Rezin co-sponsors Network Adequacy and Transparency Act for Illinois Patients Getting Raw Deal on Health Insurance

Newly proposed legislation co-sponsored by Sen. Sue Rezin offers a remedy to serious problems caused by the increasing use of narrow preferred provider networks.  These narrow networks have resulted in a dramatic reduction to access to health care for many Illinois citizens.  The Network Adequacy and Transparency Act (NATA), establishes important standards for health insurance sold in Illinois, allowing consumers to make meaningful choices about purchasing health insurance and ensuring that patients can access healthcare professionals in their network for their medical needs.

“This legislation is needed because people think they are playing by the rules when purchasing health insurance, but are often in for a surprise when they try to go to a doctor,” said ISMS President Thomas M. Anderson, MD. “Patients may have done their homework and checked that their doctor is in-network, only to show up to their appointment and find out the insurance company website was out-of-date and they won’t get the coverage they were promised.”  Narrow networks are a reality, regardless of what happens at the federal level.  Illinois is not alone in our pursuit of enacting basic network standards.  The American Medical Association expects at least 25 other states to pursue similar changes.

In addition to setting standards for the adequacy of health insurance plans and the transparency of health care professional listings, NATA also contains important provisions that allow patients to stay with their doctor. 

“Right now, many patients and doctors are frustrated and inconvenienced when insurance companies reduce network options with little to no communication,” Sen. Sue Rezin (R-Peru) said. “These decisions by insurers require patients to sometimes have to abruptly switch doctors and in turn, drive incredibly long distances just to see a physician in their network. This legislation protects these patients and doctors by requiring insurers to create networks so patients’ needs are met and communicate with patients when changes are coming to their network.”  

Network Adequacy and Transparency Act (NATA) Facts:  How S.B. 70 and H.B. 311 Help Patients.

NATA will protect Illinois patients in three ways:

1)      Insurance companies will have to make sure their networks meet patients’ needs.  That means insurance plan networks must have enough doctors, including specialists, in close proximity to where their policyholders live.

2)      It will bring transparency. Patients will know which doctors are in-network. If a doctor is dropped from the network, the insurance company will have to notify patients in a timely fashion and offer an option for patients to switch plans to stay with a preferred doctor.

3)      Patient care will not be disrupted due to changes in health insurance networks.  A patient’s doctor may be dropped from the network, but pregnant women or anyone with certain complex conditions will be able to stay with their doctor long enough to make a smooth transition – without getting charged extra.

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