(This article has been updated with a correction.)
Many healthcare stakeholders want more muscle from state insurance commissioners' efforts to help states police how health plans assemble and manage their provider networks.
The National Association of Insurance Commissioners is circulating a draft model state law (PDF) addressing increasingly fractious practices. Providers and consumer advocates have generally applauded the effort but plan to press for the document to propose more stringent standards regarding provider directories, out-of-network billing and what constitutes an adequate provider network.
Controversies over provider networks have erupted across the country since the rollout of the exchanges, where consumers must choose health insurance plans from an often complicated menu of options with different premiums, cost-sharing amounts and networks.
The NAIC's model law has not been updated for nearly two decades. The proposed update is the result of weekly meetings involving dozens of interested parties since May. If eventually adopted by state legislatures, the rules would apply to all health plans.
“The Patient Protection and Affordable Care Act standardized many aspects of insurance coverage, including essential benefits and tiers of coverage. But it didn't do much to address the adequacy of provider networks, which makes the actions of state legislators and regulators crucial to providing consumer protections,” said Lynn Quincy, associate director for health reform policy at the watchdog organization Consumers Union.
“The big dimension that remains unstandardized and opaque to consumers is the provider network,” Quincy said. “It's like a big missing piece of the puzzle.”