Too Many Illinois Patients Getting Raw Deal on Health Insurance

The Illinois State Medical Society has proposed legislation that would address the problem with narrow networks across the state of Illinois. This legislation will protect patients and their relationships with their physicians. The Network Adequacy and Transparency Act (or the “NAT Act”) was introduced in January as SB 70 and HB 311. So far, it has attracted bipartisan co-sponsorship and enthusiasm from state lawmakers. However, passing these bills will require tremendous effort and grassroots support. Health insurance companies are actively engaged in efforts to defeat this proposal.

The Illinois State Medical Society today released the following media announcement:

Springfield, IL – Newly proposed legislation 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 in access to health care for many Illinois citizens. The Illinois State Medical Society (ISMS) is pleased to support the Network Adequacy and Transparency Act (NATA), introduced as H.B. 311 in the House and S.B. 70 in the Senate. This legislation 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 necessary 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that their doctor is in-network, only to show up to their appointment and find out the insurance company website was out-of-date and they won’t get the coverage they were promised.”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 consumer protections.

NATA has bipartisan support in the Illinois General Assembly. “This legislation gives new consumer protections for people across Illinois who have taken all the right steps to choose a health insurance plan for themselves and their family, and then suddenly find that their plan has dropped their doctors and
hospitals,” said sponsor Rep. Gregory Harris (D-Chicago). “Living in a rural area should not prevent you from having access to top-quality health care,” added Rep. Chad Hays (R-Catlin). “Gaps in health plan networks mean patients can get stuck driving for hours to get the care they need. We are putting a stop to
that. It’s up to the insurance company offering coverage in an area to meet their obligation to patients by maintaining a robust provider network.”

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. Sen. Linda Holmes (D-Aurora) highlighted that NATA “will require patients be notified when their health insurance network drastically changes, which is important so consumers can make adjustments in getting the health care coverage they need.”

“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.

The following organizations support NATA:

  • American Cancer Society-Cancer Action Network
  • Cure Illinois
  • Depression and Bipolar Support Alliance
  • Epilepsy Foundation of Greater Chicago
  • Illinois Health and Hospital Association
  • Illinois Public Health Association
  • Mental Health America of Illinois
  • Mental Health Summit
  • National Multiple Sclerosis Society
  • National Organization for Rare Disorders
  • Thresholds
  • U.S. Pain Foundation