Read this bureaucratic dribble. Network adequacy? Money down the drain and confusion for patient and provider continues unabated. 😡
Eliminate the blasted networks. Why do we need them?
In my zip code the fair price, based on the Healthcare Bluebook, for a hip replacement (surgeons fee) is $3,600. Sell insurance that pays that amount and then let the patient decide which surgeon to use and then pay less, nothing or more depending on who they select. Let the surgeon explain why his fee is what it is.
To make the system efficient require a data base of complete patient records accessible to every health care provider in the US.
We argue over the minutiae and miss the larger opportunities‼️
Enough In-Network Doctors? Trump Administration Now Lets States Decide.
Governing (02/18) Ollove, Michael
Under the Affordable Care Act, health insurance plans sold on the state marketplaces are required to maintain a sufficient number of in-network hospitals and physicians in their service area, but a Trump administration rule that went into effect this year shifts the responsibility for monitoring and enforcing network adequacy to the states. The rule affects 28 states that rely on the federal health insurance exchange and 11 states that operate exchanges in partnership with the federal government. Wisconsin Deputy Insurance Commissioner J.P. Wieske is among the state officials who stress that they are capable of reviewing network adequacy without federal help, noting that “functionally, what we saw in the prior administration was a lot of duplication.” Acting Pennsylvania Insurance Commissioner Jessica Altman said the state already vigorously enforces network adequacy, but “for us, the federal oversight was a second check, and that’s good to have there.” Tennessee will rely on accreditation, as that is how the state oversaw network adequacy in 2014 and 2015 prior to the Obama administration standards, said Kevin Walters, communications director for the Department of Commerce and Insurance. However, Washington State Insurance Commissioner Mike Kreidler said that regulating network adequacy is “labor intensive and requires a lot of in-house expertise. Even we are a work in progress. The federal government stepping away like this, that is just not good.”
Source: NAIC Newswire