Insurance Commissioner Dave Jones issued an emergency regulation package to attempt to create higher standards for insurer physician networks for PPOs and indemnity insurance plans. Traditional HMOs and health plans are regarded by the DMHC.

 

The Commissioner issued them on an emergency basis indicating that there were serious deficiencies with existing networks and the accuracy of network information being provided to insurers or patients.

 

The CRS submitted comments generally in support of many of the provisions but with concerns over one specific provision. The regulations require insurers to provide greater detail about the availability of primary care and specialist physicians, assure prompt access to referral services, and require submission of more detailed provider participation information to the Commissioner.

 

One objection related to a new requirement that would require a health facility to disclose to an insured patient prior to receiving non-emergency services in the hospital setting any hospital based physicians who were likely to provide services and were out of network along with an estimate of costs. That would apply to a radiologist who is out of network in the hospital setting and is similar to bills introduced in the Senate in the past but failed passage. The CRS argued that this requirement would be difficult meet due to the vagaries of what services might be required and the risk of misinforming the patient. We suggested that a better mechanism to protect patients from out of network charges was to require insurers who contract with a hospital to also contract with hospital based physicians.

 

The comment period on the regulations closed on January 26th and we expect that there may be some revisions prior to implementation.