Insurance commissioners blast narrow health insurance provider networks

The National Association of Insurance Commissioners has developed a model law forcing insurers to give their members more provider options

Life & Health

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Dissatisfied with the lack of patient options under a large portion of health insurance plans, insurance commissioners across the country are throwing their weight behind a new set of rules that would force insurers to widen their provider networks.

The National Association of Insurance Commissioners’ model law requires insurers to include enough healthcare providers for consumers to get all the services they require “without unreasonable travel or delay.” It suggests that state commissioners determine whether a plan does not meet this standard by looking at a variety of metrics, including the number of doctors in a geographic area and the ratio of people in the plan to the number of doctors offered.

The law also requires insurers to update their provider listings on a regular basis in order to provide consumers with accurate information on what care is in-network, and both insurers and hospitals must inform patients of any possibility they may incur extra charges by a healthcare professional that is not included in the insurer’s network

In these situations, the law asks that patients not be forced to pay more than what is required under their network-affiliated plan. Doctors who object to this must approach the insurer and engage in a mediation process. The patient, however, would be “held harmless.”

The new model law was developed in an 18-month drafting process and comes amid significant backlash from consumers and doctors groups over the abundance of narrow networks – particularly in rural parts of the country. One study suggested that as many as 83% of plans offered in Georgia include narrow networks, and another study from Harvard suggested that 15% of plans offered through the federal marketplace did not include any doctors for at least one critical specialty.

The American College of Emergency Physicians has also spoken out against the narrowness of insurance plans.

According to a new poll from the group, seven in 10 emergency physicians say their patients have delayed medical care because of excessive out-of-pocket expenses, high deductibles and high co-insurance payments. In addition, 73% of respondents say narrow networks allowed by insurers have caused disruption in necessary care, and another 67% say primary care physicians are sending patients to emergency departments to receive medical tests or procedures when health insurers refuse to cover them in an office setting.

Insurance companies are understandably opposed to the plan, arguing that narrow networks allow consumers to save money in an environment of increasing costs.
 

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