Imagine pre-ordering a new car. You select a reliable minivan from a well-known brand, and drive away happy. A few days later, you realize that you didn’t get everything you thought you were. The gas tank only holds six gallons, the engine only runs for two hours a day, and the navigation system only provides directions to certain places. The dealer brushes you off; you should have read the fine print.
We’d never accept this from a car dealer, but many patients are suffering similar difficulties when buying and using something far more crucial to their wellness — health insurance.
Shopping for insurance used to mean comparing premiums, calculating out-of-pocket expenses, checking to make sure a preferred doctor and hospital are in-network and then selecting a plan.
It’s not so simple any more. Many health plans are trying to save money by offering PPO plans with “narrow networks,” leaving patients with limited numbers of in-network doctors and hospitals to choose from. Sometimes insurers even alter those networks outside of the open enrollment period, essentially locking patients into a health plan that doesn’t meet their needs.
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These network changes create confusion for patients and often result in them paying more to go out-of-network.
That’s bad enough for a healthy person, but imagine a cancer patient or expectant mother being told their trusted physician or institution is no longer in-network. Health insurance companies should be a conduit to better and more affordable care, not medical home wreckers.
Last year, the state’s largest insurer slashed network options in its most popular PPO plan just before open enrollment began. Many patients were automatically enrolled in the more narrow replacement without even knowing it.
Soon after, a different insurer dropped a big academic health system from its network after the open enrollment period ended. Patients who chose the plan because of that system found themselves locked into the plan – and locked out of the care they wanted.
Witnessing the confusion and disruption our patients experience is immensely frustrating for doctors. There is good news, though: We’ve identified a treatment.
Legislation has been introduced in Springfield that will impose new rules for health insurers. If enacted, insurers will be required to demonstrate that their plan has enough doctors and hospitals to meet patient needs. They will also be required to show that patients are able to access care without traveling long distances. When a plan changes the network outside of the open enrollment window, patients with certain conditions and pregnant moms will be allowed to continue care as if their doctor were still “in-network” — and all patients will be allowed to reconsider their coverage.
In short, H.B. 6562, the Network Adequacy and Transparency Act, will give patients peace of mind, helping ensure that they get what they pay for — and that they will be able to access the care they need. Contact your lawmakers in Springfield today and urge them to pass this important legislation in 2016.