H.B. 6562 Will Set New Standard for Health Insurance Networks in Illinois
on Thursday, April 21, 2016
HB 6562, the Network Adequacy and Transparency Act, will require health insurers to develop networks of health professionals, hospitals and facilities that meet the needs of the patients enrolled in their insurance plans. It will also require insurers to maintain up-to-date directories of in-network professionals and facilities, and communicate with patients about changes to their networks. Hays and Harris are carrying the bill the House; Holmes will carry the bill in the Senate.
H.B. 6562 also protects those who have had the same insurance for years, ensuring continuity of care even when their preferred physician is no longer in-network. “This legislation will help protect pregnant moms, families whose kids need highly specialized care, and people undergoing treatment for severe conditions like cancer from suddenly losing their doctor on short notice and having to scramble just because insurance companies decided to drop or limit providers,” said Harris.
“Living in a rural area shouldn’t prevent you from having access to top-quality health care,” added Hays. “Gaps in health plan networks mean patients can get stuck driving for hours to get the care they need. We’re putting a stop to that. It’s up to the insurance company offering coverage in an area to meet their obligations to patients by maintaining a robust provider network.”
Insurance companies will be required to file specific information with the Illinois Department of Insurance before marketing any health plan, including details about the professionals and institutions covered by the plan, the ratio of health care professionals to plan beneficiaries, procedures for ensuring beneficiary access to care if not enough in-network professionals are available, and more.
“This consumer-driven legislation will establish important protections for patients when they lose access to their physician by no fault of their own,” said Holmes. “Patients, particularly those with medically complex or life-threatening conditions should not have to worry about interruptions in their care.”
To hear more from Rep. Hays about this bill, click here.