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December 11, 2013 at 05:51 AM
California regulators are considering beefing up health insurance plan provider network regulation.
The California Department of Insurance held a meeting on the topic Tuesday in Sacramento.
Traditionally, health maintenance organizations have put tight restrictions on enrollees’ ability to see out-of-network providers.
Preferred provider organization plans have let members see out-of-network doctors but, in many cases, impose higher deductibles, higher co-payment amounts and other rules and payments that encourage members to see in-network providers.
Because the PPO plans had looser restrictions on access to out-of-network doctors and hospitals, many states have had tougher network rules for HMOs, and some have had few or no rules for PPOs.
The Patient Protection and Affordable Care Act requires the plans sold through the new public exchanges to offer adequate networks, but it does not define how many providers of various types a plan network must offer, or how close the providers have to be to the enrollees.
Patient groups and others have complained that exchange plans are not always posting the kinds of provider directories that PPACA requires them to post and that, at this point, the directories that are up seem skimpy.
