When consumers enroll in a health insurance plan, they should have reasonable access to all covered services in the plan. Narrow provider networks are increasingly common, and healthcare consumers are at greater risk of not being able to access needed medical services and providers without going out-of-network and incurring additional costs. Georgia Watch supports legislation that sets stronger network adequacy standards for insurance plans and improves access to care.
House Bill 872 sponsored by Rep. David Knight (R – Griffin), requires insurance companies to be more transparent about the structure of and changes within their provider networks, beginning with a provision that requires insurers to make publicly available to consumers a plain language description of their provider network standards on their website. Importantly, the bill also stipulates that if an insurer advertises a physician as being in a plan’s provider network as a consumer enrolls in an insurance plan, the insurer is required to cover the health care services received from that provider at an in-network rate during the entire contract year. That means that a consumer may select a plan during open enrollment that includes their preferred provider and would be able to receive services at an in-network rate for the entire plan year regardless of changes to the provider’s participation status.