State regulators are working on model law revisions that could have a big effect on which doctors, hospitals and other providers are in your health insurance customers’ provider networks.
Members of the Network Adequacy Model Review Subgroup, part of the National Association of Insurance Commissioners (NAIC), have just released a draft of the proposed revisions that is full of red ink. The red ink shows that revisions regulators could make in the existing model.
The subgroup is preparing to talk about the draft at a session Monday.
Some health insurers, provider network management companies and policymakers have argued that flexibility in network design is one way for an insurer to hold the cost of a plan down without restricting access to benefits. Critics say some plan enrollees, especially those who are using the new Patient Protection and Affordable Care Act (PPACA) public exchange system, may end up plans based solely on the monthly premiums without understanding how limited their access to doctors and hospitals might be.