Regulators tiptoe into provider network battle

By Allison Bell

May 21, 2014 at 01:06 PM

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State insurance regulators will spend months talking to interest groups before they dare touch health plan provider network standards.

J.P. Wieske of Wisconsin talked about the cautious strategy of the new Network Adequacy Model Review Subgroup today at a conference call organized by the subgroup's parent, the Health Insurance and Managed Care Committee.

The committee is part of the National Association of Insurance Commissioners.

Members of the NAIC have been talking about updating the network adequacy model act, which was approved in 1996, in response to reports that some health plans now have so few doctors and hospitals in their networks that patients have a hard time seeing in-network providers.

Consumer groups have told the NAIC they think updating the network adequacy model is a high priority.

America's Health Insurance Plans says regulators should see how the new narrow network plans work in the real world before changing the model.

The subgroup will holding meetings with consumer groups, health care accreditation organizations, health care providers, insurers and state regulators before it even starts to analyze the existing network adequacy rules in detail, Wieske said.

"We want to understand where the minefields are before getting into the nitty gritty," Wieske said.

The subgroup might be ready to make suggestions about model changes by next winter, Wieske said.

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