Networks must include sufficient specialists
Under budget reconciliation, the Alliance stressed the importance of making certain that provider networks include sufficient numbers of specialists and subspecialists per enrollee. In addition, network directors should be updated in real time and patients provided with clear, concise, and accurate information. Finally, the Alliance said, decisions to remove a physician from the network without cause should not be made in the middle of a contract year.
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“We urge the committee to ensure appropriate oversight to hold insurers accountable to ensure patients have timely access to the right care, in the right setting, by the most appropriate health care provider,” the Alliance’s letter said.
In addition, the Alliance said these provisions should be maintained to ensure access to affordable health insurance and access to specialty medicine:
- Eliminate exclusions in coverage for pre-existing conditions, as is now provided by the ACA.
- Provide adequate access to specialty care through any benefit package.
- Protect against the rescission of health coverage.
- Ensure continuity in Medicaid coverage for children who go in and out of the system.
- Ensure coverage for routine services provided in conjunction with clinical trials.
- Ensure access and coverage of preventive screening services.
- Prohibit annual and lifetime coverage limits.
The Alliance said its recommendations stemmed from the results of a survey of 1,000 provider members to determine the extent to which those issues placed a burden on timely access to specialty care.
“The results indicate that these barriers to care have gotten far greater and more difficult to navigate in recent years,” the Alliance explained.