South Dakota to vote on narrow networks
- In the wake of increasingly-narrow insurance networks, a ballot initiative in South Dakota will allow voters to determine whether health plans in the state will be required to include any provider that meets the payer's standard. If passed, South Dakota will be the 28th state to have some form of "willing provider" law.
- The insurance industry opposes these laws, claiming that the legislation impairs their ability to provide efficient care and negotiate with physicians. The Federal Trade Commission and groups like America's Health Insurance Plans also contest the bills.
- According to McKinsey and Co., about half of all networks in plans sold on the state exchanges in 2014 were narrow networks. This can be particularly challenging in rural states like South Dakota where people may have to drive hundreds of miles to see providers.
Insurers are holding firm to the fact that narrow-network plans are the future of insurance—that they will be the only way to keep costs down under healthcare reform. As the second year on the exchanges is rolled out, it will likely become even more of an issue as consumers fight back. Meanwhile, the National Association of Insurance Commissioners is currently revising its model regulations for adequate networks.
That consumer pushback has taken the form of legal action in some states. In a class action lawsuit, WellPoint, Inc.'s Anthem Blue Cross of California was accused of misleading "millions of enrollees" about whether their doctors and hospitals participate in its new reform plans, and of not disclosing that many policies won't cover care outside its approved network. A similar suit seeking class-action status was filed June 20 against Anthem, The Los Angeles Times reported. In response to the two lawsuits, Anthem said "materials at the time of enrollment and in members' explanation of benefits have clearly stated that the plan was an EPO [exclusive provider organization] plan which may not have out of network benefits," according to The Times.
- The Washington Post Should you be able to see any doctor you want?