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Insurance Fairness and Transparency

Increased transparency in health care benefits will help patients to actively participate in decisions regarding their health care and address the root causes of problems they may experience with their health insurance companies.  As the consumer-directed health care market grows, patients will want to maximize the value of their health care dollar and make informed decisions about their care.

Please contact Emily Carroll, JD, Senior Legislative Attorney, with any questions. 

Out of network benefits

The AMA believes information about out-of-network benefits should be conveyed in clear, 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 legislation. 

Learn about how FAIR Health is increasing out-of-network transparency by allowing patients and their physicians to look-up the billed charges for specific medical services in their area.

View AMA letters on state out-of-network transparency legislation. 

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.  Access the AMA's "Meaningful Access to Physicians and other Health Care Providers: Network Standards Act," model legislation. 

Visit the AMA's website on state implementation of the ACA for additional model bills on network adequacy and transparency, and an issue brief including general principles on network adequacy.

View AMA letters on network adequacy.

Accurate provider directories

Provider directories must be accurate and comprehensive so patients have all the information relevant to their medical needs, including whether their physicians and preferred hospitals are in- or out-of-network and whether these physicians and hospitals are still accepting new patients.  Access the AMA's "Meaningful Access to Physicians and other Health Care Providers: Accurate Provider Directories," model legislation.