The NAIC — a regulatory support organization governed by the chief insurance regulators from each state — issues model laws designed to serve as templates for state legislatures.
A Consumers Union survey conducted this past March indicated that 30 percent of privately insured Americans received a surprise medical bill in the past two years in which insurance paid less than expected.
Surprise medical bills incur when patients unknowingly receive care from an out-of-network physician at an in-network facility. This can add significant and unforeseen out-of-pocket costs patients are unwilling and sometimes unable to pay, leading to poor reimbursement rates and a host of other collection problems for healthcare providers.
Here are five provisions in the Network Adequacy Model Act intended to save costs for both hospitals and consumers:
1. Allowances for patients to receive out-of-network care at no extra cost if the insurance provider cannot provide in-network care access without unreasonable travel or delay.
2. Guaranteed continuity of care should a provider be removed from an insurance company’s network mid-care.
3. Patients would not be held financially accountable for receiving emergency care treatment by an out-of-network physician at an in-network facility.
4. Standards to improve the accuracy of insurance company provider directories.
5. A requirement that state insurance commissioners determine if provider networks are adequate.
More articles on revenue cycle:
Texas hospital granted Medicare reimbursement extension
Provider tax proposal is back to help Va. hospitals cover uncompensated care
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