Insurers must expand provider networks in Washington


The Washington state insurance department has adopted a new rule requiring insurers incorporate certain adequacy standards in their provider networks.

The rule, which mandates that insurers have enough doctors and facilities covered to avoid unreasonable delays in care and include a diverse array of essential community providers, effectively requires them to broaden their networks. It also gives the state's insurance department better tools to evaluate insurer networks.

Insurers also will have to specifically explain what costs members will have to shoulder, their referral and authorization practices, and whether emergency room doctors at an in-network hospital are also in the network. They also must update their provider network directories on a monthly basis.

Insurance Commissioner Mike Kreidler said the rule came partly as a result of insurers' increased use of narrow networks in their plans sold on health insurance exchanges.

"I have heard from many consumers over the last several months who were upset to find their health plan no longer included their trusted doctor or hospital," Kreidler said Sunday in a statement. "And some people only discovered this after they had enrolled."

Kreidler moved forward with the rule despite strong opposition from insurers and hospitals. Insurers, in particular, are concerned about the short timeline they have to comply with the rule, which takes effect for the 2015 plans.

To learn more:
- here's the Kreidler statement
- check out the Washington state rule (.pdf)

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