Bill would make insurers notify members of provider contracts ending


A bill requiring insurers to notify the insurance commissioner and affected members before they terminate a provider contract has reached the desk of the California governor.

The bill (AB 2152), which was sponsored by Insurance Commissioner Dave Jones and passed during the final week of the 2011-2012 California legislative session, would force insurers to inform PPO members 10 days in advance of a contract termination with their provider or hospital, therefore making a visit to that provider out of network.

"At least [consumers] will know ahead of time, if they really, really want to go to that doctor or hospital, what they're going to be charged for," Jones told the North County Times.

Plus, insurers would have to tell the California Department of Insurance at least 30 days in advance of a contract termination. The department will then verify that the insurer still has an adequate provider network, reported LifeHealthPro.

The bill was partly spurred by recent high-profile contract terminations between payers and providers. Despite requests from the insurance commissioner's office, Blue Shield of California refused to notify its members that it was terminating its contract with UCLA Medical Center and refused to cover the cost difference for affected members to see the newly terminated providers out of network. And last month, Aetna ended several contracts without informing the department, FierceHealthPayer previously reported.

To learn more:
- read the California bill
- see the LifeHealthPro article
- check out the North County Times article

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