Insurers and consumer representatives are disagreeing about when the National Association of Insurance Commissioners should revise its suggested health plan provider network standards.
America’s Health Insurance Plans wants the NAIC to put off work on the Managed Care Network Adequacy Model Act, to give insurers time to see how plans with small networks perform both on and off the new health insurance exchanges.
Moving too early could hurt insurers’ efforts to create plans with efficient, high-quality networks, Colleen Gallaher, an AHIP state policy specialist, said in a comment letter.
But the people who officially speak for consumers in NAIC proceedings responded in their own comment letter that the NAIC should put revising the network adequacy model at the top of its to-do list.
The consumer reps note that the NAIC has not updated the network adequacy model since it was adopted in 1996.
PPACA sets network standards for all exchange plans, but the NAIC model applies only to managed care plans, the reps add.
“Network adequacy problems can also mask other problems,” the reps write.
In some cases, the reps say, network problems can be a sign of unfair marketing practices, or plan or provider insolvency.