ODs: Make your voice heard about narrow networks

As state insurance officials revisit a model law on provider networks, the AOA is urging members to take proactive steps to support the broadening of these panels.

The National Association of Insurance Commissioners, at its annual meeting at the end of March, plans to do an initial review of its model law to ensure networks offer enough choices for consumers.

In the wake of the Affordable Care Act, insurers have been trending toward narrower networks.

"Overall, we've been hearing a frustration from our members that the health plans, specifically the ones on the exchanges, are narrowing their networks in what they claim is an opportunity to save money," says Brian Reuwer, the AOA's associate director of State Government Relations.

In the past, ODs have been shut out of limited networks. In turn, that limits access to patients. If an influential panel such as NAIC—which sets policy for insurance commissioners—reverses the trend on narrow networks, it could open up more choices for both ODs and patients.

The AOA is encouraging members to get in touch with their respective state insurance commissioners and health reform task forces. Members should ask them to support the broadening of networks.

"The best thing individual members can do now is report back to their state association or AOA's Third Party Center any instances of discrimination or restrictive networks that they've become aware of," Reuwer says.

This is not an issue that's unique to optometry, he adds. "Anyone in the medical field who has an independent practice is likely to struggle with narrow networks."

Change won't be immediate

According to NAIC officials, it's too soon to know what changes in the model law will be considered, if any. It will not be amended during this particular meeting.

Instead, an NAIC regulatory framework task force plans to convene at the meeting and discuss possible changes, gathering input from interested parties and the public. Once changes are drafted, several rounds of internal adoption would have to take place before NAIC officially amends the law.

Reuwer acknowledges, "We don't want to put all of our eggs in the NAIC basket."

"NAIC's approach to setting policy is to assess what's best for the commissioners, and how they can easily enforce the law. As a result, it may not necessarily develop an outcome that will be beneficial to AOA members," Reuwer says.

Some existing laws may help get around network restrictions. One example is the "any willing provider" law, where participation in a managed care network is granted to providers willing and able to meet its requirements.

Several states also have "freedom of choice" laws in place. These allow patients to choose between an optometrist or ophthalmologist for the same covered eye care services on a particular network. This approach may end up being preferable because it gives patients the option of choosing an OD in these situations, Reuwer says.

March 12, 2014

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