As provider networks continue to narrow, it is imperative that states reevaluate their network adequacy requirements and the ways in which they safeguard patient access to in-network care.

It is also critical that policymakers ensure transparency in both in-network and out-of-network coverage and require up-to-date and accurate provider directories to help patients make informed health care decisions. The AMA is committed to working with advocates and policymakers to address these vital network issues.

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. Network adequacy should be determined before a plan is sold to patients and measured using objective standards.

Out-of-network coverage

Information about out-of-network coverage should be conveyed in transparent, simple and accurate terms, and patients must receive fair coverage for their health care needs when they purchase a health insurance product.

Accurate provider directories

Provider directories must be accurate and comprehensive so patients have all the information they need to make important decisions about their health care and health insurance, including whether providers are in- or out-of-network and whether physicians are accepting new patients.

Issue briefs

PDF 1: Issue brief: Balance billing

Model legislation

PDF 2: Model bill: Truth in Out of Network Healthcare Benefits Act

PDF 3: Model bill: Physician Profiling Programs and Network Determination Act

PDF 4: Model bill: Meaningful Access to Accurate Provider Directories​​​​​​​

Other resources

LINK 1: Multi-stakeholder Letter on NAIC Network Model Act

LINK 2: Georgetown University Health Policy Institute: Defining Narrow Networks — Stakeholders’ Perspective

PDF 5: AMA’s Response to Georgetown Narrow Network Research

Contact information

For more information on provider network advocacy:

CONTACT 1: Provider network advocacy

As provider networks continue to narrow, it is imperative that states reevaluate their network adequacy requirements and the ways in which they safeguard patient access to in-network care.

It is also critical that policymakers ensure transparency in both in-network and out-of-network coverage and require up-to-date and accurate provider directories to help patients make informed health care decisions. The AMA is committed to working with advocates and policymakers to address these vital network issues.

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. Network adequacy should be determined before a plan is sold to patients and measured using objective standards.

Out-of-network coverage

Information about out-of-network coverage should be conveyed in transparent, simple and accurate terms, and patients must receive fair coverage for their health care needs when they purchase a health insurance product.

Accurate provider directories

Provider directories must be accurate and comprehensive so patients have all the information they need to make important decisions about their health care and health insurance, including whether providers are in- or out-of-network and whether physicians are accepting new patients.

Issue briefs

PDF 1: Issue brief: Balance billing

Model legislation

PDF 2: Model bill: Truth in Out of Network Healthcare Benefits Act

PDF 3: Model bill: Physician Profiling Programs and Network Determination Act

PDF 4: Model bill: Meaningful Access to Accurate Provider Directories​​​​​​​

Other resources

LINK 1: Multi-stakeholder Letter on NAIC Network Model Act

LINK 2: Georgetown University Health Policy Institute: Defining Narrow Networks — Stakeholders’ Perspective

PDF 5: AMA’s Response to Georgetown Narrow Network Research

Contact information

For more information on provider network advocacy:

CONTACT 1: Provider network advocacy

Why Join the AMA?

An AMA membership means you’ve got access to world-class clinical research, education and insights. Access peer-reviewed medical research findings and editorial opinions from JAMA ®, the Journal of the American Medical Association, JAMA Network Open™ and the 11 specialty journals, with CME at no cost.

Join Now

Why Join the AMA?

An AMA membership means you’ve got access to world-class clinical research, education and insights. Access peer-reviewed medical research findings and editorial opinions from JAMA ®, the Journal of the American Medical Association, JAMA Network Open™ and the 11 specialty journals, with CME at no cost.

Join Now

CONTACT 1: Provider network advocacy

Emily Carroll

senior legislative attorney

[email protected]

Why Join the AMA?

An AMA membership means you’ve got access to world-class clinical research, education and insights. Access peer-reviewed medical research findings and editorial opinions from JAMA ®, the Journal of the American Medical Association, JAMA Network Open™ and the 11 specialty journals, with CME at no cost.

Join Now