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Your Right to Know!
What Is "Network Transparency"?
Network Transparency is all about making sure consumers have the information they need, both when shopping for a health insurance plan and when putting that plan to use. Health insurance networks are made up of many different contracts between healthcare providers, such as doctors or facilities, and the insurance company. The Department wants to ensure that consumers have access to their network information.
Why Is Network Transparency Important ?
Transparency in networks is essential for consumers to know what they will have to pay for their healthcare services. For example, should a consumer access care from a provider that is not in their network, additional expenses usually occur. That is why the Department has put in place new requirements to make sure network information is readily available for consumers.
Building a Framework for Consumer Protection
Administrative Law 3901-8-16
Required Provider Network Disclosures for Consumers
Beginning in January 2016, health insurance plans must comply with new requirements to ensure network information is accessible.
The Department's goal is to make sure that consumers can easily access accurate
information about their doctors and networks. The new rule requires that directories
contain up-to-date information about the provider and network status.
- Directories must be updated once the insurance company is made aware of a change in the status of a provider or facility;
- Directories must not require a login or member ID number for access. Paper copies of the directory shall be made available upon request;
- Network names should be easily identifiable and remain consistent across publications and webpages provided by the insurance company;
- Directories must include certain information for each in-network provider, such as name, gender, specialty, status of accepting new patients, languages spoken, office locations and various affiliations and certifications;
- Upon termination of a provider from the network, the insurance company must provide notice to any enrollee who has received services from the provider within the previous 12 months;
- The directory must be updated before an insurer can charge additional, out-of-network costs to a consumer.
What Can I Do To
Networks and provider directories may change many
times throughout the policy period. Contracts with health carriers may expire, or providers may move locations or cease providing services. While the new rule works to require that directories remain as up-to-date as possible, there are steps a consumer can take to better protect themselves from unexpected costs.
Contact your insurance company to verify that the directory information you saw regarding your network is correct.
Document the exact time the phone call took place and ask for the name of the person you spoke with. When searching online, be sure to screenshot or print the information you see.
When verifying the network status of your provider, be sure to specify the location at which you will be receiving services, particularly if your provider practices at multiple locations.
When checking in at the provider or facility, provide your most recent insurance information or verify that what is on file in the office is up-to-date.
Should your doctor or hospital visit require lab or pathology reports, confirm that those facilities are also in your network.
If you believe that you have been provided
inaccurate information, please contact the ODI consumer services division at 800-686-1526.