Surprise Billing

marketplace-billingEvery health insurance company is required to develop a network of providers so that its customers have access to doctors, clinics, and hospitals. The Affordable Care Act has expanded insurance enrollment for many previously uninsured populations. Washington CAN has been working with partner communities, the Health Benefits Exchange, and the Insurance Commissioner to improve the rules governing how the provider networks are serving the needs of the newly insured.

We face two major challenges: First, are the providers close enough to the patients to permit them to get to the doctor or hospital when they need to? Second, are the networks sufficiently diverse to provide adequate language access and cultural sensitivity to their new insurance customers?

Frequently, access is a matter of proximity – how long does it take and what does it cost to get to the doctor? Many of the new insurance customers live in areas where doctors have not traditionally located their practices. Can low-income people find their way to a doctor or hospital located in another part of their community or does distance provide a significant barrier?

Another issue we are advocating on is, if a low-income person can find a way to the doctor or hospital, will providers be able to communicate with them in their primary language? Will providers be sensitive to cultural differences? Will there be appropriate outreach to these communities so as to improve their participation in the health care system?

Both the Insurance Commissioner and the Health Benefits Exchange are reviewing these issues. The outcome of debates are uncertain, particularly given that the insurance industry is pioneering what they call “skinny networks” – networks that include fewer, rather than more, providers.

Leave a Reply

Your email address will not be published. Required fields are marked *