Experts debate stronger narrow-network rules
Health plans with narrow provider networks have sparked broad controversy among healthcare providers and consumers. Insurers and employers are relying on them to keep premiums down and ensure quality, following experts who say such “value networks” are effective and necessary. But some patients complain when they learn their preferred doctors or hospitals are out of network or they can’t access the most highly recommended specialists.
Last month, California lawmakers passed a bill requiring insurers to provide annual reports to the state about their networks, with state regulators publicly posting their assessments of those networks’ adequacy. Multiple lawsuits have challenged the composition of networks offered by Anthem Blue Cross.
The National Association of Insurance Commissioners is updating its model network-adequacy regulations for states, with the model rules expected in November. And the CMS has indicated it will heighten its scrutiny of exchange plan provider networks.
On Friday, the Alliance for Health Reform will host a forum on the issue on Capitol Hill. Among the scheduled speakers are former HHS Secretary Michael Leavitt; Stephanie Mohl, senior government relations adviser for the American Heart Association; and Marc Barclay, vice president of provider networks at Blue Cross and Blue Shield of Tennessee.