A new rule meant to give consumers more information about health insurers’ provider networks has been published by Washington state Insurance Commissioner Mike Kreidler. 

The new regulation applies to all state-regulated health plans offered both inside and outside of the Washington State Health Benefit Exchange, which administers the Washington Healthplanfinder online enrollment program, at www.wahealthplanfinder.org. 

“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. And some people only discovered this after they had enrolled,” Kreidler says in a press release. “This new rule increases transparency for consumers and gives my office better tools to evaluate an insurer’s ability to deliver health care services to its enrollees.”  

In addition to increasing transparency, the new rule harmonizes existing state regulations with the Affordable Care Act (ACA) and sets clear and uniform standards for how the Office of the Insurance Commissioner evaluates networks when they are initially filed and when changes to them are made, the agency said. 

Under the new rule, all health plans must:

•Have an adequate number of medical providers and facilities to support delivery of and access to covered services without unreasonable delay.

•Provide access to care in a timely manner and within reasonable proximity.

•Ensure that medical providers who serve predominately low-income, medically underserved individuals are included, based on the needs of the population served. 

The 2015 health plans and their proposed rates had to be filed with Kreidler’s office by May 1. Insurers also must begin filing provider network reports. The new rule allows issuers time to provide this information to the agency and to address network contracting issues. 

Insurers will be required to supply detailed geographic information about their networks illustrating how they meet the needs of all of their enrollees, depending on where they live.   

Kreidler said the rule became necessary, in part, to deal with the emerging trend toward narrower networks of medical providers and facilities. 

In this arrangement, insurers didn’t contract with some doctors and hospitals, an innovation designed to keep premiums as affordable as possible for consumers. While the new rule doesn’t prevent insurers from innovating, it does require all networks to guarantee adequate access to care. 

Kreidler began the rule-making process last September and circulated two drafts of the proposed regulation for comments and received comments from over 70 different organizations, groups, and individuals. After garnering hundreds of comments from insurers, medical providers, consumers, hospital representatives, and other interested parties, a public hearing was held on the revised rule on April 22.   

“The Affordable Care Act increased benefits, but it also expanded the role consumers are expected to play when shopping for health insurance,” Kreidler says. “It’s my job to give them the tools they need to be successful and to provide them with as much transparency as possible.”