have the same complaint: Doctors who treated them last year won't take their insurance now, even though they haven't changed insurers.

"They said, 'We take the old plan, but not the new one,'" says Perez, an attorney in Palo Alto, Calif.

In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly enrolled in policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks.
Such plans existed before the health law, but with its expansion of insurance, they are covering more people – and some are shrinking enrollees' options further than before. The policies' limitations have surprised some enrollees used to broader job-based coverage or to plans they held before the law took effect.

"It's totally different," said Pippenger, 57, whose new Anthem Blue Cross plan doesn't pay for any care outside its network, although the job-based Anthem plan she had last year did. "Now I can't find a doctor."

Consumer groups argue that many enrollees were misled. In California, consumers filed class-action lawsuits against some insurers, alleging they were given inaccurate information about their plans' limitations and about which doctors and hospitals participate in them.

Nationally, regulators and insurance agents are inundated with complaints, while lawmakers are considering rules to ensure consumers' access to doctors. For mplans being submitted for sale next year, the federal Department of Health and Human Services said it will more closely scrutinize whether networks are adequate.

Insurers say they are simply trying to provide low-cost plans in a challenging environment.

Anthem, one of the biggest sellers of individual insurance, offers only HMO-like plans through the new markets in six of the 14 states it serves, including New Hampshire, where it is the only insurer.

Anthem spokeswoman Kristin Binns said the insurer decided to move heavily into managed care in many of its markets after research showed most consumers, especially those who were uninsured, cared about price first and foremost.

"HMOs give them much more access than they were afforded before," Binns said.

Still, she said Anthem expects to roll out plans with out-of-network coverage in 2015 in some areas where it does not offer them. She would not specify the regions.

Other insurers made similar decisions.  Nationally, 43% of midlevel "silver" plans offered in California, New York and 34 states using the federal
marketplace have no coverage outside their networks, a study by the American Cancer Society Cancer Action Network found.

"They're all doing it," says Wall Street analyst Ana Gupte of Leerink Swann, an investment bank. "Obamacare is putting pressure on their margins, so they're on the hook to moderate costs."

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation