States Focus on Network Adequacy, Other Issues
States are updating rules to better reflect how the health system has changed as a result of the Affordable Care Act, and the Los Angeles Times takes a look at confusion by doctors, as well as consumers, about who's in the new networks.
The Associated Press: US Law Prods States To Revisit Health Care Rules
Prompted by the health care overhaul law, several states are updating their rules for insurance networks to better reflect who is covered and how people shop for and use their benefits. ... For example, nurse practitioners and physician's assistants now provide a significant share of primary care, and many consumers head to urgent care clinics instead of scheduling office visits, he said. And the current focus on hospitals ignores the reality that virtually every service provided during a short-term hospital stay is now available in other settings, including ambulatory surgical centers (Ramer, 5/31).
Los Angeles Times: Thrown A Curve By Health Networks
The problem involves not just consumers who are discovering their doctors are not covered by their plans. Some doctors have themselves been confused about whether they participate in various networks, making it difficult for them to instruct their patients. Other providers are dropping out of networks, leaving patients in the lurch (Zamosky, 5/30).