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Regulators Urge Broader Health Networks

The National Association of Insurance Commissioners is recommending new standards to address consumer complaints about limited healthcare provider networks in many plans offered on the exchanges...
November 10, 2015

The National Association of Insurance Commissioners (NAIC) is recommending new standards to address consumer complaints about limited healthcare provider networks in many plans offered on the exchanges. The NAIC has released a model law addressing the issue.

The NAIC has proposed that insurers be required to have enough doctors and hospitals in their networks to provide all covered services to consumers “without unreasonable travel or delay.” The model state law would require insurers and hospitals to inform patients of any possibility that they would incur additional charges by healthcare professionals who do not participate in the insurer’s network, and in such situations, patients should not be required to pay more than their usual share of the bill for services provided by in-network doctors. Doctors who object to the amount of the payment could haggle with the insurer in a mediation process, but the patient would be “held harmless.”


Under the model law, state insurance commissioners would consider the ratio of people enrolled in a health plan to the number of doctors in each specialty, geographic accessibility of providers, waiting times for appointments, and other factors in determining whether provider networks are sufficient.

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