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Insurance Fairness and Transparency

The AMA is committed to improving transparency in health insurance, including in health care benefits, coverage, and provider networks. Please contact Emily Carroll, JD, Senior Legislative Attorney, with any questions. 

Out of network benefits

The AMA believes information about out-of-network coverage should be conveyed in transparent, simple and accurate terms so that patients understand their rights and responsibilities.

Access the AMA's "Truth in Out-of-Network Healthcare Benefits Act" model act.   

Access NCOIL's "Healthcare Balance Billing Disclosure" model act

Network adequacy

Provider networks must contain sufficient numbers of contracted physicians and other health care providers in each specialty and geographic region to enable patients to obtain timely access to all necessary medical care from contracted providers.  The AMA's issue brief on network adequacy outlines standards to be included in state legislation.

NAIC Stakeholder Letter (October 26, 2015)

Visit the AMA's website on state implementation of the ACA for additional resources.

Accurate provider directories

Provider directories must be accurate and comprehensive so patients have all the information they need to make informed decisions about their health care and health insurance, including whether providers are in- or out-of-network and whether physicians are accepting new patients.  Access the AMA's "Meaningful Access to Physicians and other Health Care Providers: Accurate Provider Directories," model act.