When consumers enroll in a health insurance plan, they should have reasonable access to all covered services in the plan. Narrow provider networks are increasingly common, and healthcare consumers are at greater risk of not being able to access needed medical services and providers without going out-of-network and incurring additional costs. Georgia Watch supports legislation that sets stronger network adequacy standards for insurance plans and improves access to care.
Current Georgia Legislation: Representative Mark Newton (R-123) introduced House Bill 454, which amends Title 33 to stipulate that all health insurance plans must cover provider charges at in-network rates for the duration of the contract year regardless of whether the provider remains a participating provider at any point in the contract year. HB 454 has been referred to the House Special Committee on Access to Quality Healthcare.
Past Georgia Legislation: During the 2017-2018 Legislative Session, Rep. David Knight (R – Griffin) sponsored House Bill 872,which would require insurance companies to be more transparent about the structure of and changes within their provider networks. The bill began with a provision requiring insurers to make publicly available to consumers a plain language description of their provider network standards on their website. Importantly, the bill also stipulated that if an insurer advertises a physician as being in a plan’s provider network as a consumer enrolls in an insurance plan, the insurer must cover the health care services received from that provider at an in-network rate during the entire contract year. This would enable a consumer to select a plan during open enrollment that includes their preferred provider and receive services at an in-network rate for the entire plan year regardless of changes to the provider’s participation status. Unfortunately, HB 872 did not advance during the 2017-2018 Legislative Session.