DALLAS, TX--(Marketwired - November 10, 2014) - As open enrollment for the health insurance exchanges gets underway, the American Medical Association (AMA) today adopted a new policy aimed at addressing the issue of inadequate networks to ensure patients continue to get access the care they need. The new policy calls for insurers to make any provider terminations without cause prior to the enrollment period so patients can select health plans that will cover care provided by their existing physicians because today, inaccurate or late revised provider directories are leaving patients stuck with plans that dropped their physicians after they enrolled. However, the new policy allows for new physicians to be added to a network at any time. Additionally, the new policy reiterates the need for health plans to provide patients with an accurate, complete directory of participating physicians through multiple media outlets, which includes identifying providers who are not accepting new patients.
"While plans with narrow networks may have lower patient premiums, some narrow provider networks on the market today provide inadequate access to timely, convenient, quality care," said AMA President Robert M. Wah, MD. "Inadequate networks could prevent patients from being able to see the physicians that they know, trust and depend upon throughout their lives which could lead to interruptions in care, delayed care and undue harm. They can also prevent patients who are newly insured from being able to access the physicians that suit their needs in a timely manner. As enrollment opens for health insurance exchanges, patients deserve to have an honest look at their coverage options -- including the physicians, hospitals and medications they will have access to as well as cost-sharing -- so that they can make an informed choice."
In addition to calling on insurers to provide up-to-date information on the value of their plans before patients enroll, the new policy also:
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Calls on insurers to treat patient visits to out-of-network physicians the same as they would in-network physicians if the patient's plan is deemed inadequate;
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Supports regulation and legislation to require out-of-network expenses to count toward a participant's annual deductibles and out-of-pocket maximums when a patient is enrolled in a plan with out-of-network benefits or is forced to go out-of-network based on network inadequacies;
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Supports the development of a mechanism for patients to file formal complaints about network adequacy with regulators;
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Supports state regulators as the primary enforcer of network adequacy requirements to ensure state network adequacy laws and regulations are followed and patients have access to adequate provider networks throughout the plan year; and