Network adequacy and surprise billing are under the microscope as state insurance regulators and health plans wrap up the National Association of Insurance Commissioners annual meeting in Chicago this week.
The NAIC has been working on a draft model state law that would create rules and standards to determine whether a health plan's network has a sufficient number of providers for patients. The group will release the next iteration of the working draft during the annual meeting and will continue to field comments on how to best address the situation.
More health insurers have been pushing for narrow provider networks, which keep premium costs down but raise issues of whether patients have adequate access to care.
“You could have very broad differences in how different insurers within a state are interpreting what is an adequate network,” Stephanie Mohl, an adviser at the American Heart Association and a consumer representative for the NAIC, told Modern Healthcare last year.
A managed-care committee will hear updates on how states are protecting patients from surprise out-of-network bills, which often occur when out-of-network physicians practice at in-network facilities.
Consumer protections in surprise bill disputes vary widely by state, according to a draft of the NAIC presentation. Some states hold patients harmless only for emergency situations, while others have stricter guidelines for all scenarios.
