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December 18, 2013 | Comments Off on ANY WILLING PROVIDER LAWS PROPOSED
Posted by Frank Ciesla

There are many skirmishes taking place in the implementation of the Affordable Care Act.  One deals with the narrowing of the provider networks, resulting in the exclusion of a number of providers from the networks being offered under the various plans on the exchanges, and in some cases, even those plans being offered outside of the exchanges.

As pointed out in our prior blogs, this, of course, could potentially upset the relationship of patients to their providers.  Attached is a just released survey indicating that most New Jersey residents value the ability to pick their own doctors over the cost of their insurance program.  Obviously, to the extent that their insurance program becomes unaffordable, that is not a choice they will have.

This brings us to the new skirmish as set forth in the attached article “Six States Serve as Narrow Network Battleground” which indicates the consideration in some states of any willing provider statutes, which would require the insurance companies to include any provider who is willing to accept the terms being offered by the insurance carrier as providers in the network.  This is a reprise of the battles that took place in the heyday of HMOs.  To accomplish the objectives of most patients, it will be essential for states to migrate towards either the any willing provider legislation or some version of it, requiring insurance companies to include providers in their networks.  That approach may have a negative impact upon the financial actuarial assumptions being made and the pricing of those policies.

This is a skirmish which has just begun and will continue, not only because of its impact upon the individual marketplace, but also upon all insurance marketplaces, including the employer-provided marketplace.


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