NY Times: To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks

Joshua P. Worth and his wife, Maureen Weiss, in Los Angeles with their children, Talula, left, and Stanley. The couple chose a health plan after checking to make sure it included their obstetrician and pediatrician, only to discover later it did not. CreditMonica Almeida/The New York Times


WASHINGTON — The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals, leaving them with unexpected medical bills.

Federal officials said the new standards would be similar to those used by the government to determine whether Medicare Advantage plans had enough doctors and hospitals in their networks. These private plans, sold by companies like UnitedHealth and Humana, provide comprehensive care to 16 million of the 54 million Medicare beneficiaries.

States are free to adopt additional standards of their own, and Washington did so in late April.

“I heard from many consumers who were upset to find their health plan no longer included their trusted doctor or hospital,” said Mike Kreidler, the insurance commissioner of Washington State. “Some people discovered this only after they had enrolled.


Continue reading here: http://www.nytimes.com/2014/07/20/us/insurers-face-new-health-law-rules-to-widen-networks-and-prevent-surprise-bills.html?_r=0

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