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.
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.
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.
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.
For more information on provider network advocacy, contact Emily Carroll, senior legislative attorney, at [email protected].