Insurance Commissioners Aim To Address ACA Health Plan Networks
The National Association of Insurance Commissioners has issued recommendations that would require health insurance companies to have provider networks broad enough to ensure their enrollees can receive all covered services "without unreasonable travel or delay," the New York Times reports.
According to the Times, NAIC drafted the recommendations in response to consumers' complaints about limited networks offered in health plans sold through the Affordable Care Act's exchanges. The Obama administration earlier this year said it was waiting to see the NAIC's proposal before deciding whether to adopt federal standards for provider networks.
The proposal was developed over an 18-month drafting process, which was open to consumers, insurers, providers and experts.
The recommendations -- proposed in the form of a model state law -- aim to:
- Help consumers receive in-network care; and
- Protect consumers from high costs if they receive out-of-network care.
The proposal recommends that when determining whether health plans have adequate provider networks, insurance commissioners should consider factors such as:
- Appointment wait times;
- The ability of insurers to meet the health care needs of low-income enrollees and "children and adults with serious, chronic or complex health conditions or physical or mental disabilities";
- The ratio of plan enrollees to the number of physicians in each specialty who are included in the network; and
- The "geographic accessibility of providers."
The proposal also would require insurers to update their provider directories at least once monthly.
The proposal calls for hospitals and insurers to notify patients of any possible extra charges they could incur from health care providers who are not included in their insurers' networks.
Further, the proposal recommends that when individuals receive out-of-network care, they should not be required to pay more than the typical share of costs they would be required to pay for in-network services. Providers who disagree with such payments could use a mediation process to negotiate with insurers, but patients would be "held harmless" for the costs (Pear, New York Times, 11/8).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.