October 27, 2015

Missouri Dept. of Insurance: Consider provider networks when choosing health insurance coverage

Open enrollment for many health insurance plans begin Nov. 1

Jefferson City, Mo. - The Missouri Department of Insurance reminds Missourians it is important to consider more than just the monthly premiums and other costs when shopping for health insurance coverage during open enrollment. For many Missourians, this is the time to choose a new health plan for coverage starting Jan.1, 2016. While deductibles, co-insurance and co-payments (collectively known as "cost sharing") can add up quickly, it is equally important to look for a health plan with a network that provides adequate access to providers. 

Increasingly, health insurance companies are shrinking their provider networks to control costs. This means many plans will have networks with fewer providers (doctors, hospitals and other health care providers). The result is Missourians will either not have access to the providers they want or they will pay more out of pocket for care they receive out of network.  Provider networks can differ from plan to plan - even within the same health insurance company. Missourians should pay close attention to which doctors and hospitals are within network for the specific plan they are considering.

"Missouri law only requires HMO (Health Maintenance Organization) plans to meet network adequacy requirements, so there is no guarantee other plans will offer adequate access to pediatricians, oncologists or other specialty providers in their networks," said Missouri Department of Insurance Director John M. Huff.  "There is always a balance between cost and coverage with health insurance. Health insurers need to be transparent about their provider networks so Missourians can make an informed choice about their health care coverage."

Network adequacy standards ensure consumers have access to a sufficient range of health care providers, specialists and facilities without having to travel too far.  The National Association of Insurance Commissioners (NAIC) is completing work on a new Network Adequacy Model Act that would establish a uniform standard for network adequacy for all types of private health plans. The Model Act will also include requirements for the accuracy of provider directories and includes protections against "surprise medical bills" which are known as balance bills.  This draft model law comes as a result of an over year-long process of gathering input from state regulators, industry, and consumer advocates in public forums.  NAIC-drafted model laws are routinely used or adopted by state lawmakers when enacting insurance laws in their respective jurisdictions. 

Consumers with questions about their health insurance plans can call the department's Insurance Consumer Hotline at 800-726-7390 or visit insurance.mo.gov.