Legislation would force quick updates to health insurance networks

By Monica Stabile

New legislation in the Illinois Statehouse would require health insurance companies to quickly update provider networks.

A pair of identical bills in the Illinois General Assembly target insurers whose customers are allegedly thrown into disarray when they find out too late that their doctor is no longer in the insurer’s coverage network.

The Network Adequacy and Transparency Act, proposed in House Bill 311 and Senate Bill 70, would require insurance companies to maintain updated and accurate online provider listings within 10 days of a change so patients know which doctors are in-network.  Under the proposal, insurers would have to give providers and plan beneficiaries 60-days’ notice before a provider is dropped from the insurer’s network. Insurers would also have to inform the Illinois Department of Insurance of changes to provider networks within 15 days.

Consumers rely on updated listings of hospitals, doctors and specialists on health insurance websites to make decisions on medical insurance based on providers covered under that plan. The legislation aims to make sure there are enough doctors and specialists located near patients’ homes and covered under patients’ insurance plans.

“Patients may have done their homework and checked that their doctor is in-network, only to show up to their appointment and find out the insurance company website was out-of-date and they won’t get the coverage they were promised,” said Dr. Thomas Anderson, president of the Illinois State Medical Society.

Under the legislation, patient care would not be disrupted due to changes in the health insurance network, especially if the patient is pregnant or has a special medical condition. The proposal includes a 90-day grace period for patients to continue being seen by a doctor who was previously in their insurer’s network.

“This is to protect a continuity of care,” said Rep. Greg Harris, D-Chicago, who sponsors HB 311.

NATA would also protect rural Illinois residents who are forced to travel long distances to attend doctor visits by requiring insurers to maintain adequate provider networks. Meaning insurance plan networks must have enough doctors and specialists operating near the policyholders home.

Rep. Chad Hays, R-Catlin, is also sponsoring the legislation because geography plays an important role for his constituents access to quality health care.

“Many of my constituents have a situation already where some folks are traveling as far as an hour away,” Hays said. “When we have patients who find that those health care providers are changing without notice, it really is a situation that is more pronounced than if they were traveling a very short distance.”

“Right now, many patients and doctors are frustrated and inconvenienced when insurance companies reduce network options with little to no communication,” Sen. Sue Rezin, R-Peru, said in a press release.

The proposal has support in both chambers from Republicans and Democrats.

NATA is being introduced in the Illinois General Assembly at a time when lawmakers in Washington D.C., are battling over whether to repeal the Affordable Care Act, also known as Obamacare.

Both legislators and the medical industry said they have received little information of the future of the ACA from insurance companies, employers and consumer protection agencies based in the nation’s capitol.

“We in the Medical Society would hope that we aren’t going to wait on Washington to do something to the ACA before we move forward with NATA,” Anderson said.

Contact Monica Stabile at [email protected].





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