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Network Adequacy Concerns Raised by ISMS

Tuesday, March 14, 2017   (0 Comments)
Posted by: Colleen Flannery
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The Illinois State Medical Society is advocating for creation of the Network Adequacy and Transparency Act, which will come before the House Insurance:  Health & Life Insurance Committee as soon as next week.  Among other things, this legislation requires that health insurers provide adequate notice to patients when their health care professional is nor longer in their network, and allow patients to change plans if this occurs.


This information was developed by the Illinois State Medical Society to address concerns relating to network adequacy:


House Bill 311 is an ISMS initiative that would protect patients in Illinois and ensure that their health insurance networks will provide for the health care they need:

  • Provides the Illinois Department of Insurance a framework to ensure that patients have access to necessary health care professionals, including specialists and appropriate health care facilities.
  • Requires health insurers to provide notice to patients when their health care professional is no longer in their network, and allows patients to change plans if this occurs. 
  • Allows patients with serious health conditions or who are pregnant to stay with their health care professional for a designated period of time if the network changes. 
  • Ensures that network directories are accurate and kept up-to-date for patients to make informed decisions about selecting both their health insurance plans and health professionals. 

The health insurance lobby is aggressively opposing this legislation and telling legislators that nothing should happen given the likelihood of changes at the federal level. 
While the direction of our health care system is being debated in Washington, narrow networks and the trend to narrow them even further without any transparency will continue.  We need to enact consumer protections at the state level. 
ISMS has developed a brief video and a press release to explain the need for this important legislation.  Please share them with your legislators and anyone else who values high-quality health insurance.

HB 311 has been assigned to the House Insurance: Health & Life Committee.  You can follow this legislation here:

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